Androgen Receptors is the most comprehensive and up to date volume on the topic, including discussions of the basic mechanisms of androgen-androgen receptor actions, their roles in the androgen-related diseases, and their potential clinical applications. Key topics covered include: -The discovery and cloning of the androgen receptor; -Androgen receptor coregulators; -Androgen related genes and their consensus DNA response elements; -Basic mechanism of action including functional analyses, cellular localization and phosphorylation studies; -Cross-talk to other signal transduction systems; -The recent connections of androgens to women's diseases, such as osteoporosis and ovarian cancer. This book is of interest to students, basic scientists, and clinicians as both a study guide and reference of research in the androgen field. It could also be used as an advanced level text in endocrinology, urology, OBGYN, or oncology.

The aimoftheHypospadiasand Genital Symposium, held at theUniversityof California,SanFrancisco,wastoprovideaforumforauthoritativeinvestigatorswhoare activelyinvolvedinthevariousdisciplineswhichdefinetheleadingedgesofhypospadias and genital research. It is important for such investigators to continue to meet for the purpose of discussing the latest developments in their individual fields, to analyze the significanceofcurrent research, to discuss new tactics for unresolved problems and to develop new theories andapproaches asneeded. The two day conference on hypospadiasandgenitaldevelopment research was organizedintothreesections: 1)HumanStudies;2)MechanismofGenitalDevelopment; and 3) Endocrine Disruptors and Sexual Dimorphism in the Animal Kingdom. Each sessionwasintroducedbyanexpertmoderatorfollowedtheinvitedspeakerswithtimefor extensiveinteractionbetweeninvestigators. Thisbookdocumentstheproceedingsofthe HypospadiasandGenitalDevelopmentSymposium. Iwould especially like to thank Kari Gaudette for editorial assistants, Cynthia Ashe, Selcuk Yucel, Antonio Souza and the administrative staffinthe Departmentof Urology. Ihopeyoufindthisresourceuseful. Laurence S. Baskin,M. D. ProgramChair ChiefPediatricUrology UCSF vii ACKNOWLEDGEMENTS Supportforthissymposiumisgratefullyacknowledged TheNationalInstituteofHealthGrant#R13DK*HDS997 UCSFDepartmentofUrology AmericanUrologicAssociation CONTENTS Introduction...1 SECTIONI. HUMANSTUDIES EpidemiologyofHypospadias...*...*...25 J. DavidErickson EndocrineEvaluationofHypospadias...31 G. HyunandT. Kolon EndocrineAbnormalitiesinBoyswithHypospadias...45 R. I. Silver GeneticandClinicalStudiesonHypospadias...***...**...*...73 A. Nordenskjold SECTIONII. MECHANISMOFGENITALDEVELOPMENT DevelopmentofthePenileUrethra. . 87 G. CunhaandL. Baskin AnatomicalStudiesoftheMouseGenitalTubercle...103 L. Baskin,W. Liu,J. Bastacky,andS. Yucel AnatomicalStudiesoftheFibroblastGrowthFactor-l0Mutant,Sonic HedgeHogMutant,andAndrogenReceptorMutantMouseGenital Tubercle...*. **. . 123 S. Yllcel,W. Liu,DCordero,A. Donjacour,G. Cunha,andL. Baskin DevelopmentalGeneticsofHypospadias...149 M. Cohn xiii xiv Contents DevelopmentoftheMouseExternalGenitalia: UniqueModelof Organogenesis...159 K. Suzuki, K. Shiota,Y. Zhang,L. Lei,andG. Yamada NewConceptsontheDevelopmentoCtheVagina...173 E. Shapiro. H. Huang,andX. R. Wu SECTIONIII. ENDOCRINEDISRUPTORSANDSEXUAL DIMORPHISMINTHEANIMALKINGDOM EndocrineDisruptionOverview: AreMalesatRisk? 189 T. Colburn EndocrineDisruptionandHypospadias...203 G. Steinhardt Toxicant-InducedHypospadiasintheMaleRat * 217 L. E. Gray. . I. Ostby,J. Fun,C. Wolf,C. Lambright,V. Wilson, and N. Noreiga MasculinizationofFemaleMammals: LessonsfromNature...243 N. J. PI:H'candS. Glickman Index...255 SectionI Introduction HYPOSPADIAS LaurenceS. Baskin* M. D. ,FAAP 1.

