This treatise commemorates the 32nd anniversary of the first successful allogenic kidney transplant in a human being and the beginning of a con tinuing challenge for well over a generation of anesthesiologists. If compari sons can be permitted, this epoch-making event can be ranked with the first pulmonary lobectomy and subsequently the initial ligation of a patent ductus arteriosus in the late 1930s when thoracic and cardiac surgery began. Was it merely a coincidence that brought these events to the fore so close upon one another after many years of ideation and frustration? Not so, according to Lewis Thomas, for this was the time of medicine's second revolution-its transformation from an empirical art into a powerfully effective science. The remote Galenic conception of disease with its emphasis on disturbed body humors was about to be supplanted by effective therapeutics, as signified by the introduction of the sulfonamides and antibiotics for the specific treatment of infection. Anesthesiology had been dormant up to that era, still relying upon a few agents, more or less utilized from the beginning, and purveyed by a handful of specialists who had not yet begun to ask the scientific questions necessary for their maturation into a bona fide discipline. However, anesthesiology was in evitably caught in the ferment, for as Peter Caws observed, "It serves to re mind us that the development of science is a step-wise process: nobody starts from scratch and nobody gets very far ahead of the rest."

The twenty-first century will be the era of the market economy, a century char acterized by the penetration of market forces into every social field, even into government activities, education, and medical care. Guidelines for the provision of clinical care have been developed in recent years chiefly in American health-care services, which are the most thoroughly exposed to the market economy. The problem of escalating medical costs in the United States led the government and consumer groups to introduce clinical practice guidelines. Guidelines were introduced to control medical costs and quality. Initially, guidelines were developed mainly on the consumer side, but professionals, too, soon recognized the importance of clinical practice guidelines. The involvement of diverse groups in the development of guidelines has inten sified the need to create and improve scientific methods for drawing up those guidelines. Owing to the development of systematic and structured abstraction methods, evidence-based guidelines have been proposed. Principally, guidelines are a sum mary of published treatments created by statistical analysis of clinical outcomes."

This book is a point-of-care resource for effective sexual and reproductive healthcare for patients of all ages, sexual orientations, gender identities and medical backgrounds in the primary care setting. This useful guide is divided into three parts, and other than part three, which deals exclusively with transgender and gender diverse patients, all content will relate to patients of all gender identities. Part one presents sexual and reproductive health (SRH) using a lifespan approach, including chapters on pediatrics, adolescents and young adults, adults, and older adult patients. Part two presents an approach to common SRH issues that span multiple age groups, including contraception and family planning, sexually transmitted infections and cancer screenings as well as sexual and reproductive health in the setting of common medical conditions. Part three is dedicated to sexual and reproductive health for transgender and gender non-binary patients, including psychosocial, medical, surgical and legal aspects of health. This book provides primary care clinicians with a framework for providing effective sexual and reproductive healthcare to patients of all ages, sexual orientations and gender identities in a way that is inclusive, focuses on health, and addresses the needs unique to specific populations.

"Gay Becker, the leading ethnographer of the infertility experience in the U.S., provides a powerful account of how American women and men think, feel, and talk about their utilization of new reproductive technologies. This book will be required reading for those embarking on the infertility treatment odyssey, as well as for scholars interested in the relationship of gender to technology." --Marcia Inhorn, author of "Infertility and Patriarchy

"This is a very powerful book. It forces the reader to scrutinize his/her own relationships to biology, to parenthood and to normalcy. But Gay Becker's real tour de force goes beyond even this! The deeper accomplishment of her work is that when, in a decade or two, children born through these new reproductive technologies ask the parents why they were born in the first place, they will be able to turn to Becker's book. The answers will be cultural as well as personal, deeply anchored not only in their parents' desires and experiences but also in profound social and technological innovations." --Isabelle Bazanger, author of "Inventing Pain Medicine from the Laboratory to the Clinic

"As a longtime facilitator of infertility support groups, I found The Elusive Embryo to be a fascinating and powerful examination of the cultural forces that shape the experience of being infertile as well as of the relationship between reproductive technologies and the consumers they serve. This is a book that makes you think; it is also one that offers recognition, perspective, and ultimately solace to those undergoing the transforming process of dealing with infertility."--Cecile T. Lampton, M.S.

