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.

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."

To present a coherent and meaningful survey of scientific research endeavour in an area that has expanded as fast as physiology and biochemistry of reproduction in the male is no mean task these days. No less prodigious than the growth of knowledge of male reproductive function has been the rate at which the outpouring of publications on this subject has continued since the appearance of 'The Biochemistry of Semen and of the Male Reproductive Tract' in 1964. Since cyclopaedic treatment of this vast literature did not appeal to us, we have made no attempt either to rehash the material contained in that book or to enlarge the bibliography beyond the nearly 3500 references included in the present treatise. At the same time, whilst writing, we felt strongly that to advance, it is necessary to understand the past, and for this reason we have not hesitated to refer (especially in the introductory chapter) to a number of those fundamental early discoveries in which today's knowledge is deeply and firmly rooted.

Sexology as a discipline has had to fight for full-fledged recognition in the scientific community. Yet special knowledge of normal and disturbed sexual behavior is expected of medical professionals, psychologists and educators alike. Based on the papers given at the 8th World Congress for Sexology in 1987, this volume gives an up-to-date discussion of the most interesting and controversial topics, such as AIDS, in the field. Contributions have been grouped under the main headings: Family Planning, Sterility and Sexuality, Erectile Dysfunction, Sexuality in the Elderly and in Marriage, Transsexualism, Sexual Therapy, and Sexuality and Illness, and include items of historical interest as well as transcultural comparisons.

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."

A further volume in the successful 'Clinical Practice in Urology' series Urological Protheses, Appliances and Catheters, provides for the first time practical information on all those aspects of urology which depend on manufactures articles that are inserted in or attached to patients.

MRI has opened up new possibilities in combined morphological and functional imaging, and now there is a book which discusses both aspects together. Two systems which already demonstrate the advantages of MRI are presented. In the cardiovascular system, motion and flow can be imaged so that even flow velocities in the deep vessels of the body can be measured, and turbulences can be identified. In the study of the kidneys, a combination of renally excreted contrast media and imaging provides within seconds insight into glomerular filtration in health and disease. These current possibilities, and their limitations, bring insight into the future potential of MRI.

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.

Diagnostic and exfoliative cytology has today achieved a status that few could have envisaged 20 years ago. While exfoliative cytology has long been employed in gynecological diagnosis, new and rewarding spheres have now developed in which cytological diagnosis plays an important role. Exfoliative cytology, for example, is widely employed as an aid in the continuous assessment of urinary tract tumors, and aspiration cytology in the diagnosis of thyroid dis eases. This has given rise to a growing demand for pathologists experienced in cytological diagnosis. However, clinicians with an interest in morphology were often the first to adopt these simple and safe methods, being naturally attracted by the chance to avoid conducting biopsy, which, in the last analysis, is nothing less than a surgical operation. In this Atlas of Prostatic Cytology Leistenschneider and Nagel expertly demonstrate what can be achieved when clinicians skilled in morphology take an interest in cytological methods. Not only do they have direct contact with the patient, but they also profit from immediately being in a position to assess the results of their diagnostic procedures by examining the specimen obtained. From the technical point of view aspiration biopsy of the prostate is by no means a simple procedure and the difficulties involved would seem to have been underestimated in the initial phase of enthusiastic acclaim. Consequently it has been not unusual for clinicians and pathologists to be disappointed by the high rate of unsatisfactory samples obtained by this method.

Any discussion of the present success in management of urological cancers evokes a mixed response. Oncologists and urologists can enjoy the success with chemotherapy for testicular cancers but cannot forget the dismal results with any form of treatment, other than surgery, for renal carcinoma. But these are the less frequent urolegi cal tumours: what are the attitudes to the more common prostate and bladder cancers. Intensive study, many clinical trials and much debate lead us to the conclusion that we understand them better, we can tailor the treatment more appropriately to the individual patient but there remains some uncertainty as to the overall success that we have achieved. There have been no striking changes in the 5-year survival data. Clinicians tend to see their success in terms of their special interest. Radiotherapists point to their success in stage-reduction but what are we to do with the many patients whose tumour is unaltered by radiotherapy. Urological surgeons, and especially those who are still influenced by the shadow of Halsted, point to their success in excising the cancer but apart from that highly selected group, what are we to do for the very large number of patients for whom surgery is inappro priate. Bystanders can only watch and listen to the arguments for and against these views.