The aim of Bladder Research Congress, San Francisco, California, April 23-25, 1998, was to provide a forum for authoritative investigators who are actively involved in the various disciplines which define the leading edges of bladder research. It is important for such investigators to continue to meet regularly for the purpose of discussing the latest developments in their individual fields, to analyze the significance of current research, to discuss new tactics for unresolved problems, to critically evaluate current theories, and to develop new theories and approaches as needed. The two and a half day meeting was organized into five half day sessions, with each session encompassing one of five topics: (1) Epithelial-Mesenchymal Interactions; (2) Ex tracellular Matrix and Muscle; (3) Nerves and Pharmacology; (4) Infection and Immunol ogy; and (5) Oncology. Each session was introduced by a moderator followed by five to six invited expert speakers with time for extensive interaction from the participants. Two late-afternoon poster sessions allowed further interactions between investigators. This book documents the proceedings of the Bladder Research Congress. It is organ ized into the five half-day sessions of the meeting with moderators overview and an edited transcription of discussions that followed each presentation. I would like to thank Sarah Burke and the Office of Continuing Medical Education, USCF; Joanne Hayward, Editorial Assistant; and Miriam Escamilla, Administrative Assis tant. I hope you find this resource useful. Laurence S. Baskin, M.D.

The anticipation of seeing and having to manage patients suffering from sensory disorders of the urinary tract brings dismay and foreboding to the urologist. This stems from his experience of the time that these patients take up, both at the stage of initial interview and subsequently during numerous consultations over periods of months and years. This and the largely unsatisfactory response to various forms of therapy in the past are reason enough for this bold attempt to define with objectivity the notoriously subjective disorders of interstitial cystitis, urethral syndrome and prostatodynia. In writing this book the principal aim of the authors has been to define these three entities concisely and to describe the investiga tional methods which are required to establish the diagnosis in each case. The importance of this cannot be overestimated since, when the label of one or other of these conditions is attached to a patient, further objective consideration of the case is-endangered. The casual attribution of these sensory diagnoses to inappropriate cases is already on record as having dulled clinical awareness and led to oversight of progressive disease and its sometimes avoidable conse quences."

The aim of this series is to bring the reader up-to-date data and opinions on the practice of urological surgery. The ten titles published since 1982 have all been concerned with adult urology, with reference to paediatric problems included in some relevant chapters. The addition of this title on paediatric urology is especially welcome because it brings together the important components of the sub-specialty. This book has developed from one of the first of the annual courses in urological sub-specialties provided for trainees in the UK as part of their higher surgical training. But that audience is not the only one at which this book is aimed. In his Preface, Robert Whitaker emphasises the changes over the past ten to fifteen years: this means that any urologist over the age of 45 is already out of date in much of his or her knowledge of paediatric urology - unless there has been a genuine attempt at continuing medical education. Attendance and discussions at meetings and reading of current literature are useful methods of updating our knowledge. However, this book provides a much-needed link with the paediatric urology course and is a splendid reference source for all urologists. Robert Whitaker has gathered together four eminent co-authors to present their material on the main issues in paediatric urology. In keeping with the aims of this series, the data are up to date, the perspectives are contemporary and in every way this is an excellent addition to Clinical Practice in Urology.

The handbook on lithiasis edited by Kurt Boshamer and originally brought out in 1961 was for more than two decades the standard work in this field for researchers and clinicians alike. However, our knowl edge of urolithiasis has been increased so enormously - by worldwide interdisciplinary research into the genesis of urinary calculi, by the new treatment possibilities opened up principally by advances in tech nology, and by the success achieved in prevention of recurrence - that it is almost impossible to take in all the relevant journal articles, books chapters, monographs, and proceedings. It was therefore our aim in this, the first of two independent vol umes, to provide a concise but comprehensive summary of current knowledge concerning the morphology and composition of calculi, epidemiology, pathogenesis, and diagnostic techniques. The most re cent developments are described, and nothing in the world literature is ignored. A second volume will cover medical therapy, operative, in strumental and noninvasive treatment, and prophylaxis. To have any chance of success, treatment and prophylaxis must be based on knowledge of calculus formation. Study of the composition of calculi has yielded important information regarding the conditions for formation, and this underlines once again the great value of analy sis of urinary concretions. Evaluation of epidemiological data has im portant consequences for the individual patient."