"What distinguishes this book is its focus on the subjectiveexperience of dealing with infertility and its treatment. The success of Becker's nuanced description of this difficult, emotionally-charged process may be explained by the way in which she brings to bear her own experience of infertility-a masterful exercise in involved detachment." --Simone Bateman, CNS-CERMES

It has often surprised me that in order to study the subject of obstructive uropathy, it is necessary to search through various sections of several urological, surgical and radiological textbooks rather than turn to one work on the subject. It is also true that, even now, many descriptions tend to concentrate on the causative conditions rather than their relationship to the proximal outflow tract, in a way which is predominantly structural and anatomical rather than functional and urodynamic. The subject of obstructive uropathy has changed radically in recent years. Inspired research from several centres has given us great insight into the mechanisms of obstruction and its effects on the outflow tract and nephron. It has been accompanied by the development of new methods of investigation in both the experimental and the clinical field. This book is an attempt to update and distill the subject of obstructive uropathy in one volume. For the purpose of the work, obstructive uropathy is taken to include any condition involving the outflow tract of the kidney, from minor calyces to urethra, which results in obstruction to the flow of urine. Emphasis is on physiology and pathophysiol ogy, function and urodynamics. These considerations should not be thought of as purely theoretical. Far from it. They hold the key to subsequent decisions on diagnosis and management and form the basis for a practical approach to the patient with obstruction. The only details the reader will not find here are descriptions of surgical technique."

A single referral source to find images and information concerning all pathological entities in the field of genitourinary pathology, this book contains gross photos and photomicrographs of virtually every pathologic entity, and variants of those entities, occurring in the following organs or anatomic sites: adrenal, kidney, renal pelvis and ureter, urinary bladder, urethra, prostate, seminal vesicles, testis, spermatic cord and testicular adnexae, penis, and scrotum. The book is lavishly illustrated with images accompanied by text explaining the key diagnostic points to be noted, as well as features that help separate the entity from others included in the differential diagnosis.

This book is designed for practicing pathologists and pathologists in training as well as urologists, GU radiologists, GU radiation oncologists, and GU medical oncologists.

Urinary incontinence is becoming an increasingly dominant condition in daily urological and gynaecological practice, although the total number of patients suffering from the different forms ofincontinence remains unclear. An estimated figure for The Netherlands, with a population of 14 500000, has been given as between 500000 and 600000 patients, showing that approximately 4 % of the total population suffer from this condition, the majority being female. The impact ofthis number is tremendous, not only regarding health care costs, but even more with regard to the psycho-social consequences. It is obvious that continuing efforts must be made to under stand more fully the different forms of urinary incontinence. An exact diagnosis is the first step necessary for adequate therapy. We all know how disastrous it can be to institute inappropriate treatment as a consequence of misunderstanding the proper aetiology in each individual case. What has happened in the past 15 years? During that time we have developed sophisticated machinery to diagnose in more detail the exact ori gin of each type of urinary incontinence, and on entering a urodynamic laboratory, one is struck by the complexity of measuring equipment. But how reliable are all these measurements and how can they be translated into an effective therapy? This still remains one ofthe major problems, although continuing progress has been made and will be made by the research work of many experts in the field of urinary incontinence."

This volume, focusing on the ureter and the diseases which involve it, is an updated second edition. Many journals and textbooks deal with the physiology, pathology, diagnosis, and therapy of derangements of the urinary tract. In most instances, however, the discussion properly centers on the disease process itself and its primary aspects, with only a tan gential description of effects on the ureter. The editor is therefore correct that the ureter itself should be considered a major organ. Though it has been regarded in the recent past as a simple muscular tube, reacting to stretching or filling by contraction, this simplistic view of ureteral phys iology is changing fast. With expanded knowledge of ureteral physiology, a pharmacology is developing which is becoming useful to the clinician in many ways. One of the most interesting aspects of the ureter is its role in inducing the permanent kidney, the metanephros. Relatively slight displacements in the origin of the ureteral bud result in ectopic ureteral orifices and a wide range of congenital anomalies. An ureteral bud which arises medial to the normal position at the genu of the mesonephric duct results in a lateral, and usually incompetent, ureterovesical junction after the duct is taken up to form a portion ofthe trigone. This appears certainly to be the developmental mechanism which results in primary reflux."

A unique practice-oriented survey of how the new surgical, analytical, and biomedical advances are being applied to pediatric urology. Here the practicing urologist will find informative, easy-to-read reviews of the modern evaluation of prenatal hydronephrosis, the standard treatment of reflux vs the newer injectable techniques, and the spectrum of hypospadias treatment along with new developments in bladder exstrophy. Additional updated topics include what's new in undescended testis, the evaluation of difficult duplication anomalies, voiding dysfunction and neurogenic bladders, pediatric stone disease, and the developmental problems associated with genitourinary defects.