Since the early days of medicine one concern of doctors has been the removal of kidney stones and prevention of recurrence. Owing to the hesitancy of progress in the prevention of initial stone formation and of relapse, however, removal of stones from the kidney and ureter were developed to highly refined techniques and they formerly accounted for a major proportion of the urological operations performed. In the last few years developments in the treatment of kidney stones have taken a completely different turn. In the majority of cases suit able methods are available to bring about spontaneous passage of the stones, while in a smaller proportion drug-induced litholysis is pos sible. Stones that cannot be passed are now treated mainly with extra corporeal shockwave lithotripsy, percutaneous litholapaxy or uretero renoscopy. These methods are often used in combination and comple ment each other. Nonetheless, despite the accumulating experience with the new methods there will still be situations in which stones can not be removed except by open surgery. "Our skill as surgeons and the management of the brilliantly designed equipment would amount to nothing more than highly skilled mechanical work if they did not go hand in hand with enhanced insight into the cause of lithiasis and thus into ways of preventing it - or at least of preventing the relapse that is the lot of most patients."

This volume is a report of the proceedings of an International Symposium on Bladder Cancer and a selection of Urological papers presented at the Antwerp Medical Days in Antwerp, Belgium, on the 19th and 20th September 1980. The meeting was sponsored by the Antwerp Medical Days Program Committee supported by the Royal Antwerp Circle of Medicine, the Urological Group of the European Organization for Research on the Treatment of Cancer, the Belgische Vereniging voor Urologie, the Societe Belge d'Urologie, the Province and City of Antwerp and the National Fund for Scientific Medical Research of Belgium. Contributors were briefed to avoid too much overlapping, in the hope of obtaining a coherent compilation of clinical data. We are grateful for their discipline which enables early publication. All the contributions in this volume, except he section on immunology which was selected by the editors for its related inter est, were presented at the International Symposium under the sections 'Understanding the Disease', 'Therapeutic Approaches', 'Chemotherapy', and 'Prospective Studies'."

Anil K. Mandai, M.D., is one of the trailblazers in the use of the transmission electron microscope in the study of the urinary sediment. In this book, he reviews his extensive efforts to tie his vast clinical expe rience to his elegant basic research with the electron microscope. The pictures are comprehensive, and the clinical correlates are nicely outlined in tables and text. It may astonish some readers that a book for fellows and clinical nephrol ogists has been written on the use of the transmission electron microscope in the study of urine. Some may view this as a sophisticated research instrument. I, however, applaud the effort. So many discoveries and advances in basic science lie unutilized because clinicians are not aware of the tools available or have little instruction in their use. Maybe that is the reason why so many tests have come and gone, have been found useless and dropped, or have simply been abandoned after being judged too complicated-some because they were, others because they were never applied and interpreted properly. The whole field of research seems to be pulling ahead and away from clinical medicine. Therefore, an effort like this one, which rapidly and clearly tries to introduce an advanced research examination technique into clinical medicine, is worthy of admiration and sup port."

Any book with the words percutaneous and interventional is immediately identified as one that brings to its readers a distillation of a number of new and exciting techniques. Percutaneous is not exactly a new word but it has come to take on an entirely new meaning in recent years. Interventional is a recent acquisition to medical language indicating an entirely new approach to many aspects of medical management. Exactly when is the right time to make a distillation of new thoughts and expertise requires something of the art of a master brewer. First the ingredients must be prepared, the recipe must be just right, there must be excellent quality control as well as the master brewer's touch to produce the product when the time is right. Dr. Lang has assembled just the right ingredients in the form of a very impressive team of experts in these new fields of uroradiology and urological management. Ventures into percutaneous urology may date back 30 years but the main growth in the range of procedures and the development of the technology has occurred only in the last 10 years. Relieving upper tract obstruction seemed a natural sequel to renal biopsy but the imagination to develop an effective treatment for stones was an impressive extension of the concept of minimally invasive surgery.

