Campbell Walsh Wein Urology

Campbell-Walsh Urology, 12th ed
Title Page
Copyright
Dedication
Preface
Contributors
Video Contents
I Clinical Decision Making
	1 Evaluation of the Urologic Patient
		History
			Overview
			Chief Complaint
			History of Present Illness
				Pain
					Renal Pain.
					Ureteral Pain.
					Vesicle Pain.
					Prostatic Pain.
					Penile Pain.
					Scrotal Pain.
					Narcotic Considerations.
				Hematuria
				Lower Urinary Tract Symptoms
					Urinary Incontinence.
						Stress Incontinence.
						Urge Incontinence.
						Mixed Urinary Incontinence.
						Continuous Incontinence.
						Pseudoincontinence.
						Overflow Incontinence.
						Functional Incontinence.
						Enuresis.
				Sexual Dysfunction
					Erectile Dysfunction.
					Loss of Libido.
					Premature Ejaculation.
					Failure to Ejaculate.
					Anorgasmia.
				Hematospermia
				Pneumaturia
				Urethral Discharge
				Fevers and Chills
				Constitutional Symptoms
			Medical History
				Performance Status
				Past Surgical History
				Medications
				Allergies
				Social History
				Illicit Drug Use
				Sexual Relations
				Domestic Station
				Occupation
				Family History
				Review of Systems
		Physical Examination
			Vital Signs
			General Appearance
			Kidneys
				Bladder
				Penis
				Scrotum and Contents
				Digital Rectal Examination
				Pelvic Examination in the Female
				Neurologic Examination
		Special Populations
			Children
			Elderly
				Transgender and Gender Nonbinary People
		Conclusion
		References
		References
2 Evaluation of the Urologic Patient
	Urinalysis
		Collection of Urinary Specimens
			Males
			Females
			Neonates and Infants
		Physical and Gross Examination of Urine
		Color
		Turbidity
	Chemical Examination of Urine
		Specific Gravity and Osmolality
		pH
		Blood/Hematuria
		Differential Diagnosis and Evaluation of Hematuria
		Glomerular Hematuria
		IgA Nephropathy (Berger Disease)
		Nonglomerular Hematuria
			Medical/Nonsurgical
			Surgical
		Proteinuria
			Pathophysiology
			Detection
			Evaluation
		Glucose and Ketones
		Bilirubin and Urobilinogen
		Leukocyte Esterase and Nitrite Tests
		Urinary Sediment
			Obtaining and Preparing the Specimen
		Microscopy Technique
		Cells
		Casts
		Crystals
		Bacteria
		Yeast
		Parasites
		Expressed Prostatic Secretions
		Serum Laboratory Studies
		Prostate-Specific Antigen
		Urinary Markers
		Additional Serum Studies
		Office Diagnostic Procedures
			Uroflowmetry and Ultrasound for Postvoid Residual
		Cystometrography and Multichannel Urodynamic Studies
			Cystourethoscopy
			Radiologic Imaging
			Ultrasonography
			Computed Tomography and Magnetic Resonance Imaging
			Intravenous Pyelogram and Plain Radiographs
	Summary
	References
	References
3 Urinary Tract Imaging
	Conventional Radiography
		Physics
	Radiation Management in Uroradiology
		Relative Radiation Levels
		Radiation Protection
	Contrast Media
		Adverse Reactions to Intravascular Contrast Media
			Allergic-Like Reactions
			Treatment of Contrast Reactions
				Treatment: Mild Allergic-Like and Physiologic Reactions.
				Treatment: Moderate Allergic-Like and Physiologic Reactions.
				Treatment: Severe Allergic-Like and Physiologic Reactions.
			Premedication
				Corticosteroid Premedication.
				Premedication Strategies.
				Premedication Regimens.
					Accelerated IV Premedication.
			Delayed Contrast Reactions
			Specific Contrast Considerations
				Allergy.
				Anxiety.
				Asthma.
				Beta-Blockers.
				Cardiac Abnormalities.
				Hyperthyroidism.
				Myasthenia Gravis.
				Pheochromocytoma.
				Sickle Cell Trait and Disease.
				Extravasation of Contrast Material.
				Postcontrast Acute Kidney Injury.
				Metformin and Iodinated Contrast.
				Metformin and Gadolinium.
		Magnetic Resonance Imaging Contrast Agents
			Gadolinium
			Nephrogenic Systemic Fibrosis
	Intravenous Urography
		Technique
		Indications
	Plain Abdominal Radiography
		Technique
		Indications
		Limitations
	Retrograde Pyelography
		Technique
		Indications
		Limitations
		Complications
	Loopography
		Technique
		Indications
	Retrograde Urethrography
		Technique
		Indications
	Static Cystography
		Technique
		Indications
		Limitations
	Voiding Cystourethrogram
		Technique
		Indications
		Limitations
	Nuclear Scintigraphy
		Diuretic Scintigraphy
		Nuclear Medicine in Urologic Oncology
			Whole-Body Bone Scan
			Positron Emission Tomography
			Kidney Cancer
			Bladder Cancer
			Prostate Cancer
			Adrenal Cancer
			Testis Cancer
		Positron Emission Tomography Magnetic Resonance Imaging
	Computed Tomography
		Hounsfield Units
		Urolithiasis
		Cystic and Solid Renal Masses
		Hematuria
	Magnetic Resonance Imaging
		Adrenal Magnetic Resonance Imaging
			Adrenal Adenoma
			Adrenal Cortical Carcinoma
			Myelolipoma
			Metastasis
			Pheochromocytoma
			Other Adrenal Lesions
		Renal Magnetic Resonance Imaging
			Upper Tract and Lower Tract Magnetic Resonance Imaging for Transitional Cell Carcinoma
			Prostate Magnetic Resonance Imaging
			T2-Weighted Imaging
			Diffusion-Weighted Imaging/Apparent Diffusion Coefficient Maps
			Dynamic Contrast-Enhanced Magnetic Resonance Imaging
			Magnetic Resonance Spectroscopy
			Multiparametric Magnetic Resonance Imaging
			Magnetic Resonance Fusion-Guided Prostate Biopsy
	Acknowledgments
	References
	References
		Radiation Management in Uroradiology
		Contrast Media
		Retrograde Pyelography
		Loopography
		Static Cystography
		Voiding Cystourethrogram
		Nuclear Scintigraphy
		Positron Emission Tomography (PET)
		Computed Tomography
		MRI Introduction
		Adrenal MRI
		Renal MRI
		Upper and Lower Tract MRI
		Prostate MRI
4 Urinary Tract Imaging
	Brief History of Ultrasound in Urology
	Physical Principles
		Ultrasound Image Generation
		Resolution
		Mechanisms of Attenuation
		Artifacts
	Modes of Ultrasound
		Gray-Scale Ultrasound
		Doppler Ultrasound
		Harmonic Scanning
		Spatial Compounding
		Sonoelastography
		Three-Dimensional Scanning
		Multiparametric Ultrasound
	Contrast Agents in Ultrasound
		Documentation and Image Storage
		Report
		Images
		Report and Image Storage
	Patient Safety
	Clinical Urologic Ultrasound
		Renal Ultrasound
			Technique
			Indications
			Normal Findings
			Procedural Applications
			Limitations
		Transabdominal Pelvic Ultrasound
			Technique
			Indications
			Normal Findings
			Procedural Applications
			Limitations
		Ultrasonography of the Scrotum
			Technique
			Indications
			Normal Findings
			Procedural Applications
			Sonoelastography
			Limitations
		Ultrasonography of the Penis and Male Urethra
			Technique
			Indications
			Normal Findings
			Perineal Ultrasound
			Transperineal Ultrasound
			Procedural Applications
			Limitations
		Transrectal Ultrasonography of the Prostate
			Technique
			Indications
			Normal Findings
			Procedural Applications
			Limitations
	Practice Accreditation
	Suggested Readings
	References
	References
5 Urinary Tract Imaging
	Principles of Single Photon and PET Imaging
	Functional Imaging of the Kidneys
		Relevant Renal Physiology
		Technetium-99m Diethylenetriaminepentaacetic Acid (99mTc-DTPA)
		Technetium-99m Mercaptoacetyltriglycine (99mTc-MAG3)
		Technetium-99m Dimercaptosuccinic Acid (99mTc-DMSA)
		Dynamic Renal Imaging With 99mTc-MAG3 and 99mTc-DTPA
			Patient Preparation
			Dosing and Pharmacokinetics
			Image Acquisition and Interpretation
		Additional Applications of 99mTc-MAG3 and 99mTc-DTPA Scintigraphy
			Evaluation of Renal Vascular Hypertension
			Renal Transplant Evaluation
			Assessment of Vesicoureteral Reflux
		Renal Cortical Imaging With 99mTc-DMSA
	Infection Imaging
	Molecular Imaging of Genitourinary Malignancies
		Bladder Cancer
		Kidney Cancer
		Prostate Cancer
		Penile Cancer
		Testis Cancer
	References
	References
6 Assessment of Urologic and Surgical Outcomes
	Establishing a Conceptual Framework for Assessing the Effectiveness of Treatment and Improving Care in Urology
	Long-Term Disease Outcomes That Are Commonly Assessed in Urology
		Overall Mortality
		Disease-Specific Mortality
		Other Binary “Survival” Outcomes
			Proxy Endpoints
			Disease Progression/Recurrence
			Receipt of Secondary Therapy
	Commonly Assessed Short-Term Outcomes
		Assessing Surgical Complications
			Common Terminology Criteria for Adverse Events
			Clavien-Dindo System of Classifying Complications
		Assessing Risk for Surgical Complications
			Functional Status
			Comorbidity
			Frailty
			Pain
	Patient-Reported Outcomes
		Methods of Assessing Patient-Reported Outcomes
		Specific Symptom Scales
			Lower Urinary Tract Symptoms
			Urinary Incontinence
			Sexual Dysfunction
			Health-Related Quality of Life
	Other Outcomes of Interest in Urology
		Patient Satisfaction
		Health Care Costs
	References
	References
7 Ethics and Informed Consent
	Medical Ethics
		History of Medical Ethics
		The Four-Principles Framework
		Medical Ethics in Clinical Practice
	Informed Consent
		History of Informed Consent
		Elements of Informed Consent
		Exceptions to the Informed Consent Requirement
		Quality of Informed Consent
	References
	References
II Basics of Urologic Surgery
	8 Principles of Urologic Surgery
		Preoperative Evaluation
		Presurgical Testing
			American Society of Anesthesiologists Classification and Risk
		Preoperative Cardiovascular Evaluation
			Clinical Markers
			Functional Capacity
			Surgery-Specific Cardiac Risk
		Pulmonary Evaluation
		Hepatobiliary Evaluation
		Special Populations
			Elderly
			Morbid Obesity
			Pregnancy
			Nutritional Status
		Preparation for Surgery
			Management of Medications
				Preoperative Optimization Strategies
					Optimization of Comorbid Illness.
			Antithrombotic Therapy
			Bowel Preparation
		Intraoperative Management
			Patient Environment
			Patient Safety
			Patient Positioning
			Antibiotic Prophylaxis
			Venous Thromboembolic Prophylaxis
			Anesthetic Considerations
				Selection of Mode of Anesthesia
				Monitored Anesthesia Care
				Regional Anesthesia
				General Anesthesia
					Inhalational General Anesthesia.
					Intravenous General Anesthesia.
			Skin Preparation
			Transfusion Considerations
			Pain Management
		Acknowledgments
		Suggested Readings
		References
		References
9 Principles of Urologic Surgery
	Abdominal Incisions
		Midline Incision
		Pfannenstiel Incision
		Gibson Incision
	Anterior Approaches to the Kidney and Retroperitoneum
		Thoracoabdominal Incision
		Chevron and Subcostal Incisions
	Flank Incisions
		True Flank Incisions
		12th Rib Supracostal and 11th Rib Transcostal
	Inguinal Incisions
		Incisions Above the Inguinal Ligament
		Incisions for Inguinal and/or Pelvic Lymphadenectomy in Penile Cancer
	Incisions for Specific Surgeries
		Posterior Lumbodorsal Incision or Dorsal Lumbotomy
		Scrotal Incisions
		Penile Incisions
		Perineal Incisions
	Suggested Readings
	References
	References
10 Principles of Urologic Surgery
	Patient Environment
		Patient Temperature
		Skin Preparation
		Patient Safety
		Patient Positioning
	Blood Products
		Packed Red Blood Cells
		Component Therapy
		Massive Transfusion Protocol
		Hemostatic Agents
		Dry Matrix Agents
		Biologically Active Agents
	Drains
		Penrose
		Jackson-Pratt
		Blake
		Pigtail
	Suture Material and Incision Closure
		Absorbable Sutures
			Plain Gut and Chromic Gut
			Poliglecaprone (Monocryl), Biosyn, Caprosyn
			Polyglactin 910; Vicryl
			Polydioxanone and Polyglyconate (Maxon)
		Nonabsorbable Sutures
			Polypropylene (Prolene)
			Polyester (Mersilene)
			Polyamide (Nylon)
			Silk
		Fascial Closure Techniques
			Skin Closure
			Retention Sutures
			Wound Dressing
	References
	References
11 Lower Urinary Tract Catheterization
	History
	Anatomic Considerations
		Male Urethra
		Female Urethra
	Indications for Lower Urinary Tract Drainage
		Diagnostic
		Therapeutic
		Contraindications
	Technique of Urethral Catheterization
		Preparation for Catheterization
		Urethral Catheterization in Men
		Urethral Catheterization in Women
		Urethral Catheterization of Children
		Types of Urethral Catheters
			Catheter Sizing
			Double-Lumen Catheters
			Single-Lumen Catheters
			Hematuria Catheter
			Diagnostic Catheters
			Drain Catheters
			Condom Catheters
	Suprapubic Catheterization
		Indications
		Techniques
			Open Cystotomy
			Placement With a Guidewire and the Seldinger Technique
	Difficult Catheterization
		Prostatic Obstruction
		Urethral Stricture
		Urethral Trauma
		Abnormal Anatomy
			Posterior Urethral Valves
			Obesity
			Reconstruction of the Lower Urinary Tract
			Bladder Replacement or Neobladder
			Continent Urinary Reservoir or Indiana Pouch
			Urinary Conduit
			Bladder Neck Reconstruction or Closure
			Artificial Urinary Sphincter
	Complications of Lower Urinary Tract Drainage
		Infection
		Iatrogenic Trauma
		Stricture
		Erosion
		Malignancy
		Catheter Knotting and Balloon Malfunction
	References
	References
12 Fundamentals of Upper Urinary Tract Drainage
	Percutaneous Renal Access and Drainage
		History
		Indications
			Simple Drainage
			Diagnostic Studies
			Therapeutic Instillations
			Percutaneous Renal Surgery
		Anatomic Considerations
			Perirenal Anatomy
			Renal Parenchyma and Collecting System
			Intrarenal Vasculature
		Surgical Technique
			Provider Obtaining Access
			Antimicrobial Prophylaxis
			Management of Anticoagulation
			Diagnostic Imaging
			Patient Positioning
			Prone Position
			Supine Position
			Modifications to Prone or Supine Positioning
			Anesthetic Considerations
			Choice of Calyx for Access
			Upper Pole Calyx
			Interpolar Calyx
			Lower Pole Calyx
			Image Guidance for Puncture
				Fluoroscopic-Guided Access.
				Ureteroscopic-Assisted Fluoroscopic Access.
				Ultrasound-Guided Access.
			Advanced Guidance Techniques
				“Blind” Access.
				Access Needles.
				Guidewires.
				Tract Dilation.
			Postprocedural Drainage
				Balloon Catheters.
				Cope Catheter.
				Malecot Catheter.
				Nephroureteral Stent.
				Circle Catheter.
				General Considerations.
				“Tubeless” With Ureteral Stent.
			No Drainage Tube
				Tract Sealants.
		Training
		Special Situations
			Horseshoe Kidney
			Pelvic/Ectopic Kidney
			Transplant Kidney
		Complications
			Acute Hemorrhage
			Delayed Hemorrhage
			Collecting System Injury
			Visceral Injury
			Pleural Injury
			Metabolic and Physiologic Complications
			Postoperative Fever and Sepsis
			Neuromusculoskeletal Complications
			Venous Thromboembolism
			Collecting System Obstruction
			Loss of Renal Function
			Death
	Retrograde Renal Access and Drainage
		History
		Indications
		Surgical Technique
			Guidewire Placement
			Stent Placement
		Stent Varieties
			Materials
			Design
		Stent Tolerance
	References
	References
13 Principles of Urologic Endoscopy
	Introduction
	History of Endoscopy
	Basic Equipment and Video-Endoscopic Systems
	Cystourethroscopy
		Indications
		Equipment
			Rigid Cystourethroscopes
			Flexible Cystourethroscopes
		Patient Preparation
		Technique
		Special Circumstances
			Suprapubic Cystostomy
			Continent Urinary Diversions
	Upper-Tract Endoscopy
		Indications
			Urolithiasis
			Upper Urinary Tract Urothelial Carcinoma
			Ureteropelvic Junction Obstruction and Ureteral Stricture
			Other Indications for Ureteroscopy
		Equipment
			Semirigid Ureteroscopes
			Flexible Ureteroscopes
			Digital Ureteroscopes
			Care and Sterilization
			Guidewires
			Dilation Devices
			Intraluminal Lithotripsy Devices
			Stone-Retrieval Devices
			Retropulsion Prevention Devices
			Miscellaneous Devices
			Ureteral Access Sheaths
			Fluoroscopy Equipment
		Ureteroscopy Technique
			Preparation for Ureteroscopy
			Accessing the Ureter
			Semirigid Ureteroscopy Technique
			Flexible Ureteroscopy Technique
	Conclusion
	Suggested Readings
	References
	References
14 Fundamentals of Laparoscopic and Robotic Urologic Surgery
	Preoperative Preparation
		Patient Selection and Contraindications
			Morbid Obesity
			Extensive Prior Abdominal or Pelvic Surgery
			Pelvic Fibrosis
			Organomegaly
			Ascites: Benign Cause
			Pregnancy
			Hernia
			Iliac or Aortic Aneurysm
		Bowel Preparation
		Enhanced Recovery After Surgery Protocols
		Preparation of Blood Products
	Operating Room
		Setup of the Operating Room
		Patient Positioning
		Prophylaxis and Other Preparations
	Strategic Placement of Operative Team and Equipment
		Standard Laparoscopic Carts
		Integrated Endoscopy Systems
		Robotic Systems
		Placement of the Operative Team for Laparoscopic Procedures
			Transperitoneal Procedures in the Upper Abdomen
				Laparoscopic.
				Robotic.
			Retroperitoneal Procedures in the Upper Abdomen
				Laparoscopic.
				Robotic.
			Transperitoneal and Extraperitoneal Pelvic Procedures
				Laparoscopic.
				Robotic.
	Performing the Procedure
		Before the Initial Incision
		Achieving Transperitoneal Access and Establishing the Pneumoperitoneum
			Closed Techniques
				Veress Needle.
					Sites for Needle Passage.
					Assessment of Proper Needle Placement.
			Open Access Techniques
				Hasson Technique.
				Hand Port Access.
			Laparoendoscopic Single-Site Surgery
			Robotic Laparoendoscopic Single-Site Surgery
		Retroperitoneal Access and the Retroperitoneal Space
			Technique for Balloon or Self-Styled Dilator Placement: Open (Hasson) Technique
				Balloon Dilation.
				Commercially Available Balloons.
				Self-Styled Dilators.
				Manual Dilation.
		Extraperitoneal Access and the Extraperitoneal Space
			Technique for Balloon or Self-Styled Dilator Placement: Open (Hasson) Technique
			Limitations and Advantages of Transperitoneal Versus Extraperitoneal Approach to the Flank and Pelvis
				Transperitoneal Versus Retroperitoneal Renal and Adrenal Surgery.
				Transperitoneal Versus Extraperitoneal Pelvic Surgery.
		Access Technology: Trocars, Hand Ports, and Single-Port Access
			Trocars
			Hand-Assist Devices
			Laparoendoscopic Single-Site Surgery Access Devices
				Robotic Laparoendoscopic Single-Site Surgery Devices.
