"Rule IV. There is need of a method for finding out the truth. Rule V. Method consists entirely in the order and disposition of the objects toward which our mental vision must be directed if we would find out any truth. We shall comply with it exactly if we reduce involved and obscure propositions step be step to those that are s- pler, and then starting with the intuitive apprehension of all those that are absolutely simple, attempt to ascend to the knowledge of all others by precisely similar steps. " -Rene Descartes, Rules for the Direction of Mind ..".Perhaps he would sooner satisfy himself by resolving light into colours as far as may be done by Art, and then by examining the properties of those colours apart, and afterwards by trying the effects of reconjoyning two or more or all of those, and lastly by separating them again to examine what changes that reconjunction had wrought in them. This will prove a tedious and difficult task to do it as it ought to be done but I could not be satisfied till I had gone through it. " -From Newton's letter, quoted in The Life of Isaac Newton by Richard Westfall. Cambridge University Press, 1993.

This eighth volume in the series Recent Advances in Endourology brings together the latest clinical findings regarding various endourological treatment modalities and innovative materials. World-recognized experts outline their techniques clearly and concisely to provide an updated review of state-of-the-art endourological techniques. International management of urological diseases is focused in this latest issue.

This comprehensive volume covers the entire field of uncomplicated incontinence ranging from current concepts, to surgical management, to medical management. It includes a special focus on the latest diagnostic tests, new surgery including laparoscopy, and medical therapies. Additional coverage includes special topics such as prolapse, male incontinence, and costs and education. It is a state-of-the-art reference work on continence management for all urologists and gynecologists.

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.

Erectile dysfunction can affect all age groups. Numerous physical and emotional risk factors may contribute to the problem. These risk factors can range from chronic diseases and medications to psychological factors. In the U.S. alone, it has been estimated that 18 to 30 million men suffer from erectile dysfunction. This number has increased significantly as awareness of the disorder has heightened. Researchers and health care professionals now have a better understanding of what causes erectile dysfunction and the effective medications and non-medication treatments used to treat the condition. Comprehensive and state-of-the-art, Contemporary Treatment of Erectile Dysfunction: A Clinical Guide synthesizes the literature and covers all aspects of treating erectile dysfunction and other related male sexual dysfunctions. This invaluable title offers all physicians, residents, and fellows -- and even medical students and other health professionals such as nurse practitioners and physician assistants -- an essential reference for enhancing diagnosis and treatment of this debilitating disorder.

Disintegration of kidney and gall stones by intense laser radiation is becoming increasingly important as a complementary technique to extracorporeal shockwave treatment. This book gives for the first time a complete overview of laser lithotripsy combining a critical comparison of the methods and a thorough evaluation of instrumental developments and clinical applications. Readers from the medical as well as from the engineering side will find it a stimulating source of information on all aspects of laser-stone interaction.

Advanced Renal Cell Carcinoma (RCC) cannot be cured by surgery alone. Its resillience to irradiation and chemotherapy demands a new approach to the management of this disease. This book provides an overview of the scientific and clinical developments of RCC, and clarifies the fields ofimmunotherapy and immunobiology. The book contains a compilation of approaches that will enhance the effectiveness of the management of advancedRCC, even in the absence of definitive pre-clinical data. These require additional study and will stimulate the reassessment of preliminary results.Furthermore, preliminary results of already implemented clinical trials withbiological modifiers are presented. Of special interest are the current achievements in the field of immunotherapy using topically and subcutaneously low dosage combinations of cytokines. This concise volume will benefit those seeking a thorough review of the research and the clinical aspects of RCC simultaneously.

Presented by recognised experts around the world this reference book helps identify the role of medical and surgical therapies in the treatment of Benign Prostate Hyperplasia (BPH), prostate cancer and prostasis. By combining the latest epidemiological data with detailed comment on management and treatment, the book is a unique up-to-date and fully referenced resource on the subject.

The human prostate gland is of undoubted importance in reproductive physiology and is one of the commonest causes of clinical urological problems in the male patient. Despite the wealth of published lit erature relating to the prostate gland surprisingly little is understood about its neural innervation, the influence of pharmacological factors and its precise physiological functions. Indeed, benign disorders of the prostate gland including benign prostatic hyperplasia, bladder neck dyssynergia and inflammatory disorders of the prostate (prostatitis, prostatodynia) although well recognised clinically, are as yet poorly characterised and understood. It was not until the late 1960s that the subject of urodynamics, which for the first time allowed scientific assessment of the function of the lower urinary tract, was introduced. The first section of this book considers recent advances in our understanding of the innervation of the bladder and prostate gland and the changes in bladder function which accompany prostate medi ated bladder outflow obstruction. The clinical consequence of benign prostatic hyperplasia in many patients is bladder outflow obstruction and although the traditional treatment of these conditions is by the use of ablative surgery, in recent years a number of new modalities have been investigated and are reviewed in the second section of the book.