Genetic disorders have emerged as a prominent cause of morbidity and mor tality among infants and adults. As many as 10% to 20% of hospital admis sions and at least 10% of the mortality in this age group are due to inherited diseases. There are at least two factors that have brought genetic disorders into the forefront of pediatrics. One is a great reduction in childhood mortality due to infections and nutritional deficiency states, and the other is the rapid progress made in the identification of genetic defects. Amniocentesis, chorionic villus sampling, and recombinant DNA technology have already had a tremendous impact on the practice of medicine. This is why the first two chapters of this volume are dedicated to general principles of molecular genetics and to a description of the techniques used to diagnose genetic disorders at the DNA level. The relevance of this new area of science to the study of inherited renal diseases is reflected in the large body of knowledge that has been generated regarding the association between various glomerular nephritides and genetic markers such as the HLA system, and even more impressively in the direct or indirect identification of abnormal genes or gene products in Alport's syn drome, autosomal dominant polycystic kidney disease, and Lowe's syndrome. These discoveries figure prominently in the pages of this book. Yet, the progress we have made has barely scratched the surface of the problem."

Volume 5 of Contemporary Nephrology summarizes major advances in 15 different areas of nephrology. As in previous volumes the different chapters constitute up- of the discipline contributed by individuals dates in both basic and clinical aspects with in-depth expertise in their respective areas. We are grateful to the authors for their outstanding contributions to this fifth volume. Drs. Reuss and Cotton review in Chapter 1 new advances in our understanding of water transport in epithelial tissues responsive to antidiuretic hormone. In Chap- ters 2 and 3 Dr. Knox and Dr. Schoolwerth and their associates summarize respec- tively new information in the areas of renal hemodynamics and electrolyte excre- tion, and renal metabolism. Chapter 4, written by Drs. Laski and Kurtzman, updates recent developments in the regulation of acid-base balance in health and disease. Chapter 5, contributed by Drs. Sutton and Cameron, provides the reader with a detailed account of progress in the area of mineral metabolism. In Chapter 6, Dr. Campese examines the contribution of sodium, calcium, and neurogenic factors in the pathogenesis of essential hypertension. The immunological aspects of renal disease are clearly discussed by Dr. Couser in Chapter 7. New developments in this field are emphasized and should provide the reader with a clear understanding of the direction in which this field is moving. Drs. Humes and Messana (Chapter 8) discuss selected areas in which new developments have occurred in our understand- ing of acute renal failure and toxic nephropathy.

With contributions by D. Albrechtsen, O.H. Bentdal, H. Bondevik, I.B. Brekke, P. Fauchald, J.G. Fjeld, A. Flatmark, A. Foss, A. Hartmann, H. Holdaas, R. Innes, A. Jakobsen, N.E. Klow, B. Lien, O. Oyen, P.F. Pfeffer, K. Rootwelt, G. Sodal and K. Vatne

Where do you begin to look for a recent, authoritative article on the diagnosis or management of a particular malignancy? The few general oncology text books are generally out of the date. Single papers in specialized journals are informative but seldom comprehensive; these are often preliminary reports on a very limited number of patients. Certain general journals frequently publish good in depth reviews of cancer topics, and published symposium lectures are often the best overviewes available. Unfortunately, these reviews and supplements appear sporadically, and the reader can never be sure when a topic of special interest will be covered. Cancer Treatment and Research is a series of authoritative volumes which aim to meet this need. it is an attempt to establish a critical mass of oncology literature covering virtually all oncology topics, revised frequently to keep the coverage up to date, easily available on a single library shelf or by a single personal subscription. We have approached the problem in the following fashion. First, by dividing the oncology literature into specific subdivisions such as lung cancer, genito urinary cancer, pediatric oncology, etc. Second, by asking eminent authori ties in each of these areas to edit a volume on the specific topic on an annual or biannual basis. Each optic and tumor type is covered in a volume appear ing frequently and predictably, discussing current diagnosis, staging, markers, all forms of treatment modalities, basic biology, and more."