Prostatitis continues to be a major clinical enigma. In this book, all modern aspects of etiology, pathogenesis, diagnosis and therapy are critically evaluated. Of special interest to the readers will be the modern diagnostic management of chronic prostatitis and the debatable therapeutic approach to chronic nonbacterial prostatitis. From the contents: Radical Transurethral Prostatectomy for Chronic Bacterial Prostatitis; Etiology, Pathogenesis, and Inflammatory Reactions in Chronic Bacterial Prostatitis; Therapy of Nonbacterial Prostatitis; Ultrasonographic Features of Prostatitis.

The introduction of lasers into operative medicine and advances in fiberoptic technology have made a significant contribution to minimally invasive surgery. This book was written to raise awareness of the capabilities and advant ages of lasers in urological surgery and to make this tech nology more widely accessible. The book reflects the cumulative experience of 25 years of laser research and clinical application, starting in 1972 with studies on laser tissue interactions, endoscopic studies with fiberoptic "sutures;' and the first clinical use of lasers in 1975 and 1976. These early efforts were followed by the develop ment oflaser lithotripsy in the early 1980 s and a Lubeck based research program leading to the development of a "smart" laser lithotriptor (Lithognost) in the late 1980s. There have been recent advances in the field of photo dynamic diagnosis based on the use of locally adminis tered photo sensitizers, a development that will redefine the role of the Nd:YAG laser in the treatment of bladder cancer. Perhaps the most interesting concept is the inter stitiallaser therapy of prostatic hyperplasia and, perhaps one day, certain forms of prostatic cancer. We have also developed a technique, first described in 1986, for the laser treatment of schistosomal bladder lesions. I dedicate this book to the many pioneers oflaser medi cine and to all the colleagues and research assistants who accompanied me on this journey. I cannot name them all; their names can be found in more than 300 publications.

Obstetric fistula is as old as mankind. While the incidence has diminished progressively with better health care in Western societies, the situation has changed little in many developing countries. Fistulae of pelvic organs, often monstrous defects, still are a major complication of child-birth causing misery to uncounted young women, and if they cannot find help in one of the very few hospitals with trained specialists, they became urological cripples losing everything: family, home and job. The magnitude of the problem is illustrated by some figures given by Reginald and Catherine Hamlin-about 700 fistula patients treated each year-a total of over 10,000 cases operated upon in their fistula hospital in Addis Ababa, Ethio pia. Most of these injuries could be prevented by better health care at the village level as some studies have shown conclusively. The incidence of fistula is an indicator of the standard of health and obstetrical care. The author of this book-Obstetric Fistula-is an internationally known Australian gynaecologist who for many years has been interested in all aspects of gynaecological urology, especially urinary stress inconti nence, other forms of involuntary loss of urine, and associated gynaeco logical conditions. He has devised a number of new operations to treat pelvic defects. Robert Zacharin's interest in obstetric fistula was a con sequence of his surgical activity in developing countries."

Tumours in Urology is an up-to-date review of the advances in clinical management, clinical science, and basic science aspects of urological oncology. The text is divided into four parts for ease of reference: In these sections the molecular biology and biochemistry of bladder cancer, prostate cancer, and renal cell cancer are examined. There are authoritative reviews of the risk factors in superficial bladder cancer, the role of chemotherapy and bladder reconstruction in invasive cancer, along with comparative views of conservative treatment and the role of radical surgery in prostate cancer. Current methods of hormonal manipulation are also discussed. Conservative surgery for renal cancer, the use of interleukins, and the use of radical lymphadenectomy for testis cancer are comprehensively set out for the reader. A unique feature is the review at the beginning of each section of the controversial areas within each major topic. This gives the reader an excellent overview of recent advances in the field.