		Trocar Placement
			Placement of Initial Trocar
			Hand-Assist Placement
			Secondary Trocar Placement
				Standard Approach.
				Hand-Assist Approach.
			Trocar Configuration
			Robotic Considerations
		Laparoscopic Instrumentation
			Instruments for Visualization
				Laparoscope and Camera
					Standard Systems.
					Three-Dimensional Systems.
			Instrumentation for Grasping and Blunt Dissection
			Instrumentation for Incising and Hemostasis
				Sharp Dissectors.
				Monopolar Electrosurgical Devices.
				Bipolar Electrosurgical Devices.
				Laser Instrumentation.
				Ultrasound Instrumentation.
				Combined Devices and Other Instrumentation.
			Surgical Pharmaceuticals
				Fibrin-Based Glue.
				Non–Fibrin-Based Surgical Hemostats.
				Chemical-Based Sealants.
			Instrumentation for Suturing and Tissue Anastomosis
				Needle Drivers.
				Endo Stitch.
				Lapra-Ty Clips.
				Barbed Suture.
			Instrumentation for Stapling and Clipping
				Stapling Devices.
				Clipping Devices.
			Instrumentation for Specimen Entrapment
			Instrumentation for Morcellation
			Instrumentation for Retraction
				Mechanical Assistants.
		Robotic Instrumentation
			Instrumentation for Incising and Hemostasis
			Instrumentation for Grasping and Blunt Dissection
			Instrumentation for Suturing and Tissue Anastomosis
			Other Available 8-mm and 5-mm Instruments
		Instrumentation for Single-Site Surgery
		Instrumentation for Natural Orifice Transluminal Endoscopic Surgery
		Exiting the Abdomen
			Port Removal and Fascial Closure
			Instrumentation for Port Site Closure
		Closure of the Skin
	Physiologic Considerations in the Adult
		Choice of Insufflant
			Carbon Dioxide
			Alternative Gases
		Choice of Pneumoperitoneum Pressure
		Cardiovascular Effects of the Pneumoperitoneum
			Venous Flow
			Cardiac Arrhythmias
			Unreliability of Central Venous Pressure Readings
		Respiratory Effects of the Pneumoperitoneum
			Pressure-Mediated Effects
			Non–Pressure-Related Respiratory Effects
		Renal Effects of the Pneumoperitoneum
		Effects of the Pneumoperitoneum on Mesenteric Blood Flow and Intestinal Motility
		Acid-Base Metabolic Effects of Pneumoperitoneum
		Hemodynamic Effects Related to Patient Position and Type of Approach
		Hormonal and Metabolic Effects During Laparoscopic Surgery
		Immunologic Effects of Laparoscopic Surgery
	Complications and Troubleshooting in Laparoscopic and Robotic Surgery
		Minimizing the Incidence of Complications During the Learning Curve
		General Procedural Complications
			Malfunction of Equipment
			Complications Related to Obtaining the Pneumoperitoneum
				Complications Associated With Closed Access (Veress Needle Placement)
					Preperitoneal Placement.
					Vascular Injuries.
					Visceral Injuries.
				Complications During Open Access (Hasson Technique).
			Complications Related to Insufflation and Pneumoperitoneum
				Bowel Insufflation.
				Gas Embolism.
				Barotrauma.
				Subcutaneous Emphysema.
				Pneumomediastinum, Pneumothorax, and Pneumopericardium.
			Complications Related to Initial “Blind” Placement of the First Trocar After Obtaining a Veress Needle Pneumoperitoneum
				Injury to Gastrointestinal Organs.
				Injury to Intra-abdominal Vessels.
				Injury to the Urinary Tract.
			Complications Related to Placement of Secondary Trocars
				Bleeding at the Sheath Site.
				Trocar Position–Related Problems.
			Complications Related to General Anesthesia Unique to Laparoscopy
				Cardiac Arrhythmias and Cardiac Arrest.
				Changes in Blood Pressure.
				Aspiration of Gastric Contents.
				Hypothermia.
			Complications Related to the Surgical Procedure
				Bowel Injury: Electrosurgical.
				Bowel Injury: Mechanical.
				Vascular Injury.
				Nerve Injury.
				Injury to the Urinary Tract, Spleen, or Pancreas.
					Injury to the Urinary Tract
						Bladder Injury.
					Ureteral Injury.
					Pancreatic Injury.
					Splenic Injury.
			Complications Related to Exiting the Abdomen
				Bowel Entrapment.
				Bleeding at the Sheath Site.
			Early Postoperative Complications
				Pain.
				Incisional Hernia.
				Deep Venous Thrombosis and Pulmonary Embolism.
				Wound Infections.
				Rhabdomyolysis.
			Late Postoperative Complications
				Lymphocele Formation.
				Chylous Ascites.
	Training and Practicing Laparoscopic and Robotic Surgery
		Equipment for Practicing Laparoscopic and Robotic Surgery
			Laparoscopic Training Boxes
				Live Animal Models.
				Cadaveric Models.
			Virtual Reality Trainers
			Formal Training Programs
	Conclusion
	Acknowledgment
	References
	Suggested Readings
	References
15 Basic Energy Modalities in Urologic Surgery
	Tissue Dissection and Cauterization
		Electrosurgery
			Monopolar Electrosurgery
				Basic Physics.
				Argon Beam Coagulator.
				Generator Settings.
			Safety
				Capacitive Coupling.
				General Safety Tips.
			Types of Electrosurgical Instruments
				Monopolar Devices.
				Bipolar Devices.
		Ultrasonic Instrumentation (High-Frequency Vibratory Device)
			Comparing Various Energy-Sealing Devices
		Laser Instrumentation: Soft-Tissue Applications
			Pulsed and Continuous Wave Lasers
			Delivery Systems
			Light-Tissue Interaction
			Types of Lasers
				Neodymium:Yttrium-Aluminum-Garnet.
				Potassium Titanyl Phosphate.
				Lithium Triborate.
				Diode.
				Holmium:YAG.
				Thulium:YAG.
				Carbon Dioxide.
	Intracorporeal Lithotripters
		Electrohydraulic Lithotripsy
			Physics and Mechanism of Action
			Tissue Effect
			Ureteroscopy
			Bladder Stones
	Pneumatic Lithotripsy
		Basic Physics
		Tissue Effects
		Ureteroscopy
		Bladder Stones
		Percutaneous Nephrolithotomy
	Ultrasonic Lithotripsy
		Basic Physics
		Tissue Effects
		Ureteroscopy
		Percutaneous Surgery
	Holmium:YAG and Erbium:YAG Laser Lithotripsy
		Basic Physics
		Ureteroscopy
		Percutaneous Nephrolithotomy
		Bladder Stones
	Dual-Modality Lithotripters
		LithoClast Ultra
		CyberWand
		ShockPulse-SE
		Tissue Effects
		Clinical Use
	References
	Suggested Readings
	References
16 Evaluation and Management of Hematuria
	Classification and Timing of Hematuria
	Microscopic Hematuria
		Criteria for the Diagnosis of Microhematuria
		Requirement for Microscopic Evaluation
		Causes of Microhematuria
		Selecting Patients for Evaluation of Microhematuria
		The Question of Screening for Hematuria and Bladder Cancer
	Guideline-Based Evaluation of Patients With Microhematuria
		Cystoscopy in the Diagnostic Evaluation of Hematuria
		Upper Tract Imaging in the Diagnostic Evaluation of Hematuria
		Urine Cytology and Urinary Biomarkers in the Diagnostic Evaluation of Hematuria
		Natural History of Microhematuria in Patients With a Negative Initial Evaluation
	Symptomatic Microscopic Hematuria
	Gross Hematuria
	Hemorrhagic Cystitis
		Management of Hemorrhagic Cystitis
	Hematuria From Prostatic Origin
	Urethral Bleeding
	Hematuria Originating From the Upper Urinary Tract
		Medical Renal Disease
		Vascular Conditions Affecting the Urinary Tract
		Lateralizing Essential Hematuria and the Evaluation of Upper Urinary Tract Bleeding
	Suggested Readings
	References
	References
17 Complications of Urologic Surgery
	Classification of Complications
		The Clavien-Dindo Scale
	Physiologic Complications
	Positional and Neuromuscular Complications
		Positional Nerve Injury
		Operative Nerve Injury
		Gluteal Compartment Syndrome
		Lower Extremity Compartment Syndrome
	Urinary Complications
	Urine Leaks After Upper Tract Urologic Surgery
		Urine Leaks After Partial Nephrectomy
			Risk Factors and Diagnosis
			Management
	Ureteral Injuries
		Incidence and Anatomic Landmarks
		Mechanisms of Ureteral Injury
		Intraoperative Management
		Presentation of Unrecognized Ureteral Injuries
		Ureterovaginal Fistula
		Strictures
	Lower Tract Urinary Complications
		Bladder Injuries
		Urine Leaks After Radical Prostatectomy
			Overview
			Contributing Factors
			Diagnosis
			Management
	Vascular Complications
		Overview
		Intraoperative Vascular Complications
		Management
		Vascular Injury During Abdominal Access
		Mechanisms of Injury
		Comparison of Different Access Techniques
		Management of Vascular Incidents
		Injury to Epigastric Vessels
		Injury to Major Vessels
		Stapler Malfunction
		Postoperative Vascular Complications
		Diagnosis and Management
	Bowel Injuries
		Incidence and Presentation
		Mechanisms of Injury
		Duodenal and Pancreatic Injuries During Nephrectomy
		Rectal Injury
		Management
		Port Site Hernia
		Venous Thromboembolism
		Lymphoceles
	Conclusion
	References
	References
18 Urologic Considerations in Pregnancy
	Physiologic Changes During Pregnancy
		Cardiovascular
		Respiratory
		Hematologic
		Renal and Urinary Tracts
		Urine Chemistries During Pregnancy
		Hematuria in the Pregnant Patient
	Physiologic Hydronephrosis of Pregnancy
	General Considerations for Imaging of the Pregnant Patient
	General Concepts for Surgical Management of the Pregnant Patient
	General Concepts of Urologic Medication Administration During Pregnancy
	Urolithiasis in Pregnancy
		Etiology
		Evaluation
	Pregnancy in Women With Congenital Urologic Conditions
		Myelomeningocele
			Fertility
			Pregnancy
			Mode of Delivery
			Prevention of Neural Tube Defects
		Classic Bladder Exstrophy
			Genital Anatomy
			Fertility
			Pregnancy
			Mode of Delivery
	Functional and Anatomic Urologic Concerns During Pregnancy
		Intermittent Catheterization
		Urinary Diversion
		Continent Catheterizable Stoma
		Urinary Tract Infection and Urinary Diversion
	Urologic Malignancy During Pregnancy
		Renal Tumors
		Angiomyolipoma
		Bladder Tumors
	Management of Urinary Tract Infections in Pregnancy
	Urologic Management of Placental Abnormalities
	Acknowledgments
	References
	References
19 Intraoperative Consultation
	Ethical Considerations
		The Patient-Physician (and Family-Physician) Relationship
	Decision Making
	Documentation
		Surgical Time Out
	Urethral Injury
		Incidence
		Mechanisms
		Diagnosis
		Management
	Bladder Injury
		Incidence
		Mechanisms
		Diagnosis/Recognition
		Management
	Ureteral Injury
		Incidence
		Mechanisms
		Diagnosis/Recognition
		Management
		Principles of Repair
		Grade 1 and 2 Injuries
		Grade 3 to 5 Distal Ureteral Injuries
		Grade 3 to 5 Mid- and Proximal Ureteral Injuries
		Grade 5 Injury
			Ureteroscopic Avulsion Injury
			Ureteral Catheters
	Renal Injury
		Incidence
		Mechanisms
		Diagnosis/Recognition
		Management
	Placental Cases
		Consults From Urology Colleagues
	References
	References
		Ethical Considerations
		Decision Making
		Documentation
		Urethral Injury
		Bladder Injury
		Ureteral Injury
		Renal Injury
		Placental Cases
III Pediatric Urology
A Development and Prenatal Urology
20 Embryology of the Genitourinary Tract
	Development of the External Genitalia
		Clinical Correlation: Hypospadias
		Clinical Correlation: Correction of Penile Curvature
		Clinical Correlation: Duplicated Urethra
	Development of the Female External Genitalia
		Clinical Correlation: Congenital Adrenal Hyperplasia
	Development of the Human Prostate
	Development of the Human Seminal Vesicle
	Development of the Gonads
		Testicular Formation
		Ovarian Formation
		Gonadal Descent
			Clinical Correlation: Cryptorchidism
			Clinical Correlation: Streak Gonad
			Clinical Correlation: Ovotesticular Syndrome
			Clinical Correlation: Persistent Müllerian Duct Syndrome
	Müllerian Structures (Female Internal Genitalia)
		Development of the Human Female Reproductive Tract
			Uterine Tube
			Uterus Corpus and Cervix
			Vagina
			Clinical Correlation: Vaginal Agenesis and Imperforate Hymen
			Clinical Correlation: Uterus Didelphys
			Clinical Correlation: Obstructed Hemivagina and Unilateral Renal Anomalies
		Bladder: Ureteral Development
		Formation of Urogenital Sinus
		Formation of Trigone
	Development of the Ureter
		Development of the Bladder and Continence Mechanism
			Clinical Correlation: Vesico-ureteral Reflux
			Clinical Correlation: Bladder Exstrophy
			Clinical Correlation: Urachal Anomalies
			Clinical Correlation: Duplication Anomalies
			Clinical Correlation: Ectopic Ureter
			Clinical Correlation: Ureterocele
	Kidneys
		Early Events in Kidney Development
		Pronephros and Mesonephros
		Metanephros
		Collecting System
		Molecular Mechanisms of Kidney Development
		Formation of Nephric Ducts
		Ureteric Bud Outgrowth Into Metanephric Mesenchyme
			Ureteric Bud Branching
		Tubulogenesis
		Mesenchymal-Epithelial Conversion
		Renal Vascular Development
			Clinical Correlation: Vascular Anomalies
			Clinical Correlation: Ascent Anomalies
			Clinical Correlation: Cystic Renal Disease
			Clinical Correlation: Multicystic Dysplastic Kidneys
	Acknowledgment
	Suggested Readings
	References
	References
21 Urologic Aspects of Pediatric Nephrology
	Introduction
	Renal Function, Fluid, and Electrolyte Homeostasis
		Renal Development
		Glomerular Filtration Rate
		Tubular Function
		Developmental Changes in Glomerular Filtration Rate and Tubular Function
	Hematuria (Microscopic and Gross)
	Proteinuria
	Glomerular Disease
		Nephrotic Syndrome
		Glomerulonephritis
		Normocomplementemic Glomerulonephritis
	Tubulopathies
	Cystic Renal Disease
	Urolithiasis: Medical Management
	Hypertension
	Acute Kidney Injury
	Chronic Kidney Disease
	End-Stage Renal Disease: Dialysis and Renal Transplantation
	Summary
	Suggested Readings
	References
	References
22 Perinatal Urology
	Prenatal Imaging
		Maternal-Fetal Ultrasound
		Fetal Magnetic Resonance Imaging
	Grading Systems
		Anterior-Posterior Renal Pelvic Diameter
		Society for Fetal Urology Grading System
		Urinary Tract Dilation Grading System
	Prenatal Multidisciplinary Consultations
		Parental Counseling for Fetal Intervention
		Parental Counseling for Prenatal Surgery for Myelomingocele Closure
	Urinary Tract Dilation
		Risk Stratification and Management for Prenatal Urinary Tract Dilation
		Prenatal Management
			Prenatal Intervention for Lower Urinary Tract Obstruction
			Fetal Cystoscopy
			Vesicoamniotic Shunt Placement Versus Fetal Cystoscopy
	Postnatal Evaluation and Management
		Imaging
			Renal Ultrasound/Resolution of Urinary Tract Dilation
			Voiding Cystourethrogram
			Renal Scintigraphy
			Magnetic Resonance Urography
	Management Recommendations for Postnatal Urinary Tract Dilation
		P1 Urinary Tract Dilation (Low Risk)
		P2 Urinary Tract Dilation (Intermediate Risk)
		P3 Urinary Tract Dilation (High Risk)
		Considerations for Severe Bilateral Urinary Tract Dilation
		Urinary Tract Infection
			Prophylactic Antibiotics
	Key Conditions
		Etiology of Prenatal Urinary Tract Dilation
		Transient Urinary Tract Dilation
		Ureteropelvic Junction Obstruction Pattern of Dilation
			Recommendations for Ureteropelvic Junction Obstruction Pattern of Dilation
		Vesicoureteral Reflux
			Recommendations for Vesicoureteral Reflux
		Megaureter/Ureterovesical Junction Obstruction
			Recommendations for Megaureter
	Lower Urinary Tract Obstruction (Posterior Urethral Valve, Prune Belly Syndrome, Urethral Stenosis/Atresia)
		Posterior Urethral Valves
		Prune Belly Syndrome/Megalourethra
		Urethral Stenosis/Atresia
		Congenital Megacystis
			Recommendations for Lower Urinary Tract Obstruction
	Kidney Anomalies
		Multicystic Dysplastic Kidney
			Recommendations for Multicystic Dysplastic Kidney
		Duplication Anomalies/Ureterocele/Ectopic Ureter
			Recommendations for Duplex Anomalies
	Exstrophy (Bladder/Cloacal)
		Bladder Exstrophy
			Recommendations for Bladder Exstrophy
		Cloacal Exstrophy
			Recommendations for Cloacal Bladder Exstrophy
		Cloacal Malformation/Urogenital Sinus/ Congenital Adrenal Hyperplasia
			Cloacal Malformation
	Urogenital Sinus/Congenital Adrenal Hyperplasia
		Prenatal Treatment of Congenital Adrenal Hyperplasia
		Postnatal Treatment of Congenital Adrenal Hyperplasia
		Outcomes for Fetal Myelomeningocele Closure
	Perinatal Urgencies/Emergencies
		Neonatal Urologic Emergencies
		Abdominal Distension
		Upper Urinary Tract Obstruction
		Lower Urinary Tract Obstruction
			Urinary Ascites
		Urinary Retention (>24 Hours After Birth)
		Solid or Cystic Renal Masses
		Anorectal Malformation
		Ambiguous Genitalia
		Intralabial Masses in a Female Patient
		Oliguria/Anuria
		Gross Hematuria
		Scrotal Mass in the Neonate
		Testicular Torsion
	References
	References
B Basic Principles
	23 Urologic Evaluation of the Child
		Overview of Pediatric Urology
		Imaging
			Ultrasonography
				Renal Bladder Ultrasound
				Prenatal Ultrasonography
				Scrotal Ultrasonography
				Occult Spinal Dysraphism
			Voiding Cystourethrogram
				Fluoroscopy
				Nuclear Cystography
			Genitography
			Renal Scintigraphy
				Diuretic Renography
				Renal Cortical Scintigraphy
			Urodynamic Testing
			Advanced Imaging
				Magnetic Resonance Imaging
				Computed Tomography
		Presentations by Genitourinary Region
			External Genitalia of the Male
				Scrotal Conditions
					Undescended Testicle.
					Scrotal and Testicular Pain.
					Testicular Torsion.
					Torsion of the Testicular or Epididymal Appendix.
					Epididymo-orchitis.
					Scrotal Mass
						Hernia and Hydrocele.
						Varicocele.
					Testicular Tumor.
				Penile Conditions
					Foreskin
						Phimosis and Paraphimosis.
						Circumcision.
					Smegma Pearl or Smegmoma.
					Inconspicuous Penis.
					Buried Penis.
					Concealed Penis.
					Webbed Penis.
					Abnormal Penile Orientation
						Penile Torsion.
						Penile Curvature.
					Parameatal Urethral Cyst.
					Hypospadias.
					Priapism.
			External Genitalia of the Female
				Labial Adhesions
				Interlabial Masses
				Hymenal Disorders
					Imperforate Hymen.
					Hymenal Skin Tag.
					Paraurethral Cyst.