A team of authoritative urologic surgeons reviews the latest advances in urologic prosthetic surgery and the patient management techniques needed to successfully implement them. These highly experienced clinicians fully describe each technique and process, providing proven guidelines for patient evaluation prior to its use, its surgical implantation, and postoperative treatment of the patient. The topics expertly covered range from injectable materials used in a variety of circumstances to artificial urinary sphincters, from urethral stents, penile implants, testicular and penile prostheses, to the newer penile rigidity systems.

More than fifty full-time urological clinicians and surgeons from the internationally acclaimed Cleveland Clinic Glickman Urological Institute describe the most common as well as the most innovative urological procedures from the standpoint of the state-of-the-art, as it is practiced at one of the world's top institutions. Their comprehensive atlas of urological surgery offers a unique marriage of informative text with superb illustrations to provide detailed, step-by-step descriptions of all the regularly performed inpatient and outpatient urological operations, including newer approaches, such as laparoscopic and minimally invasive surgery. Highlights include robotic and laparoscopic prostatectomy, open and lapaoscopic partial nephrectomy, renal transplantation, the male sling, and minimally invasive treatments for urological conditions.

A concise, up-to-date review of the many new therapies available for the treatment of benign prostatic hypertrophy (BPH). The authors concisely evaluate the latest minimally invasive therapies, as well as time-tested surgical treatments, and review the medical therapies for BPH, namely a-adrenergic antagonists, 5-a reductase inhibitors, and their therapeutic combinations. Additional chapters examine the pathophysiology and natural history of BPH, its epidemiology, and the urodynamic evaluation of lower urinary tract symptoms. A perfect reference source for the practicing urologist seeking sound guidance on the best approach to his patients.

Chronic Prostatitis is a common and debilitating condition affecting 5-12% of men worldwide. The most common form is category III, or Chronic Pelvic Pain Syndrome. Cutting-edge clinical research has led to advancements in the diagnosis and treatment of prostatitis, a group of conditions that is at once extremely common, poorly understood, inadequately treated and under-researched. In Chronic Prostatitis/Chronic Pelvic Pain Syndrome, the author provides today's most current information covering the four categories of prostatitis (acute, chronic bacterial, CPPS and asymptomatic inflammation). A diverse international group of contributors that includes urologists (academic, primary care and front line private practice), scientists, psychologists, and pain specialists from the National Institutes of Health provide the reader with novel approaches to helping their patients. The chapters in this important new work cover general evaluation of the prostatitis patient, the approach to acute prostatitis, chronic bacterial prostatitis and chronic pelvic pain syndrome, evidence behind individual therapies and ancillary topics such as erectile dysfunction, infertility, the link between chronic prostatitis and prostate cancer, male interstitial cystitis and the potential etiologic role of calcifying nanoparticles. Chronic Prostatitis/Chronic Pelvic Pain Syndrome offers novel approaches to diagnosing this condition as well as providing ways in which to ease the suffering of the patient with prostatitis.

Many patients leave the doctor's office feeling frustrated and rushed, with unanswered questions. It's a common concern-that by expediting a patient's visit, doctors may miss important information for the sake of brevity. And for patients seeking to discuss alternative therapies outside of conventional medicine, they especially need time to discuss and confirm the truth of their personal research. In The Unfettered Urologist, readers will learn and benefit from the opinions, intuition, and common sense of Martha B. Boone, M.D. -a urologist with over thirty years of working experience and fifteen years of collegiate study. Those seeking detailed insight into the world of urology will learn what Dr. Boone always wanted to tell her patients, but could never pack into a fifteen minute office visit. The Unfettered Urologist explains: Common urology problems and options for readers to start treatment at home, with the confidence of an experienced specialist Inside information not available in medical texts or medical websites Important questions to facilitate office visits when needed When to save healthcare dollars for prevention and treatment (prior to seeing a doctor) The inner workings of the medical profession and thus be able to better utilize the system True stories of medical scenarios and real-life cases Healing techniques outside of conventional medicine that have worked in conjunction with traditional medicine In some cases, how to avoid invasive procedures Entertaining, informative, and packed with unexpected insight, The Unfettered Urologist leads readers through the health care system with humor and candor.