After the positive response which followed the first edition of this book 6 years ago, the editors were encouraged to prepare a completely reworked second edition that includes the modern advances in this field. There has been a complete change of diagnostic procedure in the detection of renal tumors, which is now based on sonography, computed tomography, and nuclear magnetic resonance imaging, pushing intravenous urography and angiography completely into the background. Also, new methods of treat ment with radionuclides using embolisation are incorporated. The description of morphological structures forms the basis for under standing and recognising pathology of the kidneys and adrenals. The con tents of pathological morphology could be extended, as we are of the opinion that the detection and therapy of renal and adrenal tumors are derived from different areas of diagnostic science. We are indebted to Springer-Verlag for the excellent book production. On behalf of all the authors, we would like to thank our colleagues and associates for their cooperation in the realisation of this project. The editors hope that this volume will be of interest to radiologists, pa thologists, urologists, pediatrists, and also radiotherapists. Essen, April 1987 EBERHARD LOHR LUTZ-DIETRICH LEDER Table of Contents Pathology of Renal and Adrenal Neoplasms LEDER, L.-D., RICHTER, H.l.

The first edition of "Testosterone: Action, Deficiency, Substitu tion" was published in 1990. Since then our understanding of the hormone that turns males into men has tremendously increased. Therefore, the editors felt that a second extended edition of the book is warranted in order to summarize established and recent findings in the field and to present the reader with an up-to-date is reflected by the textbook. The increased mass of knowledge growth of the volume from 14 to 20 chapters. In the updated edition the biochemistry and metabolism of androgens have been complemented by extensive information on the molecular biology of the androgen receptor and its disorders. The key role of testosterone in spermatogenesis is now better de fined. We have a more complete understanding of the psychotro pic effects of testosterone and know so much about the different target organs and functions that individual chapters deal with testosterone and the prostate, lipids and the cardiovascular sys tem, hair, bones and muscles. The general chapter on pharmacol ogy and clinical uses of testosterone, in particular in male hypo gonadism, is extended by pharmacokinetic studies on testoster one preparations and individual substitution modalities using testosterone esters as well as implants and advanced trans dermal applications. The physiologic basis and possible clinical applica tions of testosterone in non-gonadal diseases, in male senes cence, in hormonal male contraception and in transsexuals are discussed. The last chapter describes the role of "investigative" steroid biochemistry applied to tracking anabolic steroid abuse."

The preface to Urodynamics - Upper and Lower Urinary Tract edited by LUTZEYER and MELCHIOR (Springer-Verlag 1973) mentions the self-evidence of using functional examinations in other medical de partments: "It is self-evident that the cardiologist uses the EeG not just routinely, but continuously in an intensive-care unit, where it is computerized and always on call. It is self-evident, too, in gastro enterology and pulmology that a functional analysis is based on readings of different electronic probes. In urology, however, we tend to rely on optical control by cystoscopy, static data in order to reach a functional interpretation that is based on this information alone. " Referring to the preface mentioned above, especially the upper uri nary tract is said to be assessed mainly from an anatomic-morpho logic point of view in the clinical routine, though in this case we are also mainly concerned with an active transport system. 1971, which the Twelve years after the urodynamic meeting in above-mentioned volume was based on, a second urodynamic meet ing took place in Aachen that was called and also dealt with "Re-: viewing the Aachen 1971 Meeting. " Its purpose was to review which of the statements that had been made more than a decade before were still valuable, what had to be added or revised, and which ex perimental tests and results could be clinically applied."

The 1992 International Yearbook of Nephrology is the 4th in a successful series of yearly books updating practising nephrologists and nephrologists-in-training on rapidly changing areas of nephrology. We were encouraged to proceed in our editorial venture by reviews of the previous issues which have appeared in various Nephrology Journals. These reviews have pointed to the successful use of the International Editorial Board, the broad range of topics of current interest which have been covered and the comprehensive and practical nature of the reviews. The principal aim of the Yearbook remains to provide reviews which are more current than those which appear in Nephrology textbooks and which can be in the hands of the readers a few months after the authors have completed the manuscripts. The appointed authors are always experts in the field, who are asked to give an objective review of the topic, up-dating the readers on the world-wide literature and providing them with a complete, accurate and up-ta-date list of important recent references. We have decided to maintain the successful format of the first three issues. Thus, the volume will continue to be divided into sections; each section will continue to have a different primary focus every year, depending upon what is of greatest interest at the time.