				Urethral Prolapse
				Prolapsing Ureterocele
				Vaginal Rhabdomyosarcoma
				Vaginal Discharge
				Bladder and Bowel Dysfunction
				Foreign Body
				Sexual Abuse
				Other Vaginal Disorders
			Urinary Tract
				Urinary Tract Infection and Pyelonephritis
				Vesicoureteral Reflux
				Bladder and Bowel Dysfunction
				Urinary Incontinence
				Sexual Abuse
				Flank Pain
					Nephrolithiasis.
					Pyelonephritis.
				Ureteropelvic Junction Obstruction
				Gross Hematuria
				Microhematuria
					Benign Idiopathic Urethrorrhagia.
				Referral for Ultrasound Findings
					Prenatal Hydronephrosis.
				Renal Cysts
				Renal Tumors
				Incidental Urolithiasis
		Acknowledgments
		References
		References
24 Pediatric Urogenital Imaging
	Technique
		Nonionizing
		Ionizing
	sonography
		Fundamentals of Sonography in the Fetus and Child
		Kidney/Ureter
			Obstruction
				Hydronephrosis Versus Cystic Renal Diseases.
				Dilated Ureters.
				Functional Interpretation of Sonography of the Kidney.
			Cysts/Masses/Stones
				Renal Cysts.
				Renal/Abdominal Solid Masses.
				Renal Stones.
				Ureteral Stones.
			Infection
			Other Congenital Malformations
			Trauma
		Bladder/Urethra
			Obstruction
			Cysts/Masses
				Midline Pelvic Cysts.
				Bladder Tumors.
			Infection
			Other Congenital Malformations
				Abdominal Wall Defects.
			Trauma
				Scrotum/Testes/Internal Genitalia
					Acute Scrotum.
			Cysts/Masses
			Undescended Testis
			Differences of Sex Development
	Magnetic Resonance Imaging
		Fundamentals of MRI in the Fetus and Child
			Protocol
			Sedation in the Child
		Kidney/Ureter
			Hydronephrosis/Obstruction
			Cysts/Masses/Stones
			Infection
			Other Congenital Malformations
		Bladder/Urethra
		Scrotum/Testes/Internal Genitalia
			Acute Scrotum
			Cysts/Masses
			Undescended Testis
			Differences of Sex Development
	Conventional Radiography
		Plain Abdominal Radiography
		Intravenous Pyelography
		Retrograde Pyelography
	Voiding Cystourethrography/Micturating Cystourethrogram
		Fundamentals of Voiding Cystourethrography
		Kidney/Ureter
			Obstruction
			Cysts/Masses
			Infection
			Other Congenital Malformations
			Trauma
		Bladder/Urethra
			Obstruction
			Cysts/Masses
			Infection
			Other Congenital Malformations
			Trauma
		Scrotum/Testes/Internal Genitalia
			Differences of Sex Development
	Computed Tomography
		Fundamentals of CT Imaging in Children
		Kidney/Ureter
			Obstruction
			Cysts/Masses
			Infection
			Calculus Disease
			Trauma
		Bladder/Urethra
			Trauma
		Scrotum/Testes/Internal Genitalia
	DMSA Renal Cortical Scintigraphy
	Diuretic Renal Scintigraphy
	Radionuclide Cystography
	Radionuclide Testicular Scanning
	Suggested Readings
	References
	References
25 Infection and Inflammation of the Pediatric Genitourinary Tract
	Evaluation and Management of a Child With a Fever
		Definition of a Urinary Tract Infection
		Pathogenesis of Urinary Tract Infection Development in Children
			Bacterial Factors Leading to Pediatric Urinary Tract Infections
			Bacterial Fimbriae
			Aerobactin
			Hemolysin
			Capsular Polysaccharide
			Biofilm Formation
		Host Risk Factors Leading to Pediatric Urinary Tract Infections
			Gender and Age
			Race
			Genetics
			Circumcision
			Fecal and Perineal Bacterial Colonization
			Anatomic Abnormalities
			Vesicoureteral Reflux
			Sexual Activity
			Bladder and Bowel Dysfunction
			Neurogenic Bladder
			Iatrogenic Factors
			Immune Status
	Classification of Pediatric Urinary Tract Infections
		Biofilms
		Asymptomatic Bacteriuria
		Bacterial Nephritis
		Pyonephrosis
		Acute Renal Abscess
	Diagnosis of Pediatric Urinary Tract Infection
		Symptoms
		Physical Examination
		Laboratories
			Urine Collection Methods
			Urinalysis
			Urine Dipstick Tests
			Urine Microscopic Examination
			Urine Culture
			Serum Tests
		Radiographic Imaging
			Controversies With Imaging Strategies
			Ultrasound
			Voiding Cystourethrogram
			99mTc-Dimercaptosuccinic Acid
			Computed Tomography
			Magnetic Resonance Imaging
	Management of Pediatric Urinary Tract Infection
		Antibiotic Treatment
		Inpatient Versus Outpatient Management
		Antibiotic Duration
		Antibiotic Selection
	Management After Urinary Tract Infection
		Prophylactic Antibiotics
		Bladder and Bowel Dysfunction
		Management of Vesicoureteral Reflux
	Sequelae of Pediatric Urinary Tract Infections
		Renal Scarring
		Xanthogranulomatous Pyelonephritis
		Long-Term Sequelae
	Uncommon Pediatric Urinary Tract Infections
		Viral Cystitis
		Funguria
	Suggested Readings
	References
	References
26 Core Principles of Perioperative Management in Children
	Pediatric Anesthesia
		Perioperative Home
		Anesthesia and Potential Neurocognitive Effects
	Preoperative Assessment and Preparation for Surgery
		Anesthesia Risk
		Preoperative Setting
		Special Preoperative Considerations
			Jehovah’s Witness
			Department of Social Services
			Pain Assessment Tools
		NPO Status
			Fasting Times
		Special NPO Situations
			Ketogenic Diet
			Enteral Tube Feeds
		Diabetes and Metabolic Disorders
			Medication Administration
		Preoperative Studies
			Laboratory Tests
			Chest X-Ray and Electrocardiogram
			Pulmonary Function Testing
			Urine Evaluation
	Comorbidities: Perioperative Planning and Postoperative Considerations
		Premature Infants
		Asthma and Pulmonary Disease
		Acute Upper Respiratory Tract Infection (URTI)
		Cardiovascular Anomalies
		Renal Abnormalities
		Hematologic Disorders
		Oncologic Disorders
			Chemotherapy and Perioperative Considerations
			Pheochromocytoma
		Spina Bifida
			Congenital Adrenal Hyperplasia
		Acute Preoperative Events
			Sepsis
			Trauma
			Upper Respiratory Tract Infection
		Urinary Tract Infection (UTI)
			Nonspecific Fever
	ERAS Protocols
		Intraoperative Considerations
			Preoperative Antibiotics
		Intraoperative and Perioperative Fluid Management
		Anaphylaxis
			Malignant Hyperthermia
	Laparoscopic Procedures
		Intraoperative Pain Management
		Postoperative Management
			Immediate Postoperative Management
			Postanesthesia Care Unit and Pain Management
			Inpatient and Outpatient Postoperative Pain Management
	Opioid Use in Children
	References
	References
27 Principles of Laparoscopic and Robotic Surgery in Children
	Advantages and Disadvantages of Minimally Invasive Surgery
		Advantages of Minimally Invasive Surgery
		Drawbacks of Minimally Invasive Surgery
	Physiology of the Pneumoperitoneum
		Cardiovascular Changes
		Pulmonary Changes
		Intracranial Pressure
		Renal Physiology
		Stress Response to the Pneumoperitoneum
	Patient Selection for Mimimally Invasive Surgery
	Access
		Veress Needle
		Open Access
		Visual Obturator Access
		Comparative Effectiveness of Access Techniques
	Approach
		Transperitoneal
		Retroperitoneal
		Vesicoscopic
	Equipment and Instrumentation
		Laparoscopic Ports
		Single-Site Surgery
		Hemostatic Devices
		Staplers
		Clips
		Suture Assistance
		Robotic-Assisted Surgery
	Complications of Minimally Invasive Surgery
		Visceral Injury
		Vascular Injury
		Incisional Hernia (Fig. 27.8)
		Pulmonary Air Embolus
	Simulation Training and Evaluation
		Minimally Invasive Surgery Training
		Minimally Invasive Surgery Assessment
		Minimally Invasive Surgery Simulation
		Minimally Invasive Surgery Warm-Up
		Minimally Invasive Surgery Learning Curves
	Conclusion
	Suggested Readings
	References
	References
C Lower Urinary Tract Conditions
	28 Clinical and Urodynamic Evaluation of Lower Urinary Tract Dysfunction in Children
		Clinical Evaluation
			History
				Storage Symptoms
				Voiding Symptoms
				Bowel Function
				Clinical Aids
				Urinary Tract Infections
				Neurologic Function
				Validated Questionnaires
					Dysfunctional Voiding Symptom Score.
					Dysfunctional Voiding and Incontinence Scoring System.
					Pediatric Urinary Incontinence Quality of Life Score.
					Incontinence Symptom Index-Pediatric.
					Psychological Screening.
					Child Behavior Checklist.
					Short Screening Instrument for Psychological Problems in Enuresis.
					Selecting an Appropriate Patient-Reported Outcome Measure.
			Physical Examination
				Vital Signs
				Neurologic Examination
				Abdominal Examination
				Genital Examination
		Laboratory Testing
			Urinalysis
			Urine Culture
			Additional Testing
		Urodynamic Evaluation
			Noninvasive Testing
				Uroflowmetry
					Bell-Shaped Curve.
					Tower-Shaped Curve.
					Staccato-Shaped Curve.
					Interrupted-Shaped Curve.
					Plateau-Shaped Curve.
					Further Standardization.
				Pelvic Ultrasonography
					Bladder Wall Thickness.
					Postvoid Residual.
					Rectal Diameter.
					Urinary Debris.
					Future.
				Patch Electromyography
				Other Measures
			Formal Urodynamics
				Unique Considerations in Pediatric Patients
				Interpretation of Studies
				Frequency of Testing
		Evaluation Strategies for Specific Clinical Entities
			Non-Neurogenic Lower Urinary Tract Dysfunction
			Spinal Dysraphism
			Sacral Agenesis
			Anorectal Malformations
			Posterior Urethral Valves
			Pelvic Tumors Requiring Extirpation
			Cerebral Palsy
			Spinal Cord Injury
			Transverse Myelitis and Other Central Nervous System Disorders
		Acknowledgments
		Suggested Readings
		References
		References
29 Management Strategies for Vesicoureteral Reflux
	Historical Perspective
	Demographics
		Prevalence
		Sex
		Reflux in the Fetus
		Age
		Race
	Inheritance and Genetics
		Sibling Reflux
		Genes Involved
	Embryology of the Ureterovesical Junction
	Functional Anatomy of the Antireflux Mechanism
	Causes of Vesicoureteral Reflux
		Primary Reflux
		Secondary Reflux
		Clinical Correlates
	Urinary Tract Infection and Reflux
	Grading of Reflux
	Cortical Defects
		Congenital Defects Versus Acquired Scar
		Reflux-Associated Renal Dysplasia
		Acquired Renal Scars
		Pathophysiology of Acquired Scarring
			Age
			Papillary Anatomy
			Bacterial Virulence
			Host Susceptibility and Response
			Hypertension
			Renal Growth
			Renal Failure and Somatic Growth
	Diagnosis and Evaluation of Vesicoureteral Reflux
		Confirmation of Urinary Tract Infection
		Evaluating Urinary Tract Infection
	Assessment of the Lower Urinary Tract
		Cystographic Imaging
		Cystoscopy and the Positioning of the Instillation of Contrast Cystogram
	Assessment of the Upper Urinary Tract
		Rationale for Serial Assessment of Upper Tracts
		Renal Sonography
		Renal Scintigraphy
		Controversies in Usage of Invasive Investigations
		Renal Scintigraphy and the Top-Down Approach
	Controversies in Usage of Invasive Investigations
		National Institutes for Clinical Excellence Guidelines
		American Academy of Pediatrics Guidelines for Febrile Urinary Tract Infection Diagnosis and Management in Young Children
	Associated Anomalies and Conditions
		Ureteropelvic Junction Obstruction
		Ureteral Duplication
		Bladder Diverticula
		Renal Anomalies
		Megacystis-Megaureter Association
		Other Anomalies
		Pregnancy and Reflux
	Natural History and Management
		Spontaneous Resolution
		Resolution by Grade
		Resolution by Age
		Principles of Management
		Medical Management: Continuous Antibiotic Prophylaxis
		Antibiotic Controversies and Potential New Approaches
		Landmark Studies
			International Reflux Study in Children
			Birmingham Reflux Study (Birmingham Reflux Study Group 1987)
			Swedish Reflux Study
			Randomized Intervention for the Management of Vesicoureteral Reflux Study
			Additional Prospective Studies
		Individualizing Patient Care
	References
	References
30 Bladder Anomalies in Children
	Congenital Bladder Anomalies
		Embryology of the Urinary Bladder
		Normal and Abnormal Antenatal Sonographic Findings of the Bladder
			Nondilated or Absent Bladder
				Bladder Agenesis.
				Bladder Hypoplasia.
				Cloacal and Bladder Exstrophy.
			Dilated Bladder and Congenital Megacystis
				Megacystis.
				Megacystis Microcolon Intestinal Hypoperistalsis Syndrome.
			Bladder Duplication
			Congenital Diverticula
				Paraureteral Congenital Diverticula.
				Posterolateral and Multiple Congenital Diverticula.
			Urachal Anomalies
				Patent Urachus.
				Urachal Sinus.
				Urachal Cyst.
				Urachal Diverticulum.
	Acquired Bladder Anomalies in Children
		Noninflammatory Acquired Conditions
			Acquired Diverticula
			Bladder Hemangiomas
			Fibroepithelial Polyps
		Inflammatory Acquired Conditions
			Nephrogenic Adenoma and Cystitis Cystica
			Eosinophilic Cystitis
			Hemorrhagic Cystitis
	Acknowledgments
	References
	References
31 Exstrophy-Epispadias Complex
	Historical Aspects
	Incidence and Inheritance
	Embryology
	Classic Bladder Exstrophy
		Anatomic Considerations
			Bony Pelvis and Spinal Defects
			Pelvic Floor Defects
			Abdominal Wall Anomalies
			Anorectal Defects
			Male Genital Defect
			Female Genital Defects
			Urinary Defects
		Exstrophy Complex and Variants
		Prenatal Diagnosis
	Surgical Reconstruction of Bladder Exstrophy
		Evaluation and Management at Birth
			Selection of Patients for Immediate Closure
			Small Exstrophy Bladder Unsuitable for Newborn Closure
			Osteotomy
		Complications of Osteotomy and Immobilization Techniques
		Surgical Options in the Newborn With Classic Bladder Exstrophy
			Kelly Repair
			Complete Repair: Complete Primary Repair of Exstrophy
			Schrott-Erlangen Approach
			Mainz Repair
		Modern Staged Reconstruction of Bladder Exstrophy
		Bladder, Posterior Urethral, and Abdominal Wall Closure
		Combined Bladder Closure and Epispadias Repair
		Management After Primary Closure
		Selected Technical Aspects of Other Methods of Closure
			Kelly Repair
			Mitchell Repair
		Penile and Urethral Closure in Exstrophy
			Epispadias Repair
			Chordee
			Urethral Reconstruction
			Penile Skin Closure
			Postoperative Problems
		Female Exstrophy
		Continence and Antireflux Procedure
			Postoperative Care
	Modern Initial Repair of Bladder Exstrophy: Outcomes and Results
		Initial Closure
		Epispadias Repair
		Bladder Neck Repair
	Other Modern Exstrophy Repairs: Continence Outcomes
		Schrott-Erlangen Approach
		Complete Repair
		Kelly Repair
	Exstrophy Reconstruction Failures and Complications
		Failed Closure
		Failed Bladder Neck Repair
		Failed Genitourethral Reconstruction
		Alternative Techniques of Reconstruction
			Ureterosigmoidostomy
			Continent Urinary Diversion in the Exstrophy Patient
	Transitional Exstrophy Patient: Adolescent and Adult Concerns
	Continence
	Male Concerns
		Sexuality
		Male Fertility
	Female Concerns
		Sexuality
		Female Fertility
	Quality of Life
	Long-Term Adjustment Issues
	Epispadias
		Male Epispadias
			Associated Anomalies
			Surgical Management
		Female Epispadias
			Associated Anomalies
			Surgical Objectives
			Operative Techniques
			Surgical Results
	Cloacal Exstrophy
		Anatomic Considerations
			Neurospinal Abnormalities
			Skeletal System Abnormalities
			Intestinal Tract Abnormalities
			Genitourinary Abnormalities
			Additional System Anomalies
		Cloacal Exstrophy Variants
		Prenatal Diagnosis
	Surgical Reconstruction of Cloacal Exstrophy
		Evaluation and Management at Birth
		Gender Assignment
		Immediate Surgical Reconstruction
		Urinary Reconstruction
			Modern Staged Reconstruction
			Role of Osteotomy
			Single-Stage Reconstruction
		Failed Cloacal Exstrophy
		Techniques to Create Urinary Continence
	Long-Term Issues in Cloacal Exstrophy
	Summary
	Dedication
	Acknowledgment
	Suggested Readings
	References
	References
32 Prune-Belly Syndrome
	Genetics
	Embryology
	Clinical Features of Prune-Belly Syndrome
		Genitourinary Anomalies
			Kidneys
			Ureters
			Bladder
			Prostate and Accessory Sex Organs
			Anterior Urethra
			Testes
		Extragenitourinary Abnormalities
			Abdominal Wall Defect
			Cardiac Anomalies
			Pulmonary Abnormalities
			Gastrointestinal Abnormalities
			Orthopedic Abnormalities
			Oral Abnormalities
	Presentation
		Prenatal Diagnosis and Management
		Neonatal Presentation
		Spectrum of Disease
			Category I
			Category II
			Category III
		Incomplete Syndrome
		Adult Presentation
		Female Syndrome
	Evaluation and Management
		Initial Management
		Surgical Management of the Patient With Prune-Belly Syndrome
			Urinary Tract
				Urinary Diversion
					Supravesical Urinary Diversion.
					Cutaneous Vesicostomy.
				Upper Urinary Tract Reconstruction
					Ureteroplasty and Ureterocystoneostomy.
					Pyeloplasty.
				Lower Urinary Tract Reconstruction
					Reduction Cystoplasty.
					Internal Urethrotomy.
					Anterior Urethral Dilation or Reconstruction.
					Circumcision.
			Testes: Orchidopexy
				Transabdominal Orchidopexy.
				Spermatic Vessel Ligation.
				Laparoscopic Orchidopexy.
			Abdomen: Reconstruction of the Abdominal Wall
				Indications.
				Techniques
					Randolph Technique.
					Ehrlich Technique.
					Monfort Technique.
					Dénes Technique.
					Furness Technique.
	Long-Term Outlook
		Quality of Life
		Renal Function
		Bladder Function
		Growth and Musculoskeletal Development
		Sexual Function and Fertility
	Suggested Readings
	References
	References
33 Posterior Urethral Valves
	Background
		Description
		Genetic Basis of Posterior Urethral Valves
	Epidemiology
	Pathophysiology of Posterior Urethral Valves
		Lower Urinary Tract
		Upper Urinary Tract
		Vesicoureteral Reflux and Dysplasia
	Diagnosis
		Antenatal Diagnosis
			Ultrasonography
			Fetal Magnetic Resonance Imaging
			Postnatal Diagnosis
				Ultrasonography.
