Malignancies originating from the urogenital tract account for about 20% of all solid neoplasias. The various tumor types, including carcinoma of the prostate, transitional cell carcinoma, renal cell carcinoma, and testicular germ cell tumors, differ widely in terms of biological features, in cidence and appearance, diagnostic work-up and manage ment. It is not surprising that this complexity of urologic oncology with its related problems has increasingly attracted both experimental investigators and clinical experts. Only time will tell whether the achievements that today are con sidered* as progress will turn out to be significant contribu tions towards the ultimate goal: the cure of the patients' life-threatening diseases with little or no side effects. How ever, many innovations and improvements have already taken place in the field of urologic oncology within recent years. The high pace of innovative development requires continuous, thorough, and critical updating of our kowledge so that persisting deficits can be defined: the basic require ment for posing new scientific questions. The following examples may serve to illustrate the recent developments and the resulting new problems and questions: Recently, it has become evident that carcinoma of the prostate must be detected earlier to enable us to cure more of the affected patients in the future than currently.

For more than a century, the condition now known as Idiopathic Hydronephrosis has been recognised as a clinical entity, and following the original description by Rayer in 1841 a variety of procedures were devised in attempts to correct the condition surgically. Most of these early methods were introduced in the last decade of the nineteenth century by several illustrious clinicians, including Trendelenburg, KOster, Fenger and Sutton. For many years diagnosis was based purely upon the patients presenting signs and symptoms and not until the early part of this century was technology available to assist in the pre-operative diagnosis of the condition. Early methods depended upon radiological techniques, and the introduction of the retrograde pyelogram by Voelcker and Lichtenberg in 1906 represented a significant advance in diagnostic methodology. Other methods also dependent upon radiographic techniques were subsequently introduced, including urography in the late 1930s by Swick, and more recently, the method of cineradio graphy, as pioneered with considerable success by Peter Narath in the decade following World War II. During the past 50 years a variety of surgical procedures have been introduced for the treatment of idiopathic hydronephrosis. That so many different methods have been devised suggests that no one specific technique is capable of achieving a complete cure in all cases."

The purpose of this book is to provide some basic information regarding the fundamentals of magnetic resonance (MR) for all those who are less familiar with the technique and interested in MR spectroscopy and its possible applications in research and clinical practice. It will stimulate the reader to look more closely at the various topics covered by the contributors to this volume: tumor cell metabolism, kidney function, organ viability. Finally, several applications of high-field spectroscopy and imaging are illustrated. The book focusses on proven and possible clinical applications of MR in nephrourology: renal cell carcinoma, metabolic investigation of the kidney and pretransplant assessment of organ viability. The examples are thoroughly discussed and abundantly illustrated. The reader will benefit from this book by receiving a review of research and clinical aspects of MR 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.

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.

The first symposium of the working group on experimental urology of the German Society of Urology was held in Cologne in 1972. It was meant to be a platform to present and, in particular, to discuss experimental studies developing new diagnostic and therapeutic approaches, and to promote in novation in urology in Germany. This plan was well received, and during the last 16 years both the number of participants from other European and overseas countries and the number and quality of presentations have been continuously increasing. At the most recent meeting, held in Aachen in 1988, new data were presented on renal cell cancer, andrology, prostatic cancer and adenoma, bladder cancer, urinary diversion, urodynamics, renal pathophysiology, transplantation and the pathogenesis and treatment of urolithiasis. The present book contains 44 of the 109 papers given at the Aachen meeting, covering both basic and clinical research. It will be of eminent interest to all scientifically minded urologists, oncologists, neurophysiolo gists, endocrinologists, and pathologists because it is a synopsis of all the major scientific research currently being conducted in urology in Europe. There are no other books available which offer as comprehensive a cover age of recent experimental issues in urology. The aim of the series Inves tigative Urology is to demonstrate the continuous development of research in urology and to encourage all colleagues interested in experimental urol ogy to continue their important activities and create new international co operation.

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.

In February 1980 the Royal College of Radiologists, London, held its Second Symposium on Clinical Oncology. The subject was Prostatic Cancer and this publication is based on the presen tations at this meeting by leading authorities in the United Kingdom. The principal objective of these Symposia is to promote multi disciplinary collaboration for the benefit of cancer patients. Awareness and understanding of advances in a broad range of subjects are essential to ensure the timely and effective appli cation of new techniques in the prevention and treatment of all forms of cancer. Communication of this kind may also stimulate the creation of new ideas that may prove to be of more fundamental relevance to cancer research. Prostatic cancer has been afforded too little attention in the past, and its importance in Clinical Oncology has not been adequately recognised. And yet over the last 10 years consid erable progress has been recorded in our understanding of this disease and in its assessment and management. These achieve ments are well documented in this collection of papers and the outstanding problems are also clearly indicated. It is acknowl edged that the early diagnosis of prostatic cancer presents a continuing challenge, associated with the uncertainties that concern the clinical significance of 'latent' cancer of the prostate. The accurate assessment of the incidence and preva lence of the disease is extremely difficult and together these problems complicate the evaluation of the management of early or localised prostatic cancer."