The most recent experimental work in urology is presented in this volume. Itcontinues the biennial publication of the reports given at the internationalsymposia for experimental urological research; the tenth symposium was held in Munich in June, 1990. The wide range of subjects covers renal cell cancer and adenoma, bladder cancer, urinary diversion, uro- dynamics, renal pathophysiology and transplantation as well as the pathogenesis and treatment of urolithiasis.

Impending famine and a terrifying rate of consumption of natural resources are vital issues which have focussed public interest in the ecologic, social and political problems of ever increasing overpopulation in many countries of the world. As well as the vast material and intellectual expenditure lavished on family planning and birth control, the past decade has seen an immense research effort in the elaboration of improved methods of fertility control, both for men and for women. During the same period, however, research into the causes of male fertility disorders has proceeded with equal intensity, and a number of promising therapeutic approaches have become the subject of clinical trials. The wish of an individual or of a couple to have offspring is an absolute which requires no further justification, and there can be few challenges to a physician as essential as the spouses' predicament in a childless marriage. Only with a special knowledge of the function, pathology and pathophysiology of the reproductive system is he properly equipped to meet that challenge.

Such an important subject as urinary diversion is unlikely to remain unchanged and unchallenged for long. The problem is to determine when is an appropriate time to examine current clinical practice of this major urological procedure. Historically, urinary diversion began with attempts to resolve the distressing problems associated with ectopia vesicae; later, urinary diversion was extended to help those patients with neurological problems of bladder function and with malignant diseases of the lower urinary tract. A significant landmark in the development and use of these procedures came with the introduction of a uretero-ileostomy (ileal conduit) by Bricker. With this diversion, faecal and urinary streams were separated and the incidence of metabolic and infective problems dramatically reduced. The procedure was received with great enthusiasm and indeed the pendulum soon swung so far in its favour that some urologists would scarcely admit to carrying out an occasional ureterosigmoidostomy. The impact of change in a surgical technique can be slow to determine especially when, numerically, it is an uncommon procedure and when the follow-up is hoped to match normal life expectancy. Thus the impact of ileal conduits has taken some years to evaluate and only during the past decade have the data been sufficient to show the advantages and disadvantages. This book is a landmark in the literature on this subject. The editor has selected eminent contributors who have described the main clinical groups where urinary diversion is an important aspect of management.

Carcinoma of the prostate increasingly dominates the attention of urologists for both scientific and clinical reasons. The search for an explanation and the prediction of the variable behaviour of the malignant prostatic cell continues unabated. The search for more precise tumour staging and more effective treatment is equally vigorous. Editors Andrew Bruce and John Trachtenberg have assembled acknowledged leaders in prostate cancer to present those areas of direct interest to the clinician. There are a number of other topics that might have been considered but most of these, such as experimental tumour models or biochemical factors affecting cell growth, still lack immediate application for the clinician. Carcinoma of the prostate continues to have its highest incidence in the western world, and the difference in comparison with the incidence in the Far East appears to be real and not masked by diagnostic or other factors. A number of other epidemiological aspects need careful analysis: Is the incidence increasing? Is the survival improving? Is the prognosis worse in the younger patient? Epidemiological data are easily misused and misinterpreted so that a precise analysis of the known facts makes an important opening chapter to this book.

Once urology was established as a medical specialty, the initial anatomic-morpho logical point of view was soon supplemented by functional considerations and diagnostic procedures, thanks to the introduction of the cystoscope (NrTzE, 1877) and retrograde pyelography (VOELCKER, ]OSEPH and VON LrCHTENBERG, 1903). Intravenous urography (VOLKMANN, 1924; VON LrCHTENBERG, PFLAUMER and SWICK, 1929) lent roentgen examinations a more functional aspect. The word "urodynamics" refers to the functional approach to the urinary trac- from the renal pelvis and calyces, the ureter and bladder down to the bladder neck and urethra. The embryologically denned topographie regions of the urogenital tract are peripheral relays, while the actual site of action of both normal and patho logical urodynamics is to be found in the various hollow muscular organs. Despite extensive basic research and much knowledge acquired in this neld, the active transport system between site of production and storage, i. e. the renal pelvis and ureter, is still regarded in clinical practice mainly from the anatomic-morphological viewpoint. It is not easy to obtain adequate information for the clinical assessment of functional disturbances of the ureter. For instance, retrograde exploration methods may often be complicated by infection. Clinically applicable methods for functional assessment of the upper urinary tract are (RUTISHAUSER): direct observation of the ureteral orinces, intravenous and retro grade visualization by roentgen contrast medium, sequential pyelography, roentgen kymography, and cinematography. Such methods allow good functional exploration by an experienced investigator but they yield hardly any objectively reproducible records."