For the generation that reached sexual maturity in the 1960s, the "pill" became synonymous with sexual freedom and started a sexual revolution. For women it meant freedom from the fear of pregnancy, and for men enhanced sexual opportunity. The new era of the pill has nothing to do with fertility, but everything to do with sex. The first orally effective prescr- tion drug for treating erectile dysfunction (ED) was marketed in 1998. (R) Sildenafil (Viagra ) has rejuvenated the aging male veterans of the sexual revolution, forever changed the science of sexual medicine, and tra- formed society's perspective on aging and sex. This class of drugs, known as oral phosphodiesterase inhibitors (PDE-type 5), is highly effective in the treatment of ED. Since its introduction there has been a much greater awa- ness of ED, its comorbidities, and its effects on the quality of life. In 1997, while preparing to address the Endocrine Society on the occasion of the 92nd American Urological Association meeting, I first looked at the p- clinical studies of sildenafil. I thought "this will change everything" and it clearly has-changing practice patterns in sexual medicine, and the at- tudes of patients, potential patients, and their partners. Two new PDE-type (R) (R) 5 inhibitors, tadalafil (Cialis ) and vardenafil (Levitra ), were first approved by the European Committee for Proprietary Medicinal Products and subsequently by the Food and Drug Administration in 2003 and 2004.

Half of all women will experience some form of debilitating pelvic disease or discomfort during their lifetime. These will include chronic urinary tract infections, various kinds of incontinence, pelvic floor prolapse, and interstitial cystitis. There has been a tendency to dismiss many symptoms of these disorders as an inevitable consequence of the aging process or, worse still, as indicators of underlying psychological disease. This concise new book suggests a new approach to urinary tract disorders is long overdue. It sympathetically explains what these diseases are and what women can do to get themselves properly diagnosed and treated.

Michael J. Droller, MD and a panel of experienced clinicians bring their strong background in clinical research to bear on the assessment and management of bladder cancer. Their comprehensive discussion summarizes the state-of-the-art in diagnosis and treatment, based on the latest understanding of bladder cancer's epidemiology, carcinogenesis, and tumor markers. Topics of particular interest include the role of genetics and molecular biology in evaluating bladder cancer clinically, the evaluation of the results of systemic treatment in advanced disease, the current status of tumor markers in bladder cancer, and the means for further study in their applicability. Insightful and evidenced-based, Bladder Cancer: Current Diagnosis and Treatment provides active clinicians and clinical investigators with not only a critical survey of the rapidly expanding research in the area, but also a state-of-the-art tutorial on today's optimal assessment and treatment of bladder cancer.

This book discusses the management of various aspects of the professional life of newly qualified urologists as well as more experienced urologists. It features clear, easy-to-read chapters covering various topics, including clinical and surgical patient care, administrative duties, and research despite the increasing constraints on time and resources in today's hectic practice environment. Navigating Organized Urology: A Practical Guide systematically presents a range of practical strategies for a successful transition from trainee to practising urologist, while also offering more experienced urologists a fresh perspective on efficient management and successful adaptation of their practices for the modern age.

This book clarifies and explains perineal anatomy and the pathophysiology of anal incontinence as well as applied pharmacology. It also institutes the new recommended classification of perineal tears, and describes anal sphincter repair techniques. The emphasis is on correct post-operative management, management of pregnancy following previous anal sphincter injury, and prevention of anal sphincter tears. The book will interest students, colorectal surgeons, physiotherapists, midwives, continence advisors, labour wards and lawyers.

Management of Erectile Dysfunction in Clinical Practice is a short guide to erectile dysfunction (ED) and its management covering normal function and dysfunction, assessment, treatment options and interventions. ED is a symptom, not a disease and will have underlying causes such as hypertension, coronary artery disease, diabetes, chronic renal impairment, chronic arthritis, chronic alcoholism, multiple sclerosis.

This book will be an essential reference for family practitioners and residents in urology.

The first edition of Male Sexual Function: A Guide to Clinical Management was published in 2001. Since that time, two new oral medications for erectile dysfunction (R) (R) (ED), Vardenafil (Levitra ) and Tadalafil (Cialis ), have been introduced. Links between ED and lower urinary tract symptoms have been postulated, advances in the basic science of erectile physiology have occurred, and the appreciation of ED as a form of endothelial dysfunction and a harbinger of other more potentially lethal forms of vascular disease has become more widespread. In some instances, third-party payers have reduced or eliminated coverage for ED treatments in an attempt to cut costs. They have classified sexual activity as "recreational," "lifestyle," or not medically necessary, but have failed to appreciate the negative consequences of ED, such as depression with all of its ramifications. Male Sexual Function: A Guide to Clinical Management, Second Edition is a comp- hensive overview of the field of male sexual function and includes a chapter on female sexual dysfunction, an emerging field with a very high incidence in the population and an ever-growing following.

The Essentials in Cytopathology series publishes generously illustrated and user-friendly guides with over 100 full color images that illustrate principles and practice in Cytopathology for pathologists and clinicians. Cytologic Detection of Urothelial Lesions by Dorothy L. Rosenthal, MD and Stephen S. Raab, MD is the second volume in the series. This volume will present a simple approach to dealing with cellular samples from the urinary tract.