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."

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.

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.

After historical introduction, the aspiration technique and imaging modalities are described. Thereafter, the use of aspiration cytology in the diagnosis and mainly in the sta- ging of urologic cancers is on still not well known appli- cations of the procedure in the staging of some organs (bladder, adrenals, penis, testis and secondary ureteral strictures) are reported.

Infertility, as with many aspects of medicine, is at the mercy of rapid technological advance. Many of these developments initially seem attractive to both clinicians and patients, but need to be rigorously assessed if their real value is to be understood and clinical practice is to develop. In this book issues of importance to the management of infertile patients are discussed. The gaps in our knowledge which prevent a better understanding of the condition are identified, and recent developments, both clinical and scientific, are subjected to peer review and discussion. An important feature of the book is an acceptance that training in infertility practice is a real problem. This is perceived not only by the practising clinicians, both doctors and nurses, but particularly by the clinical scientists, including embryologists, who now provide such an essential part of the service. Similarly the provision of the clinical service has been examined in detail from a variety of standpoints, in an attempt to make sensible recommendations which balance real need with limited resource. The book is based on the papers presented and discussed at the 25th RCOG Study Group held in April 1992. The discussion after each paper was civilised but uncompromising and forms an important part of this publication. The rapid processing of the written and recorded material by the staff at the RCOG, and particularly Miss Sally Barber, has ensured that the book has been produced while the issues are live, the reviews contemporary and the discussion relevant.

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."

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 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."

Andrology for the Clinician consists of two parts: In Part One, the busy clinician can easily find the problem-orientated information he or she needs on such issues as male factor fertility problems, male contraception, and male genital tract infection and tumours. Part Two contains in-depth subject-orientated information and adds important scientific background information to the recommendations received in Part One. Several leading experts have contributed to this work, which has been extensively subedited by world-renowned editors to ensure a well-structured didactic design and homogeneous content. This outstanding book is of great value for all Urologists, Andrologists, Dermatologists, Endocrinologists, Gynaecologists, Reproductive Biologists, GPs, Gerontologists, Psychologists, Psychiatrists, Paediatricians and anyone else interested in the problems of male sex and constitution.

This interdisciplinary collection brings together the fundamental research in shock focusing and sonoluminescence. The authors report on their studies on shock focusing and related bubble dynamics, as well as their applications in medical science.

This heavily revised third edition gives an essential textbook which provides a comprehensive guide to robotic surgical techniques in urology. Extensively updated chapters cover general aspects of surgery such as aspects of operating room preparation and anesthesia. Instructions on how to use a variety of the latest techniques for procedures associated with the kidney, prostate, bladder and testicle are covered. Detailed information on how to improve outcomes, avoid potential complications and pitfalls is also provided. Instructive video clips assist the reader in being able to visualize how to enhance their methodologies further. Robotic Urologic Surgery is a detailed up-to-date resource that includes contributions from leading robotic urologic surgeons from around the world. It assists readers in refining their surgical technique and improving their patient care. Therefore, it is a critical resource for all practicing and trainee physicians involved in the care of these patients.

The Oxford American Handbook of Urology provides authoritative, point-of-care guidance on all aspects of the field, covering both benign and malignant conditions, as well as medical and surgical management. Incorporating diagnosis and treatment advice from established, published guidelines as well as drawing from the experience of four seasoned urologists, the book's concise and accessible format quickly guides the reader to desired information on common signs and symptoms, incontinence, cancer, infections and infertility plus key information on trauma, urologic emergencies, and pediatric urology. It is an invaluable resource for medical students and residents as well as a useful reference for practitioners.

Excerpted from the Textbook of the Neurogenic Bladder, Essential Guide to the Neurogenic Bladder provides information on two topics essential to the practicing clinician: evaluation and treatment. Giving the reader easy access to the diagnostic armamentarium, this well-illustrated text provides the examining physician with excellent guidelines for conducting thorough, efficient, and beneficial examinations of both adults and children using a variety of instruments and tests. Both surgical and non-surgical treatment options are written by experts from around the globe and should invariably help the reader to choose the best treatments for optimal results.