Die Traumatologie des Urogenitaltraktes gewinnt im Blickpunkt der fort- schreitenden Industrialisierung und Technisierung sowie der zunehmenden Ver- kehrsdichte eine praktische Bedeutung, die sich in samtlichen Gebieten der diagnostischen und klinischen Medizin zunehmend bemerkbar macht. Die Konzeption des Bandes beriicksichtigt die aktuelle Entwicklung neuer medizinischer Disziplinen, z.B. die interdisziplinare Stellung der Urologie zwi- schen Unfallchirurgie und groBer Chirurgie, die Wandlung der R6ntgendiagno- stik von den konventionellen Methoden zur differenzierten Nukleardiagnostik und modernen Computerdiagnostik, das Herausarbeiten abgestimmter diagno- stischer Stufenplane sowie daraus folgender primarer oder sekundarer Versor- gungsplane des Polytraumatisierten. Damit wurde die zwar organisch faBbare und anatomisch nachvollziehbare Isolierung von Niere, Harnleiter und Blase aufgegeben und der gesamte Urogeni- taltrakt einschlieBlich des auBeren Genitales in ein funktionell zusammenMngen- des Netz eingebettet. Das bedeutet die Koppelung diagnostischer Prioritaten mit teilweise spezifischen Therapiekonsequenzen. Die einzelnen Kapitel scheinen auf den ersten Blick nicht organisch aneinan- der gekoppelt zu sein. Der Polytraumatisierte bildet eine komplexe und doch differenzierte Betrachtung und ist deshalb an den SchluB gestellt. Das isolierte Nierentrauma beim Kind und beim Erwachsenen verlangt eine verfeinerte dia- gnostische Ausleuchtung; die friiher invasiven Methoden wurden durch nicht invasive, aber sichere diagnostische M6glichkeiten ersetzt. Die Traumatologie von Harnblase sowie vorderer und hinterer Harnr6hre mit oder ohne Beckenfraktur ist breit und umfassend abgehandelt. Die Vor- machtstellung dieses Kapitels gegeniiber den anderen wird durch die detaillierte Ausarbeitung charakterisiert.

Technical improvements over the past twenty years have made endos copy the procedure of choice for examination of the hollow organs of the genitourinary and gastrointestinal tracts. The development of electro surgical techniques, laser technology, injection therapy, and a wide variety of other modalities now allow the endoscopist to treat many problems that in the past required open surgery. The simultaneous development of transcutaneous abdominal sonography has had an equally dramatic impact on the practice of gastrointestinal and geni tourinary surgery. The marriage of these proven technologies, known as endoscopic sonography, provides an exciting new modality that promises to further revolutionize the diagnosis and management of many intraabdominal diseases. Endoscopic sonography opens new frontiers by overcoming the primary limitations of its parent technologies. Fiberoptic endoscopy is limited by the inability to see beyond the luminal surface, this is particularly important when considering neoplastic disease because depth of wall invasion is a key factor in determining treatment. The limiting factor in transcutaneous sonography is the distance between the transducer and the target organ. With endoscopic sonography, the transducer is placed in close proximity to the target organ. This allows the use of high frequency waves (greater than 5 MHz), which provide better tissue resolution and eliminates the image distortion caused by overlying structures.