			Voiding Cystourethrography
			Voiding Urosonography (VUS)
			Radionuclide Renal Scan
			Laboratory Evaluation
	Clinical Presentation and Initial Management
		Antenatal Presentation and Management
		Postnatal Management
			Pulmonary Hypoplasia
			Urinomas
			Delayed Presentation
	Surgical Intervention
		Valve Ablation
			Vesicostomy
			Upper Tract Diversion
			Circumcision
			Nephroureterectomy
	Management of Vesicoureteral Reflux
	Bladder Dysfunction and Valve Bladder Syndrome
		Bladder Management
			Role of Urodynamics
		Valve Bladder Syndrome
	Prognostic Indicators for Renal Function
	Transplantation in Valve Patients
	Quality of Life With Posterior Urethral Valves
	Anterior Urethral Valves
	Urethral Atresia
	Urethral Duplication
	Urethrorrhagia
	Urinary Fistula in Boys With Anorectal Malformation
	Suggested Readings
	References
	References
34 Neuromuscular Dysfunction of the Lower Urinary Tract in Children
	Neural Tube Defects
		Epidemiology of Neural Tube Defects
		Risk Factors for the Development of Neural Tube Defects
		Pathogenesis
		Perinatal Concerns
		Bladder Function After Prenatal Closure of Spina Bifida
		Initial Postnatal Management
		Findings
			Prediction of Risk for Upper Urinary Tract Deterioration
		Early Intervention in Children With Spina Bifida
			Effect of Early Intervention on Bladder Function
			Early Initiation of Clean Intermittent Catheterization Decreases the Rate of Urinary Tract Infection
			Early Intervention Decreases Upper Urinary Tract Deterioration
			Early Intervention Reduces the Rate of Vesicoureteral Reflux
			Early Intervention Decreases the Need for Surgery
			Early Intervention Decreases the Incidence of Renal Scarring and End-Stage Renal Disease
		Assessment of Renal Function in Children With Neuromuscular Dysfunction of the Lower Urinary Tract
			Kidney Size in Children With Spina Bifida
			Renal Dysfunction in Spina Bifida
				Determinants of Risk for Renal Dysfunction in Spina Bifida.
			Sexual Function
			Management of Neurogenic Bowel Dysfunction in Spina Bifida
			Initial Diagnostic Evaluation and Follow-Up of Congenital Neurogenic Dysfunction in Children
	Management of Neuromuscular Dysfunction of the Lower Urinary Tract
		Medical Management of Neuropathic Dysfunction of the Lower Urinary Tract
			Sympathomimetic Agents (Fig. 34.7)
		Surgical Treatment Options for Neuropathic Dysfunction of the Lower Urinary Tract
			Botulinum Toxin
		Surgical Management of Neuropathic Dysfunction of the Lower Urinary Tract
			Augmentation
				Complications of Augmentation Cystoplasty.
			Autoaugmentation
			Urinary Diversion
				Incontinent Urinary Diversion.
				Urethral Dilation.
			Bladder Neck Procedures
				Artificial Urinary Sphincter.
				Bladder Neck Slings.
			Injection of Periurethral Bulking Agents
			Electrostimulation
			Sacral Neuromodulation
		Artificial Somatic-Autonomic Reflex Pathway Procedure
	Management of Vesicoureteral Reflux in Neuropathic Dysfunction of the Lower Urinary Tract
	Lipomeningocele and Other Spinal Dysraphisms
		Presentation
		Pathogenesis
		Specific Recommendations
	Sacral Agenesis
		Presentation
		Pathogenesis
		Specific Recommendations
	Conditions of the Pelvis
		Anorectal Malformations
			Presentation
			Pathogenesis
			Specific Recommendations
		Pelvic Surgery
			Presentation
			Pathogenesis
			Specific Recommendations
	Central Nervous System Insults
		Presentation
		Pathogenesis
		Specific Recommendations
	Conditions of the Brain (Tumors/Infarcts/Encephalopathies)
		Presentation
		Pathogenesis
		Specific Recommendations
	Conditions of the Spinal Cord
		Traumatic Injuries
			Presentation
			Pathogenesis
			Specific Recommendations
		Tranverse Myelitis
			Presentation
			Pathogenesis
			Specific Recommendations
	Suggested Readings
	References
	References
35 Functional Disorders of the Lower Urinary Tract in Children
	Clinical Significance
	Epidemiology
		United States
		International
		Gender and Age-Related Demographics
	Self-Esteem and Quality-of-Life Issues
	Comorbidities
		Urinary Tract Infections
		Vesicoureteral Reflux
		Psychological Associations
		Bowel Dysfunction
	Terminology
	Daytime Urinary Incontinence and Bladder Dysfunction
		Treatment
			Urotherapy
		Conservative Management
			Bowel Dysfunction
			Behavior Modification
			Biofeedback
			Clean Intermittent Catheterization
		Pharmacotherapy
			Anticholinergic Agents
			α-Adrenergic Receptor Antagonists
			Botulinum Toxin
		Neuromodulation
		Special Conditions of Lower Urinary Tract Dysfunction and Their Treatment
			Giggle Incontinence (Enuresis Risoria)
			Pollakiuria (Extraordinary Daytime Urinary Frequency)
			Underactive Bladder
			Vaginal Reflux (Vaginal Entrapment and Vaginal Voiding)
	Enuresis
		Terminology and Background
		Epidemiology and Natural History
		Genetics
		Pathophysiology
			Bladder Overactivity and Reduced Nocturnal Bladder Capacity
			Nocturnal Polyuria
			Arousal and Sleep
		Evaluation
		Treatment
			Behavioral Therapy
			Enuresis Alarm
		Pharmacotherapy
			Desmopressin
			Tricyclic Antidepressants
			Anticholinergics
			Combination Therapy
			Alternative Therapies
	Suggested Readings
	References
	References
36 Management of Defecation Disorders
	Epidemiology and Classification of Disorders of Defecation
		Normal Versus Abnormal Bowel Function
		Evaluation of Abnormalities of Defecation
		Imaging Studies
	Management
		Nonpharmacologic Interventions
			Disimpaction and Large Bowel and Rectum Washout
			Maintenance Therapy
		Prognosis
		Surgical Management
			Nonsurgical Alternatives
			Patient Selection and Preparation
			Operative Technique
			Enema Regimen
			Surgical Outcomes
	Suggested Readings
	References
	References
37 Lower Urinary Tract Reconstruction in Children
	“Functional” Urinary Tract
		Dysfunction
			Upper Urinary Tract
			Bladder Dysfunction
			Other Considerations
	Patient Evaluation
		Urodynamics
			Bladder Dynamics: Capacity and Compliance
			Sphincter Dynamics: Outflow Resistance
			Bladder Emptying
	Patient Preparation
		Bowel Preparation
		Urine Culture
		Cystoscopy
	Antireflux
		Transureteroureterostomy and Single Ureteral Reimplant
		Psoas Hitch
		Antireflux With Intestinal Segments
	Bladder Neck Reconstruction
		Young-Dees-Leadbetter Repair
			Technique
			Results
		Fascial Sling
			Technique
			Results
		Bladder Neck Bulking Agents
			Technique
			Results
		Artificial Urinary Sphincter
			Technique
			Results
		Urethral Lengthening
			Technique
			Results
		Pippi Salle Procedure
			Technique
			Results
		Bladder Neck Division
	Bladder Reconstruction
		Cutaneous Vesicostomy
	Augmentation Cystoplasty
		Management of the Native Bladder
		Management of Intestinal Segments
		Ileocystoplasty
			Technique
		Cecocystoplasty and Ileocecocystoplasty
			Technique
			Appendix
			Ileocecal Valve
		Sigmoid Cystoplasty
			Technique
				Reconfiguration of Sigmoid.
		Gastrocystoplasty
		Postoperative Management
			Early Management
			Late Management
		Results and Complications of Augmentation Cystoplasty
			Gastrointestinal Effects
			Bladder Compliance After Augmentation
			Metabolic Complications
				Chloride Absorption and Acidosis.
				Patient Growth.
				Alkalosis.
				Hematuria-Dysuria Syndrome.
			Mucus
			Urinary Tract Infection
			Calculi
			Tumor Formation
			Delayed Spontaneous Bladder Perforation
				Etiology.
				Incidence.
				Treatment.
			Pregnancy
		Choice of Segment and Approach
		A Decreasing Necessity?
		Improving Quality of Life?
		Ileovesicostomy
			Technique and Results
		Alternatives to Gastrointestinal Cystoplasty
			Ureterocystoplasty
				Technique.
				Results.
			Autoaugmentation
				Techniques and Results.
				Concerns.
			Seromuscular Enterocystoplasty
				Technique and Results.
			Bladder Regeneration
	Continent Urinary Diversion
		Considerations
		Continence Mechanisms and Catheterizable Stoma
			Ureterosigmoidostomy and Its Variants
			Nipple Valves
			Flap Valves and the Mitrofanoff Principle
				Technique.
				Results.
				Alternatives.
			Ileocecal Valve
			Hydraulic Valves
			Continent Vesicostomy
				Technique.
				Results.
		Results With Pediatric Continent Diversion
		Other Considerations
			Use of Buttons as Alternative Means to Empty Bladder
				Technique.
			Transitional Care Considerations
	Summary
	References
	Suggested Readings
	References
D Upper Urinary Tract Conditions
	38 Anomalies of the Upper Urinary Tract
		Anomalies of Renal Number
			Bilateral Renal Agenesis
				Incidence
				Relevant Renal Embryology and Possible Etiology
				Mammalian Kidney Organogenesis: New Advances in Developmental Biology
				Gross Pathologic Description of Retroperitoneal Findings in Bilateral Renal Agenesis
				Phenotypic Features Associated With Bilateral Renal Agenesis
				Role of Amniotic Fluid Production in Fetal Pulmonary Development
				Prenatal and Postnatal Diagnosis of Bilateral Renal Agenesis
				Postnatal Radiographic Evaluation of a Neonate With Bilateral Renal Agenesis
				Prognosis for the Patient With Bilateral Renal Agenesis
			Unilateral Renal Agenesis
				Incidence
				Genetic/Syndromic and Other Associations
				Embryology
				Associated Genitourinary and Adrenal Anomalies
				Anomalies in the Male
				Anomalies in the Female
				Anomalies of Other Organ Systems
				Diagnosis and Radiographic Evaluation
				Special Considerations
				Prognosis
				Current Concepts Regarding Prognosis in Adults With Unilateral Renal Agenesis
			Supernumerary Kidney
				Incidence
				Embryology and Molecular Mechanisms Involved in Development of a Supernumerary Kidney
				Description and Associated Anomalies
				Associated Symptoms
				Diagnosis
		Anomalies of Renal Ascent
			Simple Renal Ectopia
				Incidence
				Description and Associated Anomalies
				Diagnosis
				Prognosis
			Cephalad Renal Ectopia
			Thoracic Kidney
				Incidence
				Embryology
				Description
				Associated Anomalies
				Symptoms
				Diagnosis
				Prognosis
		Anomalies of Renal Form and Fusion
			Crossed Renal Ectopia With and Without Fusion
				Incidence
				Embryology
				Description
			Inferior Ectopic Kidney
			Sigmoid, or S-Shaped, Kidney
			Cake, or Lump, Kidney
			L-Shaped Kidney
			Disc Kidney
			Superior Ectopic Kidney
				Associated Anomalies
				Symptoms
				Diagnosis
				Prognosis
			Horseshoe Kidney
				Incidence
				Description
				Associated Anomalies
				Symptoms
				Diagnosis and Radiographic Appearance
				Prognosis
		Anomalies of Renal Rotation
			Incidence
			Description
			Ventral Position
			Ventromedial Position
			Dorsal Position
			Lateral Position
				Symptoms
				Diagnosis
				Prognosis
		Anomalies of Renal Vasculature
			Aberrant, Accessory, or Multiple Vessels
				Incidence
				Embryology
				Description
				Symptoms
				Diagnosis
				Prognosis
		Renal Artery Aneurysm
			Renal Arteriovenous Fistula
		Anomalies of the Renal Collecting System
			Bifid Pelvis
			Calyceal Diverticulum
			Hydrocalycosis
			Megacalycosis
			Infundibulopelvic Stenosis
		Acknowledgments
		References
		References
39 Renal Dysgenesis and Cystic Disease of the Kidney
	Overview of Genetics
	Renal Agenesis and Dysplasia
		Renal Agenesis
		Renal Dysplasia
			Definition
			Etiology
	Hypoplasia and Hypodysplasia
		Renal Hypoplasia
		Oligomeganephronia
			Etiology
			Clinical Features
			Histopathology
			Evaluation
			Treatment
		Ask-Upmark Kidney (Segmental Hypoplasia)
			Clinical Features
			Histopathology
			Treatment
		Renal Hypodysplasia
	Cystic Diseases of the Kidney
		Classification
		Inheritable Cystic Disease
	Autosomal Recessive (Infantile) Polycystic Kidney Disease
		Genetics
		Clinical Features
		Histopathology
		Evaluation
		Treatment
	Autosomal Dominant (Adult) Polycystic Kidney Disease
		Genetics
		Pathogenesis
		Clinical Features
		Extrarenal Manifestations
		Association With Renal Cell Carcinoma
		Histopathology
		Evaluation
		Treatment and Prognosis
		Emerging Therapeutics
	Juvenile Nephronophthisis and Medullary Cystic Disease Complex
		Genetics
		Clinical Features
		Evaluation
		Treatment
	Other Inheritable Renal Cystic Diseases (Congenital Nephrosis)
	Familial Hypoplastic Glomerulocystic Kidney Disease (Cortical Microcystic Disease)
	Multiple Malformation Syndromes With Renal Cysts
		Tuberous Sclerosis Complex
			Genetics
			Clinical Features
			Association With Renal Cell Carcinoma
			Radiographic Evaluation
			Treatment
		von Hippel-Lindau Disease
			Etiology
			Clinical Features
			Classification
			Histopathology
			Evaluation
			Screening
			Treatment
	Multicystic Dysplastic Kidney
		Etiology
		Clinical Features
		Histopathology
		Evaluation
		Treatment and Prognosis
	Benign Multilocular Cyst (Cystic Nephroma)
		Clinical Features
		Histopathology
		Evaluation
		Treatment
	Simple Cysts
		Clinical Features
		Histopathology
		Evaluation
		Classification
		Treatment and Prognosis
	Medullary Sponge Kidney
		Clinical Features
		Histopathology
		Diagnosis
		Treatment and Prognosis
	Sporadic Glomerulocystic Kidney Disease
	Acquired Renal Cystic Disease
		Etiology
		Clinical Features
		Histopathology
		Evaluation
		Treatment
	Calyceal Diverticulum (Pyelogenic Cyst)
	Parapelvic and Renal Sinus Cysts
	Acknowledgment
	Suggested Readings
	References
	References
40 Pathophysiology of Urinary Tract Obstruction
	Prevalence
	Clinical Presentation of Obstruction
		Clinical Presentation in Children
	Progressive Renal Dysfunction
	Definition of Obstruction
	Diagnosis and Imaging
		Laboratory Studies
			Urinalysis
			Fractional Excretion of Sodium
			Assessment of Renal Function
			Biomarkers
		Diagnostic Imaging
			Ultrasonography
			Nuclear Renography
			Computed Tomography
			Magnetic Resonance Urography
			Excretory Urography
			Whitaker Test
			Retrograde Pyelography
			Antegrade Pyelography
	Pathological Changes of Obstruction
		Pathological Changes in the Mature Kidney
		Pathological Changes in the Developing Kidney
			General Observations
			Growth
				Growth Regulation of the Kidney.
				Apoptosis Regulation.
			Differentiation
				Induction Process.
	Tubulointerstitial Fibrosis
		Inflammatory Cell Infiltration
		Elaboration of Growth Factors and Cytokines
			Transforming Growth Factor-β1 (TGF-β1)
			Tumor Necrosis Factor-α
			Interleukin-18
			Angiotensin II
		Fibrosis and Extracellular Matrix in Obstructive Nephropathy
			Mechanisms of Fibrosis
				Cytokine Regulation.
				Epithelial-Mesenchymal Transition.
				Dysregulation of the Proteolytic Balance.
				Other Mechanisms.
				Apoptosis.
			Emerging Therapeutic Options
	Hemodyamic Changes With Obstruction
		Glomerular Filtration and Renal Blood Flow
		Renal Vascular Resistance
			Unilateral Ureteral Obstruction
			Bilateral Ureteral Obstruction or Obstruction of a Solitary Kidney
			Partial Ureteral Obstruction
	Effects of Obstruction on Tubular Function
		Urinary Concentrating Ability
		Sodium Transport
		Hydrogen Ion Transport and Urinary Acidification
		Other Cation Transport
	Egress of Urine From the Obstructed Kidney
	Clinical Impact of Renal Obstruction
		Hypertension
		Compensatory Renal Growth
	Treatment of Renal Obstruction
		Pain Management
		Renal Drainage
		Renal Recovery After Obstruction
		Choice of Surgical Intervention
		Postobstructive Diuresis
			Mechanism of Postobstructive Diuresis
			Clinical Management of Postobstructive Diuresis
			Experimental Modulation of Postobstructive Diuresis
	Suggested Readings
	References
	References
41 Ectopic Ureter, Ureterocele, and Ureteral Anomalies
	Classification and Anatomic Description
		General Patterns
		Ectopic Ureter
		Ureterocele
		Embryology and Etiology
		Ureteral-Trigonal-Renal Development
	Clinical Presentation
		Imaging
			Prenatal Detection
			Incidental Postnatal Detection
		Infection
		Incontinence
		Pain
		Prolapse
		Late Presentation
	Evaluation
		Anatomic Assessment
			Physical Examination
		Ultrasonography
			Voiding Cystourethrogram
		Magnetic Resonance Imaging
		Functional Assessment
			Renal Function
				Nuclear Imaging.
				Intravenous Pyelogram.
			Bladder Function
			Ultrasound Imaging Interpretation
			Ureterocele and Bladder Outlet
		Endoscopic Evaluation
	Clinical Management
		Management Goals
		Historical Perspective
		Fetal Management
		Neonatal Management
			Nonurgent Management
			Urgent Management
		General Management Principles
		Observational Management
		Total Reconstruction
		Upper Pole Partial Nephrectomy
			Open Partial Nephrectomy or Heminephrectomy
			Laparoscopic and Robotic Partial Nephrectomy
		Ureteral Clipping
			Outcomes
				Complications.
		Lower Tract Reconstruction
			Ureterocele Excision and Common-Sheath Reimplantation
		Pyeloureterostomy and Ureteroureterostomy
			Open Procedure
			Laparoscopic Procedure
		Transurethral Incision for Ureterocele
			Reflux Outcomes After Transurethral Incision
		Ureterostomy for Ectopic Ureter
		Summary of Clinical Decision Making
		Voiding Dysfunction after Ureterocele Repair
	Other Ureteral Anomalies
		Anomalies of Number
			Bifid Ureters
			Triplication
			Quadruple Ureters
		Fibroepithelial Polyps
		Anomalies of Position
			Vascular Anomalies Involving the Ureter
				Preureteral Vena Cava
					Anatomy.
					Embryology.
					Incidence.
					Diagnosis.
					Treatment.
			Other Anomalies of Position
				Preureteral Iliac Artery (Retroiliac Ureter).
				Vascular Obstruction of the Distal Ureter.
				Herniation of the Ureter.
	Suggested Readings
	References
	References
42 Surgery of the Ureter in Children
	Ureteropelvic Junction Obstruction
		Definition
		Clinical Presentation
		Secondary Ureteropelvic Junction Obstruction
		Lower Pole Ureteral Pelvic Junction Obstruction
		Associated Anomalies
		Surgical Indication
		Surgical Repair
		Dismembered Pyeloplasty
		Nondismembered Pyeloplasty
		Surgical Approach to Ureteral Pelvic Junction Obstruction
			Posterior Lumbotomy
			Flank Approach
		Minimally Invasive Techniques
			Endoscopic Approach
			Laparoscopic Pyeloplasty
				Transperitoneal or Retroperitoneal Approach.
				Robotic-Assisted Pyeloplasty.
				Technique of Laparoscopic or Robotic-Assisted Pyeloplasty.
				Stones and Congenital Hydronephrosis.
				Vascular Hitch.
			Stenting
		Outcome and Complications
		Ureteral Strictures
		Ureteral Polyps
	Vesicoureteric Reflux
		Definition and Clinical Presentation
		Surgical Management
		Incision
		Intravesical Procedures
		Politano-Leadbetter Technique
		Glenn-Anderson Technique
		Cohen Cross-Trigonal Technique
		Extravesical Procedures
		Minimally Invasive Procedures
		Robotic-Assisted Laparoscopic Ureteral Reimplantation–Extravesical (RALUR-EV)
		Postoperative Evaluation
		Complications of Ureteral Reimplantation
			Early Complications
				Persistent Reflux.
				Contralateral Reflux.
				Obstruction.