This volume contains the proceedings of the XVth North American Testis Workshop, held in Louisville, Kentucky, April 7 to 10, 1999, to describe current advances in testis biology. The first two chapters provide a useful historical perspective of testis physiology and formulate compelling research questions about important aspects of sperm formation and function. This prologue sets the scene for the remainder of the volume that follows a logical progression, as the title implies, from stem cell to cell function, but that is necessarily preceded by sex determination, the quintessential requirement for there being a testis in the first place. The program for this XVth Testis Workshop evolved from recommenda tions of the scientific committee and their advice on the selection of invited speakers. The XVth Testis Workshop has a strong comparative flavor with contributions on worms (Caenorhabditis), flies (Drosophila), and chickens, which are models that permit and thereby reveal the power of genetic analy ses of the molecular mechanisms involved in spermatogenesis. A glimpse into the future is provided with information from EST, protein, and genome databases that already have an impact on progress in our understanding of the male germ cell. Although there is heavy emphasis in these chapters on cellular and molecular e, Yents, database mining and translational profiling relevant to testis function and dysfunction and assisted reproduction tech nologies are not overlooked."

practitioner up to date on the various aspects of conditions and diseases considered to be sexually transmitted. REFERENCES 1. Crissey JT, Denenholz DA: Development of the modern forms and concepts of syphilis. Clin Dermatol, 2(1):1-10, 1984. 2. Panconesi E, Mazzi M: The day syphilis came. Int 1 Dermatol, 23:284-286, 1984. 3. Washington AE, Johnson RE, Sanders LL: Chlamydia trachomatis infections in the United States: What are they costing us? lAMA, 257:2070-2074, 1987. 4. Bulkley LD: Syphilis in the Innocent. New York: Bailey and Fairchild, 1894. 5. Syphilis: Major perinatal killer. Med World Trib, 28(16):2, 1987. 6. Renshaw DC: Management of impotence. I. Psychological considerations. Clin Therap, 9:142-148,1987. Acknowledgments. We are very grateful to our teachers for the stimulation they provided in our studies of dermatology and sexually transmitted diseases. We partic ularly acknowledge the impetus given by Herman Beerman, M.D., Emeritus Professor of Dermatology, University of Pennsylvania School of Medicine, Philadel phia. Our office staffs have been particularly helpful, and we would like to recognize the contributions of Mrs. Carmela Ciferni. Lastly, this book was conceived through the inspiration of Dr. Jerry Stone, late Senior Medical Editor of Springer-Verlag, New York. Philadelphia, Pennsylvania LAWRENCE CHARLES PARISH Vienna, Austria FRIEDRICH GSCHNAIT Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Xl . . . . . . . . . . . . . . . What are Sexually Transmitted Diseases? Chapter 1 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . . . . LOIS Y. MATSUOKA Chapter 2 Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . HARRY L. ARNOLD, JR. Diseases Chapter 3 Syphilis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . JOHN THORNE CRISSEY Chapter 4 Endemic Treponematoses . . . . . . . . . . .. . . . . . . . . . . . . . . . 32 . . ."