Frozen sections are performed for the purpose of rapid diagnosis while a patient is undergoing surgery, usually under general anesthesia, as a basis for making immediate treatment decisions. Therefore, frozen section diagnosis is often a highly demanding situation for the pathologist who must render a diagnosis quickly and a crucial determination for the patient and surgeon. In addition to the need for rapid recall of differential diagnoses, there are many pitfalls and artifacts that add to the risk of frozen section diagnosis that are not present with permanent sections of fully processed tissues that can be examined in a more leisurely fashion. Most standard pathology textbooks, both general and subspecialty, largely ignore the topic of frozen section. Few textbooks have ever focused exclusively on frozen section diagnosis and those textbooks that have done so are now out-of-date and have limited numbers of black and white figures. None has emphasized the education of the surgeon in terms of frozen section benefits, limitations or proper utilization.

The Frozen Section Library series will provide convenient, user-friendly handbooks for each organ system to expedite use in the hurried frozen section situation. These books will be small and light-weight, copiously color illustrated with images of actual frozen sections, highlighting pitfalls, artifacts and differential diagnosis. These books will also include perspectives for the surgeon and for communication with the surgeon and suggest ancillary procedures (for example, when to take tissue for microbiology cultures). Each 5 X 8 book is estimated to be about 200 to 250 pages in toto with 100 to 150 color figures each.

As a handbook for practicing pathologists, these books will be indispensable aids to diagnosis and avoiding dangers in one of the most challenging situations that pathologists encounter. Problems, such as differentiation of benign processes from malignant neoplasms which may be more difficult on frozen section than permanent section and which have a serious impact on the surgeon s immediate treatment decisions, will be emphasized. Rapid consideration of differential diagnoses and how to avoid traps caused by frozen section artifacts will be readily accessible to the users of the handbooks. A series of concise, easy-to-use, well-illustrated handbooks alleviates the often frustrating and time-consuming, sometimes futile, process of searching through bulky textbooks that are unlikely to illustrate or discuss pathologic diagnoses from the perspective of frozen

sections in the first place. Tables and charts will provide guidance for differential diagnosis of various histologic patterns.

The advantages of a series of organ-specific handbooks, in addition to the ease-of-use and manageable size, is that (1) it allows more comprehensive coverage of more diagnoses, both common and rare, than a single volume that tries to highlight a limited number of diagnoses for each organ and (2) it allows more detailed insight by permitting experienced authorities to emphasize the peculiarities of frozen section for each organ system. Although some differences in practice of frozen section exist between different institutions, such as differing policies regarding whether or not to perform frozen section on specific types of specimens, these differences are generally not significant and can be discussed ( an organ-specific handbook by an expert in that organ system permits more opportunity for this type of discussion). Touch preparations, which are used for some organs such as central nervous system or thyroid more often than others, will be appropriately emphasized and illustrated according to the need for each specific organ.

This series will be highly valuable to practicing surgical pathologists, both community and academic, and to pathology residents and fellows. The perspectives provided will also be valuable to surgeons and especially to surgery residents and fellows who must answer questions about pathology and frozen section on their board examinations. These handbooks will be easily portable by the individual but it is envisioned that many departments will want to also keep a series readily available in the frozen section laboratory. "

This collection of 21 articles is designed to serve as a state-of-the art reference book for intersexuals, their parents, health care professionals, ethics committee members, and anyone interested in problems associated with intersexuality. It fills an important need because of its uniqueness as an interdisciplinary effort, bringing together not just urologists and endocrinologists, but gynecologists, psychiatrists, psychologists, lawyers, theologians, gender theorists, medical historians, and philosophers. Most contributors are well-known experts on intersexuality in their respective fields. The book is also unique in that it is also an international effort, including authors from England, the Netherlands, Germany, Australia, India, Canada and the United States. The book begins with introductory chapters on the etiology of intersex conditions, conceptual clarification, legal issues, and reflections about the inherent characteristics of medical care that have led up to the issues we face today and explain the resistance to change in traditional practices. Researchers provide recent data on gender identity, surgical outcomes, and appropriate clinical care. Issues never having been addressed are introduced. The significance of intersexuality for Christianity and for philosophical concerns with authenticity add further depth to the collection. The final chapters deal with future possibilities in the treatment of intersex and for intersex advocacy.