			Long-Term Complications
				Obstruction.
				Recurrent or Persistent Reflux.
		Reoperative Reimplantation
	Endoscopic Treatment of Vesicoureteral Reflux
		Technique of Endoscopic Injection
		Follow-Up
		Materials Used for Endoscopic Correction of Reflux
		Recurrence of Vesicoureteral Reflux After Endoscopic Correction
	Megaureter
		Definition
		Etiology, Occurrence, and Presentation
		Surgical Indications
		Surgical Management
		Outcomes
		Dilation and Stenting
	Suggested Readings
	References
	References
43 Management of Pediatric Kidney Stone Disease
	Extrarenal Manifestations
		Evaluation
			Child With Suspected Nephrolithiasis
		Medical History and Physical Examination
			Metabolic Investigations
		Urinary Metabolic Abnormalities
			Hypercalciuria
			Hyperoxaluria
		Primary Hyperoxaluria
		Secondary Hyperoxaluria
			Hypocitraturia
			Cystinuria
			Hyperuricosuria
	Management of Children and Adolescents With Kidney and Ureteral Stones
		Medical Expulsion Therapy
		Surgical Management
		Goals of Therapy
			Stone Clearance Definition
			Radiation
			Ancillary Procedures/Anesthesia
			Surgical Antimicrobial Prophylaxis
		Ureteroscopic Management of Upper Urinary Tract Calculi
			Equipment
		Ureteroscopic Technique in Children
		Limitations and Complications
	Shock Wave Lithotripsy
		Shock Wave Lithotripsy Technique in Children
		Limitations and Concerns
	Percutaneous Nephrolithotomy
		Percutaneous Nephrolithotomy Planning for Pediatric Patients
		Percutaneous Nephrolithotomy Technique for Pediatric Patients
		Percutaneous Nephrolithotomy Complications
	Laparoscopic and Robotic-Assisted Pyelolithotomy
		Secondary Prevention
			Fluid
			Sodium
			Calcium
			Animal Protein
			Oxalate
			Citrate
			Others
		Medications
			Diuretics
			Alkali Agents
			Thiol-Containing Agents
			Allopurinol
			Pyridoxine
	References
	References
E Genitalia
	44 Management of Abnormalities of the External Genitalia in Boys
		Normal Male External Genitalia
			Embryology
				Penile Length and Tanner Classification
		Penile Anomalies
			Prepuce (Foreskin)
				Phimosis and Paraphimosis
				Circumcision
					Circumcision Complications.
					Penile Skin Complications.
					Glanular Adhesions and Skin Bridges.
					Meatal Stenosis.
					Penile Trauma.
					Balanitis Xerotica Obliterans.
			Abnormal Penile Number
				Aphallia
				Diphallia
			Inconspicuous Penis
				Buried Penis
				Webbed Penis
			Micropenis
			Abnormal Penile Orientation
				Penile Curvature
				Penile Torsion
			Penile Masses
				Parameatal Urethral Cyst
				Cyst of the Median Raphe
				Inclusion Cysts
				Congenital Penile Nevi
				Juvenile Xanthogranuloma
			Accessory Urethral Openings
				Congenital Urethral Fistula
				Urethral Duplication
			Genital Lymphedema
			Priapism
			Penoscrotal Transposition (Scrotal Engulfment)
		Scrotal Anomalies
			Bifid Scrotum
			Ectopic Scrotum
			Scrotal Hypoplasia
			Scrotal Agenesis
			Scrotoschisis
		Vascular Lesions of the Genitalia
			Congenital Hemangiomas
			Subcutaneous Hemangiomas
			Klippel-Trénaunay-Weber Syndrome
			Vascular Malformations
		Hernia and Hydroceles
			Embryology
				Definitions (Fig. 44.27)
			Epidemiology and Pathogenesis
				Inguinal Hernia and Communicating Hydrocele
				Noncommunicating Hydroceles
			Genetics and Associated Conditions
			Diagnosis
				Signs and Symptoms
				Physical Examination
				Radiologic Imaging
			Surgical Repair
				Inguinal Hernia
				Hydroceles
				Standard Inguinal Hernia Repair
				Complications
				Scrotal Approach to Inguinal Hernia Repair
				Laparoscopic Inguinal Hernia Repair
			Assessment of the Contralateral Internal Ring
			Abdominoscrotal Hydrocele
		Acute Scrotum
			Spermatic Cord Torsion
				Acute Intravaginal Spermatic Cord Torsion
					Predisposing Factors.
					Clinical Presentation.
					Diagnostic Studies.
				Management and Surgical Treatment
				Prognosis
			Intermittent Intravaginal Spermatic Cord Torsion
			Extravaginal Spermatic Cord Torsion (Perinatal Testicular Torsion)
			Torsion of the Appendix Testis and Epididymis
			Epididymitis
			Other Causes of Acute Scrotal Pain
		Varicocele
			Epidemiology and Pathogenesis
			Diagnosis and Classification
			Associated Pathological Processes
				Testicular Hypotrophy
			Testicular Histology
			Hormonal Function
			Semen Quality
			Intratesticular Varicocele
			Treatment
				Surgical Repair of Varicocele
				Subinguinal or Inguinal Microsurgical Varicocelectomy
				Retroperitoneal and Laparoscopic Varicocelectomy
				Sclerotherapy or Embolotherapy
		Epididymal and Vasal Anomalies
		Suggested Readings
		References
		References
45 Hypospadias
	Embryology
	Diagnosis of Hypospadias
	Etiology of Hypospadias
	Surgical Assessment
		Preoperative Androgen Stimulation
		Intraoperative Assessment and Management
		Assessment and Management of Ventral Penile Curvature
		General Considerations of Surgical Repair
		Distal Hypospadias Repair
	Advancement Procedures
	Tubularization Techniques
		Proximal Hypospadias
			One-Stage Hypospadias Repair
			Two-Stage Hypospadias Repair
			Two-Stage Repair With Free Graft
			Two-Stage Repair With Pedicle Flap
			Comments on Proximal Hypospadias Repair
		Postoperative Management
		Complications of Hypospadias Repair
			Urethrocutaneous Fistula
			Glans Dehiscence
			Meatal Stenosis
			Urethral Stricture
			Urethral Diverticulum
			Balanitis Xerotica Obliterans
			Recurrent Penile Curvature
			Skin Complications
	Hypospadias Outcomes
		Outcome Assessment
			Patient-Reported Outcomes
		Hypospadias Reoperations
	Future
	Suggested Readings
	References
	References
46 Etiology, Diagnosis, and Management of the Undescended Testis
	Introduction
	Definitions
	Etiology
		Embryology of Testicular Descent and Maldescent
			Differentiation of the Testis
			Testicular Hormone Production
			Gubernacular Development and Testicular Descent
			Regulation of Testicular Descent
		Epidemiology
			Congenital Cryptorchidism
			Acquired Cryptorchidism
		Pathogenesis
			Genetic Susceptibility
			Environmental Risk Factors
			Hormonal Defects
			Syndromic Cryptorchidism
	Diagnosis
		Examination
		Palpable Testes
		Nonpalpable Testes
			Hormonal Evaluation
			Imaging
			Diagnostic Laparoscopy
		Associated Pathology
			Testicular Maldevelopment
			Anomalies of the Epididymis, Processus Vaginalis, and Gubernaculum
			Other Testicular Anomalies Associated With Cryptorchidism
	General Guidelines for Management
	Medical Management
		Therapeutic LHRH and/or hCG
		Adjuvant Hormonal Therapy
	Surgical Management
		Palpable Testes
			Inguinal Orchidopexy
			Transscrotal Orchidopexy (Video 46.2)
		Abdominal Testes
			Open Transabdominal Orchidopexy
			Laparoscopic Orchidopexy and Fowler-Stephens Orchidopexy (Video 46.3)
	Prognosis
		Fertility
		Testicular Cancer
	Suggested Readings
	References
	References
47 Management of Abnormalities of the Genitalia in Girls
	Female Genital Embryology
	Evaluation and Classification of Female Genital Anomalies
	Congenital Disorders of Female External Genitalia
		Disorders of the Clitoris
			Hypertrophied Clitoris
			Diminutive Clitoris
		Disorders of the Vestibule
			Urethral Prolapse
			Urethral Polyp
			Vestibular Cysts
			Prolapsed Ureterocele
			Ectopic Ureteral Insertion
		Disorders of the Vagina
			Imperforate Hymen and Hymenal Skin Tags
			Abnormalities of Vertical Fusion
				General.
					Transverse Vaginal Septum.
					Vaginal Atresia (Distal Vagina).
					Vaginal Agenesis (Müllerian Aplasia).
			Associated Findings
			Vaginal Replacement Surgery
				Creation of a Skin Neovagina.
				Creation of an Intestinal Neovagina.
			Special Considerations: Cervical Atresia
			Abnormalities of Lateral Fusion
				Duplication of the Uterus and Cervix With Unilaterally Imperforate Vagina (Herlyn-Werner-Wunderlich Syndrome).
	Acquired Disorders of the Female External Genitalia
		Rhabdomyosarcoma
		Labial Adhesions
		Female Circumcision (Infibulation)
		Condyloma Acuminata
		Inguinal Hernias
	Suggested Readings
		Embryology
		Disorders of the Vestibule
		Abnormalities of Vertical MÜllerian Fusion
		Vaginal Agenesis Management
		Female Genital Mutilation
	References
	References
48 Disorders of Sexual Development
	Normal Sexual Development
		Normal Genotypic Development
			Chromosomal Sex
			SRY
			Additional Genes Involved in Gonadal Determination
				WT1.
				NR5A1 (SF1).
				SOX9.
				NR0B1 (DAX1) and Dosage-Sensitive Sex Reversal (DSS).
				WNT4.
				RSPO1.
		Normal Phenotypic Development
			Gonadal Stage of Differentiation
		Gonadal Function
			Testis
			Ovary
		Phenotypic Sexual Development
		Gender Identity, Gender Role, and Gender Orientation
			Psychosexual Development
	Abnormal Sexual Development
	Evaluation and Management of the Newborn With Ambiguous Genitalia
		Gender Assignment
		Disorders of Gonadal Differentiation and Development
			Klinefelter Syndrome and Variants
			46,XX Males
			Syndromes of Gonadal Dysgenesis
				Turner Syndrome.
				46,XX “Pure” Gonadal Dysgenesis.
				Mixed Gonadal Dysgenesis.
				Partial Gonadal Dysgenesis.
				46,XY Complete (Pure) Gonadal Dysgenesis (Swyer Syndrome).
			Embryonic Testicular Regression and Bilateral Vanishing Testes Syndromes
			Ovotesticular DSD
		46,XX DSD (Masculinized Female)
			Congenital Adrenal Hyperplasia
			46,XX DSD (Masculinized Female) Secondary to Maternal Androgens and Progestins and Maternal Tumors
		46,XY DSD (Undermasculinized Male)
			Leydig Cell Aplasia (Luteinizing Hormone Receptor Abnormality)
			Disorders of Testosterone Biosynthesis
				Congenital Lipoid Adrenal Hyperplasia (StAR Deficiency).
				Cytochrome P450 Oxidoreductase Deficiency.
				3β-Hydroxysteroid Dehydrogenase Deficiency.
				17α-Hydroxylase Deficiency.
				17,20-Lyase Deficiency.
				17β-Hydroxysteroid Oxidoreductase Deficiency.
			Androgen Receptor and Postreceptor Defects
				Syndrome of Complete Androgen Insensitivity.
				Syndrome of Partial Androgen Resistance.
				Mild Androgen Insensitivity Syndrome.
			5α-Reductase Deficiency
			Persistent Müllerian Duct Syndrome
		Unclassified Forms: Mayer-Rokitansky- Küster-Hauser Syndrome
		Future Directions
			Collaborative Networking
			Impact of DSD Diagnosis on Caregivers
			Ethical Considerations
	Suggested Readings
	References
	References
		Normal Sexual Differentiation
		Abnormal Sexual Differentiation
		Evaluation and Management of the Newborn with Ambiguous Genitalia
		Gender Assignment
		Disorders of Gonadal Differentiation and Development
		46,XX Males
		Syndromes of Gonadal Dysgenesis
		46,XX “Pure” Gonadal Dysgenesis
		Mixed Gonadal Dysgenesis
		Partial Gonadal Dysgenesis (Dysgenetic Male Pseudohermaphroditism)
		46,XY Complete (Pure) Gonadal Dysgenesis (Swyer Syndrome)
		Embryonic Testicular Regression and Bilateral Vanishing Testes Syndromes
		Ovotesticular DSD (True Hermaphroditism)
		46,XX DSD (Masculinized Female)
		46,XX (Masculinized Female) Secondary to Maternal Androgens and Progestins and Maternal Tumors
		46,XY DSD (Undermasculinized Male)
		Disorders of Testosterone Biosynthesis
		Androgen Receptor and Postreceptor Defects
		Syndrome of Partial Androgen Resistance
		5α-Reductase Deficiency
		Persistent Müllerian Duct Syndrome
		Mayer-Rokitansky-Küster-Hauser Syndrome
		Future Directions
			Impact on Caregivers
			Ethical Considerations
F Reconstruction and Trauma
	49 Surgical Management of Differences of Sexual Differentiation and Cloacal and Anorectal Malformations
		Classification of Urogenital Sinus and Cloacal Anomalies
			Evaluation
			History and Physical Examination
			Radiographic and Endoscopic Evaluation
				Urogenital Sinus Abnormalities
				Cloacal Anomalies
		Surgical Reconstruction of Disorders of Sex Development and Urogenital Sinus
			Initial Management, Timing, and Principles
			Current Operative Techniques for Female Disorders of Sex Development and Urogenital Sinus Repair
				Low Vaginal Confluence: Clitoral Hypertrophy
				High Vaginal Confluence: With or Without Clitoral Hypertrophy
				Total and Partial Urogenital Mobilization
			Results of Urogenital Sinus and Disorders of Sex Development Surgery
		Surgical Reconstruction for Cloacal Malformations
			Initial Management, Timing, and Principles
			Decompression of the Gastrointestinal Tract
			Decompression of the Genitourinary Tract
			Repair of Obstructive Urinary and Other Pathology
			Definitive Repair of Cloacal Malformations
				Operative Technique: Cloaca
				Results of Cloacal Surgery
		Summary
		Suggested Readings
		References
		References
50 Adolescent and Transitional Urology
	Definitions
		Transition
			Failure of Transition
			Transfer
			Models for Transition
	Patient Population
	Setting Up a Service
		Training
		The Multidisciplinary Team
		Institutional and Political Support
	Barriers to Transition
		Institutional
		Professional
		Patients
		Expanding Numbers and Management of the Service Long-Term
		The Importance of Specialist Nurses
	Clinical Delivery
		Geography
		The Clinic
	Patient/Parent Preparation for Transition
		What Does Success Look Like?
		The Price of Failure
	Clinical Practice: Major Diagnoses
		Functional Assessment of the Reconstructed Urinary Tract
		Video-Urodynamics
		Flow Rates
		Renography
		Ultrasonography
		Blood Tests
		Hypospadias
		Exstrophy
			Long-Term Reconstructive Outcomes
			Urologic
	Male
		Penile Concerns and Management
		Sexual Function
		Fertility
	Females Born With Exstrophy
		Reconstruction of the Genitalia
		Procedentia Repair
		Female Sexual Function
		Fertility
		Pregnancy and Delivery
	Spina Bifida: the Neuropathic Bladder
		Changes in Bladder Function and Continence
		Renal and Urologic Concerns
		Sex and Sexuality
		Preparation for Pregnancy
	Posterior Urethral Valves
		Sexual Function and Fertility
	Summary
	Suggested Readings
	References
	References
51 Urologic Considerations in Pediatric Renal Transplantation
	Pretransplant Assessment
		Screening
		Focused Assessment
	Pretransplant Preparation
		Bladder Preparation
			General Issues
			Hypertonicity and Poor Compliance
			Capacity
			Infections
			Clean Intermittent Catheterization
			Defunctionalized Bladder
				Neuropathic.
				Non-Neuropathic.
				Decision to Augment.
		Cutaneous Stomas
		Reconstruction Strategies
			Dialysis Issues
			Graft Placement
			Timing
			Enterocystoplasty
			Native Nephrectomy
		Managing Patients With Native Kidneys
			Avoiding Removal
			Limit Risk of Infection
			Ureteral Preservation
			Combining Nephrectomy and Transplant
	Transplantation
		Ureteral Anastomosis
			Surgical Techniques and Options
			Ureteral Stenting
	Complications
		Urine Leaks
		Infection
		Reflux
		Hydronephrosis and Obstruction
		Bladder Dysfunction
		Stones
	Summary
	Suggested Readings
	References
	References
52 Pediatric Genitourinary Trauma
	Renal Injuries
		Epidemiology
		Presentation
	Indications for Renal Imaging
	Imaging Studies for Diagnosis
		As Low as Reasonably Achievable
		Focused Assessment With Sonography for Trauma
		Dedicated Renal Ultrasonography
		Computed Tomography
	Classification and Grading of Renal Injuries
		AAST Grading System
		High-Risk Criteria
		Blunt Versus Penetrating
		Management
		Nonoperative
		Nonoperative Management Protocol
		Early Repeat Imaging
		Outcomes of Nonoperative Management
		Management of Complications in Nonoperative Patients
		Persistent Urine Leak
		Indications for Intervention for Urine Leak or Urinoma
		Ureteral Stent
		Percutaneous Drain
		Nephrostomy Tube
		Angioembolization of Isolated Renal Segment
		Renal Exploration With Repair of Urine Leak
	Persistent or Delayed Bleeding
		Indications for Angioembolization
		Renal Exploration
	Operative
		Indications
		One-Shot intraoperative Intravenous Pyelography or Ultrasonography
		Control of Renal Vasculature
		Reconstruction Versus Nephrectomy
		Renal Arterial Laceration
		Renal Arterial Occlusion
		Ureteropelvic Junction Disruption
		Renal Pelvis Rupture
		Congenital Anomalies and Renal Injuries
		Ureteropelvic Junction Obstruction
		Duplex Kidney
		Fusion Anomalies and Ectopic Kidney
		Follow-Up and Long-Term Issues
		Late Repeat Imaging and Assessment of Renal Function
		Hypertension
		Chronic Flank Pain
		Chronic Kidney Disease
		Follow-Up and Activities With a Solitary Kidney
	Ureteral Trauma
		Epidemiology
		Presentation
		Imaging Findings
		American Association for the Surgery of Trauma Classification
		Management of Traumatic Ureteral Injury
			Immediate Diagnosis
			Delayed Diagnosis
		Proximal or Mid-Ureteral Injury Surgical Repair
		Distal Ureteral Injury Surgical Repair
		Lengthy Ureteral Injuries
		Follow-Up Imaging
	Bladder Injuries
		Presentation
		Pelvic Fracture
		Imaging
		Management
		Urethral Injuries
			Evaluation
			Management
		Urethral Disruption in Females
	Genital Injury in the Pediatric Population
		Penile Injury
		Scrotal Injury
			Epidemiology
			Imaging
			Management
		Vaginal Injury
			Management
	References
	References
G Oncology
	53 Pediatric Urologic Oncology
		Neuroblastoma
			Epidemiology and Genetics
				Incidence
				Genetics
				Constitutional Chromosome Abnormalities
			Embryology and Spontaneous Regression
			Pathology
			Clinical Presentation and Pattern of Spread
			Diagnosis
				Laboratory Evaluation
				Imaging
				Screening
				Staging
			Prognostic Factors
				Clinical Variables
				Biologic Variables
			Treatment
				Surgery
					Low-Risk Disease (Stages I, II, and IV-S).
					Perinatal Neuroblastoma.
					Intermediate and High-Risk Disease (Stages III and IV).
				Chemotherapy
				New Innovative Biologic Therapies
				Radiotherapy
				Spinal Cord Compression
		Wilms Tumor
			Epidemiology
			Biology/Genetics
				WT1
				WTX
				11p15
				Familial Wilms Tumor
				Other Chromosomal Abnormalities
				Screening
			Pathology
				Favorable Histology Wilms Tumor
				Anaplastic Wilms Tumor
				Pathology After Preoperative Chemotherapy
				Nephrogenic Rests
			Preoperative Evaluation and Staging
				Imaging
				Staging
				Prognostic Factors
					Chromosomal Abnormalities.