During recent decades, it has been firmly documented that chlamydiae are com mon and important pathogens in humans and animals. In humans, chlamydiae are known to cause trachoma (which is still one of the major blinding diseases in the world) and are also one of the most common etiological agents of sexually transmitted diseases and the sequelae thereof, such as infertility. In the last few years, it has also become evident that chlamydiae, i.e., the so-called TWAR agents, are common respiratory tract pathogens. Chlamydiae are also important pathogens in birds and lower mammals, in whom they cause a variety of infectious conditions, a spectrum which has in creased every year. Some of these infections occur as zoonoses, e.g., psit tacosis/ornithosis and, as recently discovered, abortion. Know ledge of the molecular biology and immunobiology of chlamydiae has expanded rapidly during recent years. Insight into the pathophysiology of chla mydial infections has also increased, and new methods for the diagnosis of chlamydial infections have been introduced. The importance of establishing control and preventive programs for chla mydial infections has become obvious in order to combat the present chlamydial epidemic. We hope that this book can usefully serve those who want to increase their general knowledge of Chlamydia and that it can act as a handbook and reference source for those involved in chlamydial research as well as for those working with chlamydial infections in medical and veterinary clinical disciplines, includ ing clinical laboratories."

In the 5 years since the publication of Urologic Laparoscopy by the Japanese Society of Endourology and ESWL, the field has moved on apace, particularly technologically. It is with an eye on the need to disseminate the latest information on this progress that this collection has been assembled, highlighting the most recent advances in laparoscopic urologic oncology surgery. With treatment options becoming ever more complicated, it is essential to keep the prime objectives in mind - improved quality of life for the patient, minimal complications, early convalescence, and a better end result. In our effort to cover a broad range of techniques from renal cyst decortication to robotic laparoscopic camera control, we are in debt to surgeons at the forefront of treatment, not only in Japan but worldwide, and to manufacturers who are constantly innovating in their equipment. The contributors are enthusiastic in their expertise, as shown in the quality of the material they have produced.

This atlas deals with conditions commonly encountered in the male genital tract. Whilst the majority of illustra tions are photomicrographs, photographs of macro scopic specimens are also used to illustrate important features in distinguishing different pathological con ditions. Special emphasis is placed on the small biopsy specimens obtained from prostate and testis in modern urological practice and the importance of clinico pathological co-operation in pathological practice is stressed. Recent advances in our knowledge of testicu lar tumours are discussed and illustrated. The text is not entirely descriptive and attempts to give an intellectual framework around which histopathological diagnosis in this field can be practised. A modest number of references are included; they have not been singled out as representing milestones in the development of our knowledge of these conditions - the choice has rather more centred upon recent reports from which a litera ture search can be mounted if required. The atlas in no way pretends to be an encyclopaedic reference of con ditions of the male genital tract but attempts to provide an up-to-date comprehensive discussion of the histo pathology of this system. Acknowledgements I am most grateful to Mr Keith Gordon for developing all the photomicrographs and to Mr Geoff Gilbert and his staff in the Audio-Visual Department of the City Hospital who took the majority of the macroscopic illustrations. I must particularly thank my secretary, Mrs Dorothy Clay ton, for typing and retyping my draft chapters and for deciphering my hieroglyphics."

Decoding the significance of proteinuria as an indicator of severity or prognosis in kidney disease is a stimulating challenge to students and practitioners of nephrology. Sir Richard Bright in 1827 associated pro with the disease that bears his name. In the subsequent more teinuria than a century and a half, however, the meaning of the linkage between proteinuria and renal disease remains elusive. Proteinuria is discovered on routine urinalysis in about 10 million Americans, most of whom express no symptoms of kidney disease, each year. From the studies of Robinson (updated in these pages), we know that proteinuria, per se, can be present for 20 years without change in re nal function, as described in orthostatic proteinuria. By contrast, pro teinuria may be the harbinger of swift kidney destruction, rarely cul minating in clinical collapse, a syndrome typifying "malignant proteinuria" as detailed herein by Avram. Although proteinuria is ubiquitous, an orderly management strategy for rational handling of proteinuria of less than nephrotic range is lack ing. Separation of tubular proteinuria and transient proteinuria of fever is now possible routinely. This book provides a record of the contribu tions of investigators and clinicians whose work forms the substrate for production of understanding and, ultimately, marching orders for prac titioners seeking optimized management for their proteinuric patients."