In recent years, a growing interest has prompted increasing numbers of research publications and scientific conferences on the subject of urolithiasis. The aims of this symposium were three: a) to review and inte grate recent progress in major subject areas, b) to discuss current research developments and c) to stimulate interchange between investigators in Europe and in America. In a series of morning lectures, invited, recognized experts presented comprehensive reviews of major fields of urolithiasis research such as the physical chemistry of crystal formation, the metabolism of stone forming substances, and modes of therapy. A special emphasis was given to general renal physiology and the renal excretion of Ca++, Pi, Mg, oxalate and urate. Despite its obvious importance, renal function has been relatively neglected in uro lithiasis research. New research results were presented by the mechanism of after noon poster sessions. This procedure permitted informal lengthy discussions between those participants especially interested and the responsible investigator himself. In addition, informal group discussions were organized during the evenings on an ad hoc basis. In this volume, both the review lectures and brief summaries of the poster presentations have been collected. Interchange between European and American investigators was achieved by the direct participation of a large delegation from North America. This large attendance was made possible by the generous support of the National Institute for Arthritis, Metabolism and Digestive Disease U.S. N.I.H."

For more than 60 years, the Californian Family Hinman has exercised a very considerable influence on the development and practice of the highest grade of urology, not only in the American West but worldwide. The leitmotiv of the Hinman School has been honest and thoughtful consideration of the problems of the genitourinary system gone awry. Character is the quintessence of the Hinmans. This virtue distinguishes the present volume on benign pros tatic hypertrophy assembled and edited by Frank Hinman, Jr. I first came under the spell of Frank Hinman, Sr. via his classic studies of renal counterbalance. In brief, in an experimental animal the ureter of one kidney was ligated and the subsequent renal hypertrophy of its contrala teral mate was studied quantitatively from anatomic and functional stand points. There were two central questions in the Hinman study: How does a normal kidney of an experimental animal recognize that its load has been doubled abruptly? What is the signal for renal hypertrophy? Benign hypertrophy of the prostate is quite different from compensatory hypertrophy of the kidney. It is now known that benign prostatic hypertrophy (BPH) is not a hypertrophy but a benign tumor consisting of a collection of spheroids of micro- and macrodimensions. In technical terms BPH is an adenofibromyoma. Perusal of the present volume will reveal many fascinating facets of BPH of particular interest to urologists and others with an investigative bent of BPH does not occur in children. BPH occurs as a medical rarity in mind."

Chemotherapy for malignant disease has brought about many rapid and often spectacular improvements in the survival rate of some groups of patients. Yet enthusiasm for these successes has, in part, been offset by the problems in evaluating responses to treatment and by the disappointment of failing to check the progress of still so many other tumours. These reactions will be no surprise to the medical historian but perhaps the expectations from scientific progress nowadays sometimes demand more than can reasonably be expected. Another expectation is that any review of chemotherapy is com pletely up to date, even prophetic. Such is the expansion of the subject that new drugs and trial results are continually being reported but it is this very mass of information that creates its own problems and makes many clinicians despair of finding a balanced judgement on all of this information. This was the challenge accepted by Professor Spiers. He then gathered together a group of colleagues who are amongst the acknowledged leaders in the field of chemotherapy for urological tumours, all of whom have made important contributions to this subject. However, each chapter is not merely a record of the author's experience but encompasses an assessment of past and present practice as well as perspectives in diagnosis and management. Almost all chapters include reference to published work up to and including 1981."

Nephrology, initially born as a small branch of medicine, has, in the last few decades, become an extraordinary large field of medicine. The recent development of renal medicine is mirrored by the numerous nephrological journals published, a natural consequence of the increasing number of basic and clinical research studies performed continuously all over the world. Undoubtedly the progress which has occurred in the different, specific fields of renal medicine has given rise to subspecialities which range from renal physiology and pathology to hemo- and peritoneal dialysis and renal transplantation. Even the diagnostic methodology in nephrology, very useful in the clinical practice, has become a speciality within the speciality. Thus, the problem for clinical nephrologists, as well as for internists, is to remain continuously up-dated in all fields of nephrology. Nephrology textbooks are published continuously and in great number. However, the time required for having authors appointed, chapters completed, manuscript edited, galley proofs corrected and the whole book printed makes many textbooks already out of date when they go on sale and their half lives are very short. On the other hand, nephrological journals are so many and the articles so numerous and detailed, that it is often impossible to rely on them for up-dating practicing clinicians.