			Treatment
				Surgical Considerations
				Cooperative Group Trials
					National Wilms Tumor Study Group.
					Children’s Oncology Group.
					International Society of Paediatric Oncology.
					United Kingdom Children’s Cancer Study Group.
				Adult Wilms Tumor
				Relapse
				Preoperative Chemotherapy (COG Recommendations)
					Inoperable Tumors.
					Bilateral Wilms Tumors.
					Partial Nephrectomy for Unilateral Tumors.
			Late Effects of Treatment
				Mortality
				Fertility and Pregnancy
				Second Malignancies
				Cardiac Effects
				Other Renal Tumors
					Clear Cell Sarcoma of the Kidney
					Rhabdoid Tumor of the Kidney
					Congenital Mesoblastic Nephroma
					Solitary Multilocular Cyst and Cystic Partially Differentiated Nephroblastoma
					Metanephric Adenofibroma
					Renal Cell Carcinoma
					Angiomyolipoma
		References
		References
			Neuroblastoma
			Nephroblastoma
54 Pediatric Urologic Oncology
	Epidemiology and Syndromic Associations
	Pathology and Molecular Biology
	Presentation, Initial Evaluation and Management, Staging
		Presenting Symptoms and Examination
		Evaluation
			Biopsy Techniques and Management of Obstruction
			Staging and Childrens Oncology Group Risk Group Assignment
		Treatment and Outcomes
			Evolution of Multimodal Treatment
			Current Multi-Model Approaches: Children’s Oncology Group
			Current Multi-Model Approaches: European Cooperative Groups
			Local Control
			Treatment of Very Young Children
			Timing of Surgical Reconstruction
			Outcomes
			Late Effects
		Oncofertility
	Other Bladder Tumors
		Transitional Cell Carcinoma
		Cancer in the Augmented Bladder
		Urachal Carcinoma
		Adenocarcinoma and Squamous Cell Carcinoma
		Benign Bladder Tumors
	Female Genital Tract
		Tumors of the Vulva and Clitoris
		Vaginal Rhabdomyosarcoma
		Cervical or Uterine Rhabdomyosarcoma
		Ovarian Lesions
			Cystic Lesions
			Ovarian Malignancies
			Germ Cell Tumors
			Sex Cord Tumors
			Epithelial Tumors
	Testicular Tumors
		Epidemiology
		Pathogenesis and Molecular Biology
		Presentation, Evaluation, and Staging
			Ultrasonography
			Interpretation of Biomarkers in Children
			Staging
		Tumors Associated With Disorders of Sexual Development
			Germ Cell Tumors
			Gonadal Stromal Tumors
		Leukemia and Lymphoma
			Testicular Microlithiasis
			Management Algorithms
		Testis-Sparing Surgery Technique
	Paratesticular Rhabdomyosarcoma
		Presentation and Staging
		Treatment
		Role of Retroperitoneal Lymph Node Dissection
		Outcomes
	Perineal Rhabdomyosarcoma
	Suggested Readings
	References
	References
IV Infections and Inflammation
	55 Infections of the Urinary Tract
		Definitions
		Incidence and Epidemiology
		Pathogenesis
			Routes of Infection
				Ascending Route
				Hematogenous Route
				Lymphatic Route
			Urinary Pathogens
			Fastidious Organisms
				Anaerobes in the Urinary Tract
				Mycobacterium tuberculosis and Other Nontuberculous Mycobacteria
				Chlamydia
			Bacterial Virulence Factors
			Early Events in Uropathogenic E. coli Pathogenesis
				Bacterial Adherence
					Bacterial Adhesins.
					Type 1 (Mannose-Sensitive) Pili.
					P (Mannose-Resistant) Pili.
					Other Adhesins.
					Catch Bonds.
			Phase Variation of Bacterial Pili in vivo
			Epithelial Cell Receptivity
				Vaginal Cells
					Variation in Receptivity.
				Bladder Cells
					Uropathogenic E. coli Persistence in the Bladder.
			Natural Defenses of the Urinary Tract
				Periurethral and Urethral Region
				Urine
				Bladder
					Immune Response
						Pathogen Recognition.
							Toll-Like Receptor Signaling.
							Induced Exfoliation.
			Alterations in Host Defense Mechanisms
				Obstruction
				Vesicoureteral Reflux
				Underlying Disease
				Diabetes Mellitus
				Renal Papillary Necrosis
				Human Immunodeficiency Virus
			Other Conditions That Increase Risk of Urinary Tract Infections
				Renal Transplantation
				Menopause
				Pregnancy
				Spinal Cord Injury With High-Pressure Bladders
		Evaluation
			Signs and Symptoms
			Diagnosis by Urine Testing
				Urine Collection
					Key Issues in Analysis of Urine Samples.
						Urine Dipsticks.
						Urinalysis.
						Urine Culture.
		Localization
			Ureteral Catheterization
			Stone Cultures
		Imaging
			Ultrasonography
			Computed Tomography and Magnetic Resonance Imaging
			Voiding Cystourethrogram
			Radionuclide Studies
		Microbiome
		Asymptomatic Bacteriuria
		Principles of Antimicrobial Therapy
			Ecologic Impact and Collateral Damage
			Antimicrobial Formulary
				Nitrofurantoin
				Trimethoprim-Sulfamethoxazole
				Fosfomycin
				Fluoroquinolones
				Cephalosporins
				Aminopenicillins
				Aminoglycosides
				Aztreonam
				Pivmecillinam
			Choice of Antimicrobial Agents
			Duration of Therapy
		Bladder Infections
			Uncomplicated Cystitis
				Clinical Presentation
				Laboratory Diagnosis
				Management
					Antimicrobial Selection.
					Duration of Therapy.
					Cost of Therapy.
				Follow-Up
					Compliance With Recommended Agents.
			Complicated Urinary Tract Infections
				Emphysematous Cystitis
					Clinical Presentation.
					Radiologic Findings.
					Management.
			Unresolved Urinary Tract Infections
				Clinical Presentation
				Laboratory Diagnosis
				Management
			Recurrent Urinary Tract Infections
				Evaluation
				Bacterial Persistence
				Management
					Behavioral Modification.
					Self-Start Therapy.
					Low-Dose Continuous Prophylaxis.
					Non-Antibiotic Management.
					Cranberry.
					Estrogen.
					Probiotics.
					Methenamine.
					D-Mannose.
					Immunoactive Prophylaxis.
		Kidney Infections
			Renal Infection (Bacterial Nephritis)
				Pathology
				Acute Pyelonephritis
					Clinical Presentation.
					Laboratory Diagnosis.
					Bacteriology.
					Renal Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging.
					Differential Diagnosis.
					Management
						Initial Management.
						Subsequent Management.
						Unfavorable Response to Therapy.
						Follow-Up.
				Acute Focal or Multifocal Bacterial Nephritis
					Clinical Presentation.
					Radiologic Findings.
					Management.
				Emphysematous Pyelonephritis
					Clinical Presentation.
					Radiologic Findings.
					Management.
				Renal Abscess
					Clinical Presentation.
					Laboratory Diagnosis.
					Management.
				Infected Hydronephrosis and Pyonephrosis
					Clinical Presentation.
					Radiologic Findings.
					Management.
				Perinephric Abscess
					Clinical Presentation.
					Management.
					Perinephric Abscess Versus Acute Pyelonephritis.
				Chronic Pyelonephritis
					Clinical Presentation.
					Radiologic Findings.
					Pathology.
					Management.
				Bacterial “Relapse” From a Normal Kidney
			Infectious Granulomatous Nephritis
				Xanthogranulomatous Pyelonephritis
					Pathogenesis.
					Pathology.
					Clinical Presentation.
					Bacteriology and Laboratory Diagnosis.
					Differential Diagnosis.
					Management.
				Malacoplakia
					Pathogenesis.
					Pathology.
					Clinical Presentation.
					Radiologic Findings.
					Differential Diagnosis.
					Management.
				Renal Echinococcosis
					Pathogenesis and Pathology.
					Clinical Presentation.
					Laboratory Diagnosis.
					Radiologic Findings.
					Management.
		Other Infections
			Fournier Gangrene
				Clinical Presentation
				Laboratory Diagnosis and Radiologic Findings
				Management
				Outcome
			Periurethral Abscess
				Pathogenesis
				Clinical Presentation
				Management
		Bacteremia, Sepsis, and Septic Shock
			Definitions
			Pathophysiology
				Bacterial Cell Wall Components in Septic Shock
				Cytokine Network
			Clinical Presentation and Diagnosis
			Bacteriology
			Management
			Bacteriuria in Pregnancy
				Pregnancy
			Pathogenesis
			Anatomic and Physiologic Changes During Pregnancy
				Increase in Renal Size
				Smooth Muscle Atony of the Collecting System and Bladder
				Bladder Changes
				Augmented Renal Function
			Complications Associated With Bacteriuria During Pregnancy
				Prematurity and Prenatal Mortality
				Maternal Anemia
				Laboratory Diagnosis
				Management
				Pregnancy in Women With Renal Insufficiency
		Bacteriuria and Urinary Tract Infections in the Elderly
			Epidemiology
			Screening for Bacteriuria
			Pathogenesis
			Diagnosis
			Management
		Catheter-Associated Urinary Tract Infection
			Pathogenesis
			Clinical Presentation
			Laboratory Diagnosis
			Management
		Management of Urinary Tract Infections in Patients With Spinal Cord Injury
			Epidemiology
			Pathogenesis
			Clinical Presentation
			Bacteriology and Laboratory Diagnosis
			Management
		Kidney Transplant Recipients
		Antimicrobial Prophylaxis for Common Urologic Procedures
			Principles of Surgical Antimicrobial Prophylaxis
			Urethral Catheterization and Removal
			Urodynamics
			Transrectal Ultrasound-Guided Prostate Biopsy
			Shock-Wave Lithotripsy
			Endoscopic Procedures: Lower Urinary Tract
				Simple Cystoscopy (Without Manipulation)
			Transurethral Resection of the Prostate and Bladder (Cystourethroscopy With Manipulation)
			Endoscopic Procedures: Upper Urinary Tract
				Ureteroscopy
				Ureteral Stenting
				Percutaneous Renal Surgery (Prophylaxis Indicated in All Patients)
			Open, Laparoscopic, and Robotic Surgery
				Skin Preparation for Surgery
				Vaginal Surgery
			Special Considerations
				Patients With Risk of Endocarditis
				Patients With Indwelling Orthopedic Hardware
		Acknowledgments
		References
		References
56 Inflammatory and Pain Conditions of the Male Genitourinary Tract
	Prostatitis
		Historical Perspective
		Current Classification of Prostatitis
			NIH Classification
		Histopathology
			Histology
		Specific Cases of Prostatic Inflammation
			Granulomatous Prostatitis
			Immunoglobulin G Subclass 4 (IgG4)
			Category I Prostatitis: Acute Bacterial Prostatitis
				Microbiology.
				Evaluation.
				Treatment.
					Adjuncts to Antibiotic Therapy.
			Prostatic Abscess
			Category II: Chronic Bacterial Prostatitis
				Bacteria-Causing Category II Prostatitis.
					Role of Chlamydia in Prostatitis?
				Diagnosis and Evaluation.
				Treatment of Chronic Bacterial Prostatitis (Category II).
					CP II in HIV/Immunocompromised Patients.
					Beyond Quinolones.
		Etiology
			Infection
			Inflammation
			Neurologic Causes
			Pelvic Floor Dysfunction
			Psychosocial Factors
			Endocrine Abnormalities
			Genetics
			Biomarkers
			Abnormal Sensory Processing
		Symptoms in Chronic Prostatitis and Chronic Pelvic Pain Syndrome
			Prevalence of Individual Symptoms in Men With Chronic Prostatitis and Chronic Pelvic Pain Syndrome
			Summary of Findings From the Multidisciplinary Approach to Pelvic Pain Study
			Fluctuations in Symptom Severity
			Sexual Dysfunction
			Anxiety and Depression
			Association With Other Medical Diseases
				Cardiovascular Disease.
				Neurologic Disease.
			Phenotypic Approach to Symptoms and Symptom Clustering: UPOINT
		Evaluation of Chronic Prostatitis and Chronic Pelvic Pain Syndrome
			History
			Assessment
				Pain.
				Other Urologic Symptoms
			Review of Symptoms
			Physical Examination
			Laboratory/Office Studies
		Treatment of Chronic Prostatitis and Chronic Pelvic Pain Syndrome
			Pharmacologic Treatment
				Antibiotic Treatment.
				Summary of Treatment Recommendations.
				Alpha-Blocker Treatment.
				Anti-Inflammatory Therapy.
				Reductase Inhibitors.
				Medications for Neuropathic Pain.
				Phototherapy.
				Bladder Specific: Pentosan Polysulfate.
				Other Medications
					Allopurinol.
					Mepartricin.
					PDE5 Inhibitors.
			Other Treatments for Chronic Prostatitis and Chronic Pelvic Pain Syndrome
				Conservative
					Lifestyle Changes: Diet and Exercise.
					Stress Management/Psychological Treatments.
					Acupuncture.
				Minimally Invasive Therapies
					Pelvic Floor Physical Therapy and Skeletal Muscle Relaxants.
					Adjuncts to Pelvic Floor Physical Therapy.
					Prostate Massage.
					Circumcision.
				Prostate-Specific Treatments
					Local Hyperthermia and Needle Ablation.
					Intraprostatic Injection of Onabotulinumtoxin A.
				Surgical Therapy for Chronic Prostatitis and Chronic Pelvic Pain Syndrome
					Surgical Therapy for Bladder Neck Hypertrophy.
					Neurostimulation.
					Electromagnetic Stimulation.
					Cystoscopy and Fulguration of Hunner’s Ulcer.
					Not Recommended: Radical Prostatectomy.
			Cochrane Review of Nonpharmacological Interventions for Treating Chronic Prostatitis and Chronic Pelvic Pain Syndrome
			Treatment: Summary and Approach
	Acute and Chronic Orchitis and Orchialgia
		Acute Orchitis
			Etiology
			Evaluation
			Treatment
		Chronic Scrotal Pain Syndrome: Orchialgia
			Epidemiology
			Cause of Chronic Orchialgia
			Evaluation
			Therapy for Idiopathic Orchialgia and Chronic Scrotal Pain Syndrome
				Medical Therapies.
				Spermatic Cord Block.
		Acute and Chronic Epididymitis (Epididymalgia)
			Acute Epididymitis.
				Etiology.
				Clinical Evaluation.
				Treatment.
				Follow-Up.
			Chronic Epididymitis.
				Etiology.
				Evaluation.
				Treatment.
			Tubercular Epididymitis
		Nonmedical Therapy for Chronic Scrotal Pain: Chronic Orchitis (Orchalgia) and Chronic Epididymitis (Epididymalgia)
			Minimally Invasive Treatments
				Pelvic Floor Physical Therapy.
				Botox.
				Pulsed Radiofrequency of the Spermatic Cord.
		Nonradical Surgical Treatments
			Neuromodulation
		Surgical Therapy
			Surgical Therapy for Orchalgia in Patients With Identifiable Intrascrotal Lesions
			Vasovasostomy or Vasoepididymostomy for Treatment of Postvasectomy Pain
			Microsurgical Denervation of the Spermatic Cord
			Epididymectomy for Chronic Pain
			Orchiectomy for Chronic Scrotal Pain
	References
	References
57 Interstitial Cystitis/Bladder Pain Syndrome and Related Disorders
	A Brief History and Overview
	Definition, Nomenclature, and Taxonomy
		Interstitial Cystitis/Bladder Pain Syndrome Research Criteria and Their Influence on Clinical Practice
	Historical Perspective of Interstitial Cystitis/Bladder Pain Syndrome: Early 1800S to 1970S
	Voiding Symptoms and Interstitial Cystitis/Bladder Pain Syndrome
	Epidemiology of Interstitial Cystitis/Bladder Pain Syndrome
		Interstitial Cystitis/Bladder Pain Syndrome in Children
	The Epidemiology of Hunner Lesions
		Heredity and Interstitial Cystitis/Bladder Pain Syndrome
		Natural History, Effects on Quality of Life, and Economic Burden
		Abuse and Symptoms
		Medical Costs
		Associated Disorders
	Etiology
		Animal Models
		Infection
		Autoimmunity and Inflammation
		Mast Cell Involvement
		Bladder Glycosaminoglycan Layer and Epithelial Permeability
		Inhibition of Uroepithelial Cell Proliferation: Antiproliferative Factor
		Neurobiology
		Pelvic Organ Cross-Sensitization
		Nitric Oxide Metabolism
		Urine Abnormalities
		Role of Genetics in Bladder Pain Syndrome
		Other Potential Causes
	Pathology
		Diagnosis
		Ketamine Cystitis
		High-Tone Pelvic Floor Dysfunction
	Beyond the History, Physical Examination, and Urine Studies
		The Voiding Diary
		Symptom Scales for Clinical Assessment and Research
		Urodynamic Evaluation
		Office Cystoscopy
		Cystoscopy With Hydrodistention and Biopsy
		The Search for a Marker
		Potassium Chloride Test
	Treatment of Interstitial Cystitis/Bladder Pain Syndrome
		General Principles of Therapy
		Conservative Therapies
		Diet
		The Role of Patient Support Groups
		Oral Therapies (Table 57.6)
			Amitriptyline
			Antihistamines
			Montelukast
			Pentosan Polysulfate Sodium
			Immunomodulator Drugs
				Cyclosporine A.
				Other Immunoregulating Agents.
			Miscellaneous Agents
				l-Arginine.
				Quercetin.
				Antibiotics.
				Nifedipine.
				Misoprostol.
				Dextroamphetamine.
				Phosphodiesterase Inhibitors.
				Gabapentin.
		Intravesical Therapies
			Silver Nitrate
			Clorpactin
			Dimethyl Sulfoxide
			Glycosaminoglycans
			Other Intravesical Therapies
				Sodium Channel Blocking Anesthetics (Lidocaine).
			Intradetrusor Therapy
				Onabotulinum Toxin-A (BTX-A).