The book provides a comprehensive uptodate review of the present state of knowledge of urinary enzymes. Since it deals with all the essential questions currently being discussed in connection with urinary enzymes, it will be of interest to biochemists, clinical chemists, renal physiologists, nephrologists and clinicians working on renal problems.The chapters are grouped into 5 parts, the first offeringan update of the biochemical and morphological fundamentals of the excretionof urinary enzymes, including a description of the distribution of diagnostically relevant enzymes along the nephron, the mechanisms of enzyme release, and the physiological factors influencing the excretion rate. The chapters in the second part deal with the methodological fundamentals ofthe activity determination of urinary enzymes (preanalytical treatment, quality assurance, methodical details for the most important enzymes, reviewon reference intervals). The four chapters in the third part review aspects of urinary enzyme excretion in clinical medicine (renal, renal associated, and urological disorders, kidney transplantation, nephrotoxicity, extrarenal diseases) and includes a special chapter on the general background for interpreting data on urinary enzyme excretion. The fourth part, consisting of 3 chapters, covers urinary enzymes in animal experiments (animal models, influence of different substances on urinary enzyme excretion, reference values in various animals). The book concludes with a review of the posibilities for using renal enzymes as the basis for alternative methods of screening toxic substances.

The management of advanced renal cell carcinoma is still problematic. Surgery, although the therapy of choice for locally advanced renal tumors, is still controversial as the treatment for metastases. The role of surgery in the management of patients with pulmonary, bony, and liver metastasis is one of the subject matters discussed in this book. Our results with series of patients undergoing resection of metastases from the lung, bone, and liver show that surgery may be appropriate in selected patients with a good performance status, although most of them certainly cannot be cured by this procedure alone, i.e., in the absence of effective adjuvant therapies. As recent developments show, new strategies for immunotherapy of renal cell carcinoma represent a modest advance over traditional approaches in the treatment of this cancer, such as chemo- and radiotherapy. Clinical trials employing recombinant interferon-a and interleukin 2 produced response rates in up to 30% of patients treated, as evidenced by the European Immunotherapy Trials Program. The adverse reactions and the lack of efficacy in the majority of patients warrants the search for new immunotherapeutic approaches.

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.

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.

The use oflasers in clinical practice is increasing rapidly, both in the definitive treatment of disease and in the palliation of symp toms. Consequently, this sixth contribution to the Bloomsbury Series in Clinical Science is particularly timely. It opens with an introduction to the basic physics of lasers and then focuses on the current use of lasers in urological practice, and concludes by reflecting on their potential for the future. Edited, and with several contributions by Tom McNicholas, the book also contains contributions from a number of workers at the National Medical Laser Centre in University College Hos pital. London. Given their ever widening application, there can be little doubt that lasers will be a subject the series will return to again. To date, the series has been concerned with a wide range of topics of fundamental importance in clinical science. It has now gained momentum and future titles continue to reflect its wide sphere of interest. As Series Editor, I would welcome suggestions from readers of topics and issues that could usefully be addressed in the series.

Nocturia: Causes, Consequences and Clinical Approaches is the first volume exclusively on the topic of nocturia and is designed to be a comprehensive treatise on the subject. The volume is organized into 11 chapters first introducing and defining nocturia and its impact to patients and society, followed by chapters dealing with predictors and risk factors; relationship to sleep disorders; overactive bladder; and water homeostasis. Therapeutic areas addressing nocturia are covered in specific chapters and include pharmacotherapy affecting the bladder, prostate and kidneys as well as behavioral therapy and surgical intervention. Separate chapters are devoted to alternative therapies as well as the impact of nocturia in the elderly. The volume closes with a chapter presenting avenues for future investigation into the etiology and management of nocturia. Clinical case scenarios inclusive of figures and tables illuminate the evaluation and management of patients with nocturia. Nocturia: Causes, Consequences and Clinical Approaches will give physicians and related healthcare providers the background to understand the conditions causing nocturia, how nocturia affects society and the basis for its rational treatment. It will be used as a state of the art reference by urologists, urogynecologists, internists, nephrologists, pulmonologists, endocrinologists and sleep medicine specialists.

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 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."

Our insight into the mechanisms of the physiology of reproduction has experienced a swift and constant development these last few years. The advent of more sophisticated diagnostic methods and their relatively easy clinical application allow for the incorporation of that knowledge into the evaluation of the infertile couple. These facts, together with an obvious change in social psychology, have facilitated the development of different specialities dealing with the problems of infertility. It is now possible in medical centers all around the world to undertake a better disposition of the infertile husband to look for advice, to be studied, and treated. Confronted with this situation we are still unable to offer specific therapy in most cases; however, empirically based therapy abounds. Advances in therapy have not kept pace with our increased physio logical knowledge and improved diagnostic techniques. Patho physiological mechanisms and etiological factors in male infertility are largely unknown. This has significantly hampered both clinical evaluation and advances in treatment allowing for frequent non scientific therapeutic incursions into the armamentarium of the an drologist. Several factors have given birth to therapeutic "fashions," which are bound to survive as long as this state of lack of knowledge con tinues. For example, we may ask whether the treatment of varicocele constitutes a fashion? Though we accept the treatment of varicocele as the best available treatment of male infertility, we do not know its mechanism of action and so we cannot predict a therapeutic result."

The renewal of interest in peritoneal dialysis as a treatment modality for patients with end-stage renal disease was stimulated by the report of Po- povich and his colleagues in 1976 on the technique of CAPD. With the in- troduction of commercial dialysate-containing plastic bags, which mark- edly reduced the incidence of peritonitis, the use of CAPD as a primary treatment modality has increased significantly. At the present time, more than 12% of the patients undergoing dialysis in the United States are utiliz- ing CAPD; however, the use of CAPD among pediatric patients is con- siderably greater. The First International Symposium on CAPD in Children was orga- nized in order to gather together experts with experience in treating chil- dren undergoing CAPD in an attempt to exchange current information on the utilization of this emerging technique in children. Since pediatric pa- tients comprise a small percentage of the CAPD population and since lim- ited data were available concerning specific methodology and complica- tions of CAPD in children, it was hoped that an international symposium would provide a forum for an exchange of experience that would ultimate- ly lead to better adaptation and increased utilization of this technique.

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 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."

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."

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.

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."

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.

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.