			Neuromodulation
		Surgical Therapy
			Hydrodistention
			Surgical Considerations
			Historical Procedures
			Surgery for Hunner Lesion
			Major Surgical Procedures
		“Less Is More”
	Final Thoughts
	Suggested Readings
	References
	References
58 Sexually Transmitted Diseases*
	Epidemiology of Sexually Transmitted Diseases
		Clinical Prevention Guidance
		Screening Recommendations
			Young or at-Risk Women
			Pregnant Women
			Persons in Correctional Facilities
			Men Who Have Sex With Men
			Transgender Men and Women
		Reporting Sexually Transmitted Disease
		Prevention Methods
	Urethritis
		Etiology
		Diagnosis
		Gonococcal Urethritis
		Diagnosis of Gonococcal Urethritis
		Treatment of Gonococcal Urethritis
		Nongonococcal Urethritis
		Chlamydia
		Mycoplasma Genitalium
		Trichomaonas Vaginalis
		Persistent or Recurrent Nongonoccal Urethritis
	Epididymitis
		Diagnosis of Epididymitis
		Treatment of Epididymitis
	Genital, Anal, and Perianal Ulcers
		Genital Herpes Simplex Virus Infections
		Pathophysiology of Genital Herpes
		Presentation of Genital Herpes
		Diagnosis of Genital Herpes
		Treatment of Genital Herpes
		Syphilis
		Primary Syphilis
		Secondary Syphilis
		Latent Syphilis
		Tertiary Syphilis
		Diagnosis of Syphilis
			Darkfield Examination
			Serology
			Nontreponemal Tests
			Treponemal Tests
		Treatment for Syphilis
		Chancroid
		Granuloma Inguinale (Donovanosis)
		Lymphogranuloma Venereum
		Molluscum Contagiosum
	Anogenital Warts
		Human Papillomavirus
		Presentation and Diagnostic Considerations
		Treatment of Anogenital Warts
		Human Papillomavirus Vaccine
	Zika Virus
		Transmission of Zika Virus
		Symptoms
		Diagnosis
		Preconception Counseling and Prevention of Sexual Transmission of Zika Virus
		Treatment for Zika Virus Infections
	Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)
		Diagnosis of Human Immunodeficiency Virus
		Decreasing the Transmission Risk
			Male Circumcision
			Postexposure Prophylaxis
			Pre-Exposure Prophylaxis
		Urologic Manifestations of HIV/AIDS
			HIV and Other STDs
			Nonulcerating Skin Infections
			Urinary Tract Infections
			Renal Infections
			Prostatitis
			Testis, Epididymis, and Seminal Vesicles
			Nephrolithiasis
			Renal Dysfunction
			Voiding Dysfunction
			Erectile Dysfunction
			Malignancy
			Kaposi Sarcoma
		Non–AIDS-Defining Urologic Malignancies
			Testicular Tumors
			Prostate Cancer
			Renal Cell Carcinoma
			Bladder Cancer
			Penile Cancer
	Viral Hepatitis
		Hepatitis B
			Diagnosis
			Screening
			Treatment
			Prevention
			Counseling Patients Who Are HBsAg Positive
			Vaccination
		Postvaccination Serologic Testing for Response
		Postexposure Prophylaxis
		Postexposure in a Previously Vaccinated Health Care Worker
		Postexposure in an Unvaccinated or Incompletely Vaccinated Health Care Worker
		Clinical Management of the Health Care Worker Exposed to HBV
		Hepatitis C
			Diagnosis
		Occupational HCV Exposure in the Health Care Worker
			Treatment
	Ectoparasitic Infections
		Pediculosis Pubis (Phthirus Pubis): Pubic or Crab Louse
		Scabies
	Vaginitis
		Bacterial Vaginosis
		Trichomoniasis
		Candidiasis
	References
	References
59 Cutaneous Diseases of the External Genitalia
	Introduction to Basic Dermatology
	Dermatologic Therapy
	Allergic Dermatitis
		Atopic Dermatitis (Eczema)
		Contact Dermatitis
		Erythema Multiforme and Stevens-Johnson Syndrome
	Papulosquamous Disorders
		Psoriasis
		Reactive Arthritis (Formerly Reiter Syndrome)
		Lichen Planus
		Lichen Nitidus
		Lichen Sclerosus
		Fixed Drug Eruption
		Seborrheic Dermatitis
	Vesicobullous Disorders
		Pemphigus Vulgaris
		Bullous Pemphigoid
		Dermatitis Herpetiformis and Linear IgA Bullous Dermatosis
		Hailey-Hailey Disease
	Noninfectious Ulcers
		Aphthous Ulcers and Behçet Disease
		Pyoderma Gangrenosum
		Traumatic Causes
	Infections and Infestations
		Sexually Transmitted Diseases
		Balanitis and Balanoposthitis
		Cellulitis and Erysipelas
		Fournier Gangrene (Necrotizing Fasciitis of the Perineum)
		Folliculitis
		Furunculosis
		Hidradenitis Suppurativa (Acne Inversa)
		Corynebacterial Infection (Trichomycosis Axillaris and Erythrasma)
		Ecthyma Gangrenosum
		Genital Bite Wounds
		Candidal Intertrigo
		Dermatophyte Infection
		Infestation
	Neoplastic Conditions
		Squamous Cell Carcinoma in Situ
		Bowenoid Papulosis
		Squamous Cell Carcinoma
		Verrucous Carcinoma (Buschke-Lowenstein Tumor)
		Basal Cell Carcinoma
		Kaposi Sarcoma
		Pseudoepitheliomatous, Keratotic, and Micaceous Balanitis
		Melanoma
		Extramammary Paget Disease
		Cutaneous T-Cell Lymphoma
	Benign Cutaneous Disorders Specific to the Male Genitalia
		Angiokeratoma of Fordyce
		Pearly Penile Papules
		Zoon Balanitis
		Sclerosing Lymphangitis
		Median Raphe Cysts
		Ectopic Sebaceous Glands
	Common Miscellaneous Cutaneous Disorders
		Skin Tag
		Epidermoid Cysts
		Seborrheic Keratosis
		Lentigo Simplex
		Mole (Nevus)
		Dermatofibroma
		Neurofibroma
		Capillary Hemangioma
		Vitiligo
	Suggested Readings
	References
	References
60 Tuberculosis and Parasitic Infections of the Genitourinary Tract
	Genitourinary Tuberculosis
		History
		Microbiology
		Epidemiology
		Infection, Host Immune Response, and Transmission
		Development of Genitourinary Disease
		Clinical Manifestations and Pathologic Features
			Kidney
			Ureter
			Bladder
			Epididymis, Vas Deferens, Testes, and Scrotum
			Prostate and Seminal Vesicles
			Urethra and Penis
		Diagnosis
			Culture
			Nucleic Acid Amplification Tests
			Histopathology
			Screening Tests
				Tuberculin Skin Test, Purified Protein Derivative, Mantoux Test.
				Interferon-Gamma Release Assays.
			Radiography
				Plain Radiography.
				Intravenous Urography.
				Computed Tomography With Urography.
				Retrograde Pyelography and Antegrade Pyelography.
			Ultrasonography
			Magnetic Resonance Imaging
			Cystoscopy and Ureteroscopy
		Treatment
			Medical Therapy
				Corticosteroids.
			Surgical Therapy
				Procedures to Relieve Obstruction.
				Nephrectomy.
				Ureteropelvic and Ureteral Surgery.
					Endoscopic Management.
					Open Surgical Options.
						Bladder Surgery.
				Urethral Procedures.
				Genital Surgery.
		Monitoring for Tuberculosis Relapse
		Management of Genitourinary Tuberculosis in Special Situations
			Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis
			Pregnancy and Lactation
			Human Immunodeficiency Virus Infection
			Renal Transplant Recipients
	Parasitic Infections of the Urogenital Tract
		Schistosomiasis
			History
			Biology and Life Cycle
			Epidemiology
			Pathogenesis and Pathology
			Clinical Manifestations
				Acute Schistosomiasis.
				Chronic Schistosomiasis.
			Diagnosis
			Treatment
				Medical Management.
				Surgical Management.
				Prognosis.
			Prevention and Control
		Filariasis
			Organisms
			Epidemiology
			Pathology and Clinical Manifestations
				Subclinical Infection.
				Acute Adenolymphangitis.
				Lymphedema.
				Genitourinary Manifestations.
				Funiculoepididymitis.
				Hydroceles.
				Scrotal and Penile Elephantiasis.
				Chyluria.
				Tropical Pulmonary Eosinophilia.
			Diagnosis
			Treatment
			Prevention and Control
		Other Nonfilarial Genitourinary Parasites
			Echinococcosis
			Enterobiasis
			Amebiasis
			Trichomoniasis
	Suggested Readings
	References
	References
V Molecular and Cellular Biology
	61 Basic Principles of Immunology and Immunotherapy in Urologic Oncology
		Innate Immune System
			Cytokines and Chemokines
		Adaptive Immune System
		Immune Editing Hypothesis
		Chronic Inflammation and the Endogenous Immune Response to Genitourinary Cancers
		Chronic Inflammation and the Immune Response to Bladder Cancer
		Immune Microenvironment in Kidney Cancer
		Chronic Inflammation and the Immune Response to Prostate Cancer
		Immunotherapy for Genitourinary Cancers
			Bacille Calmette-Guérin in Bladder Cancer
			Cancer Vaccines
			Vaccines for Kidney Cancer
			Vaccines for Prostate Cancer
			PD-1/PD-L1 Blockade in Genitourinary Cancers
			PD-1/PD-L1 Blockade in Second-Line Bladder Cancer
			PD-1/PD-L1 Blockade in First-Line Bladder Cancer
			Selecting Bladder Cancer Patients for PD-1/PD-L1–Based Immunotherapy
			PD-1/PD-L1 Blockade in Kidney Cancer
			PD-1/PD-L1 Blockade in Prostate Cancer
			Combination Immunotherapy Regimens in Genitourinary Cancers
				CTLA-4 Blockade in Prostate and Kidney Cancer
				Combining PD-1/PD-L1 Blockade With Androgen Deprivation Therapy in Prostate Cancer
				Combining PD-1/PD-L1 Blockade With Chemotherapy in Bladder Cancer
				Combining PD-1/PD-L1 Blockade With VEGF Inhibition in Kidney Cancer
		Conclusions
		Suggested Readings
		References
		References
62 Molecular Genetics and Cancer Biology
	Tumor Suppressor Genes and Oncogenes
		Basic Molecular Genetics
			DNA
				Transcription.
				Protein Synthesis.
				Chromosomes and Gene Structure.
		Tumor Suppressor Genes
		Oncogenes
	Cell Cycle Deregulation
		Cyclin-Dependent Kinases and Cyclins
		Cell Cycle Entry
		Retinoblastoma Protein and the Restriction Point
		Cell Cycle Progression Through S Phase
		Mitosis
		G1/S Checkpoint
		S-Phase Arrest
		G2/M Checkpoint
		Mitotic Arrest: The Spindle Assembly Checkpoint
		Retinoblastoma Protein and Genitourinary Malignancies
		Cyclin-Dependent Kinase Inhibitors
		TP53 Tumor Suppressor
	DNA Methylation
		DNA Methylation and Prostate Cancer
		Role of DNA Methylation in Bladder Cancer
		INK4A (p16) Methylation in Bladder Cancer
		Hypermethylation of Other Genes in Bladder Cancer
		Hypomethylation in Bladder Cancer
	DNA Damage and Repair
		DNA Repair Mechanisms
		Double-Strand Break Repair
	Genomic Alterations
		Specific Chromosomal Rearrangements in Genitourinary Malignancies
			Recurrent Gene Rearrangements in Prostate Cancer
			Recurrent Gene Rearrangements in Renal Cancer
			Recurrent Gene Rearrangements in Testicular Cancer
		Other Genomic Alterations in Genitourinary Malignancies
		Hereditary Prostate Cancer
		Sporadic Prostate Cancer
		Renal Cancer
		Bladder Cancer
			Intrinsic Subtypes of High-Grade Bladder Cancer
		Genetic Alterations in Bladder Pre-Neoplasia
			Genetic Alterations in Normal and Benign Bladder Urothelium
			Molecular Genetic-Based Assays for Bladder Cancer Detection and Surveillance
		Testicular Cancer
	Telomeres and Telomerase
		Telomeres and Chromosomal Instability
		Telomere Shortening Acts as a Tumor Suppressive Mechanism in Normal Cells
		Cancers and Premalignant Lesions Possess Abnormally Short Telomeres
		Telomerase Activity Restabilizing Chromosomes and Allowing Unlimited Cellular Replication
		Telomerase Activity as a Potential Diagnostic Marker
		Potential Prognostic Value of Telomere Length in Prostate Cancer
		Telomerase-Based Opportunities for Therapy
	Apoptosis
		Apoptosis and Cancer
		Apoptosis, an Evolutionarily Conserved Process
		Intrinsic Apoptotic Pathway
		Extrinsic Apoptotic Pathway
		Role of TP53 in Apoptosis
		Apoptosis and Genitourinary Malignancies
		Global Defects in Apoptosis
			Alternative Regulators of Apoptosis in Genitourinary Malignancies
	Stem Cells and Cancer
	Checkpoint Inhibition
	Microbiome and Cancer: the Metagenome
	Suggested Readings
	References
	References
VI Reproductive and Sexual Function
	63 Surgical, Radiographic, and Endoscopic Anatomy of the Male Reproductive System
		Testis
			Gross Structure
			Microanatomic Architecture
			Arterial Supply
			Venous Drainage
			Lymphatic Drainage
			Nerve Supply
			Blood-Testis Barrier
			Ultrasonography
			Magnetic Resonance Imaging
		Epididymis
			Gross Structure
			Microanatomic Architecture
			Arterial Supply
			Venous Drainage
			Lymphatic Drainage
			Nerve Supply
			Ultrasonography
			Magnetic Resonance Imaging
		Vas Deferens
			Gross Structure
			Microanatomic Architecture
			Arterial Supply
			Venous Drainage
			Lymphatic Drainage
			Nerve Supply
			Vasogram
		Seminal Vesicles and Ejaculatory Ducts
			Gross Structure
			Microanatomic Architecture
			Arterial Supply
			Venous Drainage
			Lymphatic Drainage
			Nerve Supply
			Transrectal Ultrasonography
			Computed Tomography
			Magnetic Resonance Imaging
		Prostate
			Gross Structure
			Microanatomic Architecture
			Arterial Supply
			Venous Drainage
			Lymphatic Drainage
			Nerve Supply
			Transrectal Ultrasonography of the Prostate
			Magnetic Resonance Imaging of the Prostate
		Urethra
			Prostatic Urethra
			Membranous Urethra
			Penile Urethra
			Fossa Navicularis
		Penis
			Structure
			Arterial Supply
			Venous Drainage
			Lymphatic Drainage
			Nerve Supply
			Cavernosogram
			Doppler Ultrasound of the Penis
			Magnetic Resonance Imaging
		Scrotum
			Gross Structure
			Arterial Supply
			Venous Drainage
			Lymphatic Drainage
			Nerve Supply
		Suggested Readings
		References
		References
64 Male Reproductive Physiology
	Hypothalamic-Pituitary-Gonadal Axis
		Basic Endocrine Concepts
		Components of the Reproductive Axis
			Hypothalamus
			Anterior Pituitary
			Testis
		Development of the Hypothalamic-Pituitary-Gonadal Axis
		Aging and the Hypothalamic-Pituitary-Gonadal Axis
		Testis
			Gross Architecture
		Testis Cytoarchitecture
			Interstitium
				Leydig Cells.
				Testosterone.
				Control of Testosterone Synthesis.
				Testosterone Cycles.
			Seminiferous Tubules
				Sertoli Cells.
				Germ Cells.
			Peritubular Structure
			Blood-Testis Barrier
		Spermatogenesis
			Testis Stem Cell Migration, Renewal, and Proliferation
				Testis Stem Cell Migration.
				Testis Stem Cell Renewal.
				Testis Stem Cell Proliferation.
			Meiosis
			Spermiogenesis
			Sertoli Cell–Germ Cell Interaction
			Genetics
			Genetics and Paternal Age
				Age-Related Sperm Chromosomal Anomalies.
				Age-Related Sperm Genetic Mutations.
				Age-Related Sperm Epigenetic Changes.
	Epididymis
		Gross Architecture
			Vascular and Lymph Supply
			Innervation
		Cytoarchitecture
			Epididymal Epithelium
				Epididymal Contractile Tissue.
		Epididymal Function
			Sperm Transport
			Sperm Storage
			Sperm Maturation
				Sperm Motility.
				Sperm Fertility.
				Sperm Biochemical Changes.
			Regulation of Epididymal Function
	Ductus (Vas) Deferens
		Gross Architecture
		Cytoarchitecture
		Vas Deferens Function
			Sperm Transport
			Absorption and Secretion
	Seminal Vesicle and Ejaculatory Ducts
		Gross Architecture and Cytoarchitecture
			Seminal Vesicle
			Ejaculatory Ducts
		Seminal Vesicle and Ejaculatory Duct–Unit Function
		Seminal Vesicle Function
	Spermatozoa
		Anatomy and Physiology
	Summary
	Suggested Readings
	References
	References
65 Integrated Men’s Health
	Rationale for Integrative Men’s Health
		Introduction to the Problem
		Gender Longevity Gap
		Health and Wellness Gap by Gender
		Explanation of the Poorer Health of Men
			Propensity for Risk-Taking Behavior
			Masculinity Defined Norms of Behavior and Attitudes Toward Health
			Physical and Chemical Exposure in the Workplace
		Targets and Effective Interventions
		Global Men’s Health Movement
	Metabolic Syndrome and Men’s Health
		Introduction, History, and Definitions
		Prevalence and Predictors of Metabolic Syndrome
		Physiology of Metabolic Syndrome
			Abdominal Obesity
			Insulin Resistance
			Dyslipidemia
			Hypertension
			Genetics
			Endothelial Dysfunction
			Hypercoagulable State
			Dietary Factors
			Glucocorticoid and Stress-Response Mediators
			Obstructive Sleep Apnea
		Metabolic Syndrome and Urologic Disorders
			Renal Conditions
				Renal Insufficiency.
				Stones.
					Tumors.
			Bladder Cancers
			Overactive Bladder
			Lower Urinary Tract Symptoms
			Prostate Cancer
			Low Testosterone and Erectile Dysfunction
		Targeting Metabolic Syndrome as a Novel Strategy in Disease Etiology
			Diet and Exercise
			Statins
			Metformin
			Testosterone Therapy
		Metabolic Syndrome in Integrative Men’s Health
		Conclusion
	Testosterone Therapy and Cardiovascular Risk: Advances and Controversies
		Introduction and Historical Context
		Clinical Trials: Evidence of Effectiveness
		Cardiovascular Risk
		What Is a Clinician to Do?
	Association Between Cardiovascular Disease and Erectile Dysfunction
		Predisposing Factors
		Erectile Dysfunction and Subclinical Cardiovascular Disease
	Mental Health and Opioid Abuse in Men
		Mental Illness in Men
		Consequences of Opioid Abuse
		Opioid Prescriptions
		Gonadal Dysfunction
		Role of Urology
	Building an Integrative Men’s Health Center
		Components
		Curriculum
		Future Business Plan
	References
	References
66 Male Infertility
	Epidemiology
	History
		Spermatotoxicity
			Endocrine Modulators
			Recreational Drugs
			Antihypertensives
			Antipsychotics
			Opioids
			Antibiotics
			Cytotoxic Chemotherapeutics
			Anti-Inflammatory Agents
			Phosphodiesterase V Inhibitors
			Environmental Toxicants
			Thermal Toxicity
			Radiation
		Infections and Inflammation
		Childhood Diseases
			Pediatric Surgery
			Testis Torsion
			Cryptorchidism
			Testicular Dysgenesis Hypothesis
			Genetics
			Sexual History
	Physical Examination
		General Physical Examination
		Male Reproductive Physical Examination
			Examining the Scrotum
			Examining the Testis and Epididymis
			Examining the Spermatic Cord
			Examining the Phallus
			Examining the Prostate and Seminal Vesicles
	Laboratory Evaluation of Male Infertility
		Endocrine Evaluation
		Evaluation of Semen
			Bulk Semen Parameters and the World Health Organization Criteria
				Semen Volume.
				Sperm Density.
				Sperm Motility.
				Sperm Morphology.
				Sperm Vitality.
				Computer-Assisted Semen Analysis.
			Secondary Semen Assays
				Pyospermia Assays.
			Tertiary and Investigational Sperm Assays
				Sperm DNA Integrity Assays.
				TUNEL Assay.
				Comet Assay.
				Denatured Sperm DNA Assays.
				Reactive Oxygen Species.
				Acrosome Reaction.
				Sperm Mucus Interaction.
				Sperm Ovum Interaction.
				Sperm Ultrastructural Assessment.
				Sperm Fluorescence in situ Hybridization.
		Genomic Assessment
			Karyotype
			Y Chromosome Microdeletion Testing
			Genomic Sequence Assessment
			Cystic Fibrosis Transmembrane Conductance Regulator Mutation Assessment
	Imaging in the Evaluation of Male Infertility
		Scrotal Ultrasonography
		Vasography
		Venography
		Transrectal Imaging
		Abdominal Imaging
		Cranial Imaging
	Testis Histopathology
	Assisted Reproduction
		Intrauterine Insemination
		In vitro Fertilization
		Diagnoses and Therapies
		Genetic Syndromes
			Chromosomal Numerical Disorders
			Structural Chromosomal Anomalies
			Epigenetic Anomalies
		Testicular Causes
			Spermatogenic Dysfunction
			Steroidogenic Dysfunction
			Microductal Obstruction
		Pituitary Dysfunction
			Hypogonadotropic Hypogonadism
			Pituitary Tumors and Diseases
			Other Pituitary Lesions
			Extrapituitary Endocrine Modulators
		Extratesticular Endocrine Dysfunction
		Developmental Disorders
			Intersex or Disorders of Sexual Development
			Hypospadias and Epispadias
			Cryptorchidism
			Microductal Aplasia
				Congenital Unilateral Absence of the Vas Deferens.
				Congenital Bilateral Absence of the Vas Deferens.
		Varicocele
		Ejaculatory Dysfunction
			Ejaculatory Ductal Obstruction
			Retrograde Ejaculation
			Anejaculation
		Structural Sperm Abnormalities
		Empirical Treatment
	Fertility Preservation in Cancer
		Sperm Cryopreservation
		Testicular Tissue Cryopreservation
		Prepubescent Considerations
		Future Perspectives
	Suggested Readings
	References
	References
67 Surgical Management of Male Infertility
	Surgical Anatomy
		Testicular Blood Supply
		Epididymal Blood Supply
		Blood Supply of the Vas Deferens
		Anatomy of the Excurrent Ducts
		Ejaculatory Ducts
	Testis Biopsy
		Indications
		Open Testis Biopsy: Microsurgical Technique
		Percutaneous Testis Biopsy
		Percutaneous Testicular Aspiration
		Complications of Testis Biopsy
	Vasography
		Indications
		Technique of Vasography and Interpretation of Findings
		Complications of Vasography
			Stricture
			Injury to the Vasal Blood Supply
			Hematoma
			Sperm Granuloma
		Transrectal Vasography and Seminal Vesiculography
		Summary
	Vasovasostomy
		Preoperative Evaluation
			Physical Examination
			Laboratory Tests
			Anesthesia
		Surgical Approaches: Scrotal
		Surgical Approaches: Inguinal
		Preparation of the Vasa
		When to Perform Vasoepididymostomy
		Multiple Vasal Obstructions
		Varicocelectomy and Vasovasostomy
		Anastomotic Techniques: Keys to Success
		Setup
		Microsurgical Multilayer Microdot Method
		Anastomosis in the Convoluted Vas
		Crossed Vasovasostomy
			Technique
		Transposition of the Testis
		Wound Closure
		Postoperative Management
		Postoperative Complications
		Long-Term Follow-Up Evaluation After Vasovasostomy
	Surgery of the Epididymis
		Vasoepididymostomy
			Indications
			Microsurgical End-to-Side Vasoepididymostomy
			Intussusception Vasoepididymostomy
			Technique When Vasal Length Is Severely Compromised
			Varicocelectomy and Vasoepididymostomy
			Long-Term Follow-Up Evaluation and Results
	Transurethral Resection of the Ejaculatory Ducts
		Diagnosis
		Technique
		Complications
			Reflux
			Epididymitis
			Retrograde Ejaculation
		Results
	Electroejaculation
		Indications
		Anesthesia
		Technique
	Sperm Retrieval Techniques
		Microsurgical Epididymal Sperm Aspiration Techniques
			Open Tubule Technique
			Percutaneous Epididymal Sperm Aspiration
		Testicular Sperm Extraction
			Microsurgical Testicular Sperm Extraction
				Technique.
				Results.
		Postmortem Sperm Retrieval
	Varicocelectomy
		Scrotal Operations
		Retroperitoneal Operations
		Laparoscopic Varicocelectomy
		Microsurgical Inguinal and Subinguinal Operations: the Preferred Approaches
			Anesthesia
			Inguinal and Subinguinal Approaches
			Dissection of the Cord
			Delivery of the Testis
		Radiographic Occlusion Techniques
		Complications of Varicocelectomy
			Hydrocele
			Testicular Artery Injury
			Varicocele Recurrence
		Results
		Summary
	Orchiopexy in Adults
		Retractile or Ectopic Testes in Adults
	Acknowledgments
	References
	References
68 Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction
	Physiology of Penile Erection
		Historical Contexts on Our Understanding of Erectile Physiology
		Functional Anatomy of the Penis
			Corpora Cavernosa, Corpus Spongiosum, and Glans Penis
			Tunica Albuginea
			Arteries
			Veins
		Hemodynamics and Mechanism of Erection and Detumescence
			Corpora Cavernosa
			Corpus Spongiosum and Glans Penis
		Neuroanatomy and Neurophysiology of Penile Erection
			Spinal Centers and Peripheral Pathways
				Autonomic Pathways.
				Somatic Pathways.
			Supraspinal Pathways and Centers
			Neurotransmitters
				Peripheral Neurotransmitters and Endothelium-Derived Factors Facilitating Penile Erection.
				Peripheral Neurotransmitters and Endothelium-Derived Factors Opposing Penile Erection.
				Interactions Among Nerves and Neurotransmitters.
				Molecules That Modulate Penile Erection via the Central Nervous System.
					Dopamine.
					Oxytocin.
					Nitric Oxide.
					Serotonin.
					Norepinephrine.
					Melanocortins.
					Prolactin.
					γ-Aminobutyric Acid.
					Opioids.
					Cannabinoids.
		Smooth Muscle Physiology
			Cytosolic Calcium and the Calcium Sensitization Pathway
				Cytosolic Free Calcium.
				Rho Kinase Signaling Pathway.
			Molecular Pathways That Directly Modulate Intracellular Free Calcium
			Molecular Pathways That Indirectly Modulate Intracellular Free Calcium
			Modulation of Antitumescence Pathways By Protumescence Pathways
				Cyclic Guanosine Monophosphate–Signaling Pathway
					Nitric Oxide.
					Carbon Monoxide.
					Hydrogen Sulfide.
					Natriuretic Peptides.
					Guanylyl Cyclase Pathway.
					Protein Kinase G.
					Adenylyl Cyclase Pathway.
					Protein Kinase A.
					Phosphodiesterase.
				Caveolae.
				Ion Channels.
				Additional Cyclic Adenosine Monophosphate– Signaling Pathways
					Adenosine.
					Calcitonin Gene–Related Peptide Family.
					Prostaglandins.
					Vasoactive Intestinal Peptide.
				Molecular Oxygen as a Modulator of Penile Erection.
				Intercellular Communication.
			Intracavernous Tissue Architecture and Erectile Response
	Pathophysiology of Erectile Dysfunction
		Incidence and Epidemiology
			Risk Factors
			Psychogenic
			Neurogenic
			Endocrinologic
			Arteriogenic
				Cardiovascular Diseases.
				Hyperlipidemia.
				Obesity.
				Hypertension.
				Mechanism of Vascular Erectile Dysfunction
					Arteriogenic ED.
					Enhanced Smooth Muscle Contraction and Vasoconstriction.
					Impaired Endothelium-Dependent Smooth Muscle Relaxation.
			Corporal Structural Defects
				Sonic Hedgehog Protein.
				Endothelium.
			Drug-Induced
				Antihypertensive Agents.
					Diuretics.
					β-Adrenergic Blockers.
					α-Adrenoceptor Blockers.
					Angiotensin-Converting Enzyme Inhibitors.
					Angiotensin II Type 1 Receptor Antagonists.
					Calcium Channel Blockers.
					Aldosterone Receptor Antagonists.
					Summary on Antihypertensives.
				Psychotropic Medication.
					Antipsychotics.
					Antidepressants.
					Other Antidepressants.
					Anxiolytics.
					Anticonvulsants.
				Antiandrogens.
				Miscellaneous Drugs.
					Digoxin.
					Statins.
					Histamine H2 Receptor Antagonists.
					Opiates.
					Antiretroviral Agents.
					Tobacco.
					Alcohol.
			Aging, Systemic Disease, and Other Causes
				Diabetes Mellitus.
				Metabolic Syndrome.
				Chronic Renal Failure.
				Hyperuricemia.
				Other Chronic Medical Conditions.
			Primary Erectile Dysfunction
				Micropenis.
				Vascular Abnormalities.
	Perspectives
	Suggested Readings
	References
	References
69 Evaluation and Management of Erectile Dysfunction
	Historical Perspective
	Public Health Significance
		Epidemiology
		Health Policy
	Management Principles
		Early Detection
		Shared Decision Making and Treatment Planning
		Step-Care Approach
		Role of Partner Interview
		Cardiac Risk Assessment
		Specialist Referral
		Follow-Up Care
	Diagnostic Evaluation
		Sexual, Medical, and Psychosocial History
			Sexual History
			Medical History
			Psychosocial History
		Physical Examination
		Questionnaires and Sexual Function Symptom Scores
			Cardiovascular Risk Assessment Tools
		Laboratory Tests
	Specialized Evaluation and Testing
		Vascular Evaluation
			Combined Intracavernosal Injection and Stimulation
			Duplex Ultrasonography (Gray Scale or Color-Coded)
			Dynamic Infusion Cavernosometry and Cavernosography
			Penile Angiography
		Historical and Investigational Studies of Penile Blood Flow
			Penile Brachial Pressure Index
			Penile Plethysmography (Penile Pulse Volume Recording)
			Radioisotopic Penography
			Penile Magnetic Resonance Imaging
			Penile Near Infrared Spectrophotometry
			Cavernous Smooth Muscle Content
		Psychophysiologic Evaluation
			Penile Tumescence and Rigidity Monitoring
			Audiovisual and Vibratory Stimulation
			Neuroimaging
		Psychological Evaluation
		Neurologic Evaluation
			Somatic Nervous System
				Biothesiometry.
				Sacral Evoked Response: Bulbocavernosus Reflex Latency.
				Dorsal Nerve Conduction Velocity.
				Genitocerebral Evoked Potential.
			Autonomic Nervous System
				Heart Rate Variability and Sympathetic Skin Response.
				Penile Thermal Sensory Testing.
				Electrochemical Skin Conductance Testing.
				Corpus Cavernosum Electromyography and Single Potential Analysis of Cavernous Electrical Activity.
		Hormonal Evaluation
			Serum Testosterone Measurements
			Serum Gonadotropin Measurements
			Serum Prolactin Measurement
			Magnetic Resonance Imaging Scans
			Serum Thyroid Function Tests
	Treatment Considerations
		Lifestyle Modification
		Medication Change
		Psychosexual Therapy
		Hormonal Therapy
		Testosterone Therapy
			Intramuscular.
			Subcutaneous.
			Transdermal.
			Buccal.
			Oral.
			Alternative Hormone Treatments
			Hyperprolactinemia Treatments
		Pharmacologic Therapies
			Oral Therapy
				Phosphodiesterase Type 5 Inhibitors.
				α-Adrenoceptor Antagonists.
				Dopaminergic Agonists.
				Melanocortin-Receptor Agonists.
				Serotonin-Receptor Effectors.
				Other Oral Therapies.
			Intracavernosal Injection
				Alprostadil.
				Papaverine.
				Phentolamine.
				Vasoactive Intestinal Polypeptide.
			Intraurethral Suppositories
			Transdermal/Topical Pharmacotherapy
		Medical Device
		Surgery
			Penile Prosthesis Surgery
			Penile Revascularization Surgery
				Arterial Revascularization.
				Venous Reconstruction.
		Combination Therapies
			Alternative Therapies
	Future Directions
	Acknowledgment
	References
	References
70 Priapism
	Defining Priapism
		Classifying Priapism
			Ischemic Priapism (Veno-occlusive, Low-Flow)
			Stuttering Priapism (Intermittent, Recurrent Ischemic Priapism)
		Nonischemic Priapism (Arterial, High Flow)
	Priapism: Historical Perspectives
	Epidemiology of Priapism
		Etiology of Ischemic Priapism (Veno-occlusive, Low-Flow)
			Sickle Cell Disease
			Iatrogenic Priapism: Intracavernous Injections
			Iatrogenic Priapism: Oral Phosphodiesterase Type 5 Inhibitors, Medications for Attention-Deficit/Hyperactivity Disorder, and Nutritional Supplements for Erectile Dysfunctions
		Etiology of Stuttering Priapism (Recurrent Ischemic Priapism)
		Etiology and Pathophysiology of Nonischemic (Arterial, High-Flow) Priapism
		Priapism in Children
	Molecular Basis of Ischemic and Stuttering Priapism
	Evaluation and Diagnosis of Priapism
		History
		Physical Examination
		Laboratory Testing
		Penile Imaging
	Medical Treatments
		Ischemic Priapism
		Stuttering Priapism
			Hormonal Therapies
			Baclofen
			Phosphodiesterase Type 5 Inhibitors in the Management of Stuttering Priapism: A Counterintuitive Treatment Strategy
	Surgical Management of Ischemic Priapism
		Shunting
		Immediate Implantation of Penile Prosthesis
	Interventional Angiography in the Management of Arterial (Nonischemic, High-Flow) Priapism
	Surgical Management of Arterial (Nonischemic, High-Flow) Priapism
	Summary
	Suggested Readings
	References
	References
71 Disorders of Male Orgasm and Ejaculation
	Anatomy and Physiology of the Ejaculatory Response
	Premature Ejaculation
		Classification of Premature Ejaculation
		Definition of Premature Ejaculation
			Traditional Definitions of Premature Ejaculation
			International Society for Sexual Medicine Definition of Premature Ejaculation
				Rationale for ISSM Definition of Lifelong and Acquired Premature Ejaculation.
					Rationale for Inclusion of “The Inability to Delay Ejaculation on All or Nearly All Vaginal Penetrations.”
				Rationale for Inclusion of “Negative Personal Consequences, Such as Distress, Bother, Frustration, and/or the Avoidance of Sexual Intimacy.”
				Rationale for Exclusion of Sexual Satisfaction.
			Diagnostic and Statistical Manual of Mental Disorders Definition of Premature Ejaculation
		Prevalence of Premature Ejaculation
		Cause of Premature Ejaculation
			Lifelong Premature Ejaculation
			Acquired Premature Ejaculation
			Premature Ejaculation and Sexual Performance Anxiety, and Psychological or Relationship Problems
			Premature Ejaculation and Comorbid Erectile Dysfunction
			Premature Ejaculation and Prostate Disease
			Premature Ejaculation and Hyperthyroidism
		Evaluation of Men Complaining of Premature Ejaculation
			Medical History
		Diagnosis of Premature Ejaculation
			Determination of Intravaginal Ejaculation Latency Time
		Patient Reported Outcome Measures
			Premature Ejaculation Profile
			Index of Premature Ejaculation
			Premature Ejaculation Diagnostic Tool
		Assessment of Erectile Function
		Physical Examination
		Treatment of Premature Ejaculation
			Psychosexual Therapy
			Pharmacologic Treatment
				Treatment With Selective Serotonin Reuptake Inhibitors and Tricyclic Antidepressants.
					Dapoxetine.
					Off-Label Selective Serotonin Reuptake Inhibitors and Tricyclic Antidepressants.
				Topical Local Anesthetics.
				PDE5 Inhibitors.
				On-Demand Treatment With Off-Label Tramadol.
				Daily Treatment With Off-Label α1-Adrenoceptor Antagonists.
				Intracavernosal Injection of Off-Label Vasoactive Drugs.
				Emerging Investigational Drugs
					DA-8031.
				Oxytocin Antagonists.
				Modafinil.
				Botulinum-A Toxin.
			Acupuncture
			Surgical Neurotomy, Cryoablation, and Neuromodulation of the Dorsal Penile Nerve
	Kate! Delayed Ejaculation, Anejaculation, and Anorgasmia
		Definition, Terminology, and Characteristics of Men With Delayed Ejaculation
			Terminology and Definition
		Epidemiology of Delayed Ejaculation
		Cause of Delayed Ejaculation/Anejaculation
		Psychological Delayed Ejaculation
		Congenital Disorders
		Infective Disorders
		Ejaculatory Duct Obstruction
		Endocrinopathy
		Iatrogenic Causes
		Treatment of Male Pelvic Cancers
			Prostate Cancer
			Rectal Carcinoma
			Testicular Cancer
		Neurologic Disorders
			Spinal Cord Injury
		Evaluation of Men With Delayed Ejaculation
		Treatment of Men With Delayed Ejaculation/Anejaculation
			Psychological Strategies in the Treatment of Delayed Ejaculation
			Pharmacotherapy in the Treatment of Delayed Ejaculation
	Retrograde Ejaculation
		Treatment
	Sperm Retrieval in Men With Anejaculation Pursuing Fertility
	Ejaculatory Anhedonia
	Post-SSRI Sexual Dysfunction
	Orgasmic Headache
	Painful Ejaculation
	Postorgasmic Illness Syndrome
	Conclusion
	Suggested Readings
	References
	References
72 Surgery for Erectile Dysfunction
	Types of Implants Available
	Informed Consent
	Preoperative Preparation
	Incisions
	Technique of Device Placement
		Reservoir Placement
	Intraoperative Troubleshooting
		Fibrotic Corpora
		Crural Crossover
			Corporal Perforation
			Hypermobile Glans Penis
			Curved Erection After Cylinder Placement
	Postoperative Complications
		Implant Infection
		Cylinder Aneurysm
		Cylinder Extrusion
		Cylinder Erosion
		Visceral Erosion of the Reservoir
		Penile Necrosis After Implant Placement
	Special Situations
		Immunosuppressed Patients
		Penile Implants in Ischemic Priapism
		Lax Suspensory Ligament
		Long-Distance Bicycle Riding
	Postoperative Care
		Mechanical Reliability: Repair for Mechanical Defect
	Patient and Partner Satisfaction
	Suggested Readings
	References
	References
73 Diagnosis and Management of Peyronie’s Disease
	General Considerations
	Natural History
	Epidemiology
		Incidence
		Associated Conditions
			Aging
			Diabetes
			Erectile Dysfunction
			Psychological Aspects
			Radical Prostatectomy
			Hypogonadism
			Collagen Disorders
	Penile Anatomy and Peyronie’s Disease
		Impact of Wound Healing on the Development of Peyronie’s Disease
	Etiology of Peyronie’s Disease
		Role of Oxygen Free Radicals and Oxidative Stress
		Role of Nitric Oxide in Peyronie’s Disease
		Role of Myofibroblasts in Peyronie’s Disease
		Role of Transforming Growth Factor-β1 in the Etiology of Peyronie’s Disease
		Fibrotic Gene Expression in Peyronie’s Disease
	Symptoms
	Evaluation of the Patient
	Treatment Protocols
	Nonsurgical Treatment of Peyronie’s Disease
		Oral Medications
			Potaba
			Vitamin E
			Tamoxifen
			Colchicine
			Carnitine
			Pentoxifylline
			Phosphodiesterase Type 5 Inhibitors
		Intralesional Injection
			Verapamil
			Nicardipine
			Interferon Alfa-2b
			Collagenase Clostridium Histolyticum
		Topical Drug Application
		Electromotive Drug Administration
		Extracorporeal Shock Wave Therapy
		Penile Traction
		Vacuum Therapy
		Combination Therapy
		Radiation Therapy
		Conclusion
	Surgical Management
		Indications
		Tunical Shortening Procedures
		Tunical Lengthening Procedures (Plaque Incision or Partial Excision and Grafting)
			Graft Materials
			Grafting Surgical Technique
			Postoperative Management
		Penile Prosthesis for Men With Peyronie’s Disease
			Indications
			Techniques for Straightening When Placing a Penile Prosthesis for Peyronie’s Disease
	Conclusion
	Suggested Readings
	References
	References
74 Sexual Function and Dysfunction in the Female
	Anatomy and Physiology of Female Sexual Organs
		Vulva
			Mons Pubis
			Clitoris
			Labia
			Vestibule
			Introitus
			Hymen Vaginae
			Fourchette
			Perineal Body
			Female Urethra and Urethral Orifice
			Vulva: Vascularization, Lymphatic Drainage, and Neuroanatomy
		The Clitoral Complex
			Clitoral Complex: Vascularization and Neuroanatomy
			Female Sexual Physiology
		Female Sexual Response
		Neurogenic Mediators of the Female Sexual Response
		Hormonal Regulators of Female Sexual Response
			Estrogens
			Testosterone
		Mental Aspects of Sexual Response
	Evaluation of Sexual Wellness
		History Taking
			The PLISSIT Model of Assessment and Treatment
		Questionnaires
			Evaluation of the Partner
		Physical Examination
		Laboratory Tests
			Physiologic Measures of Sexual Function
		Definitions of Sexual Dysfunctions in Female Patients
		DSM-5 Definitions of Sexual Dysfunctions in Women
			Female Sexual Interest–Arousal Disorder
			Female Orgasmic Disorder
			Genito-Pelvic Pain-Penetration Disorder
		International Consultation on Sexual Medicine Definitions of Sexual Dysfunctions in Women
			Hypoactive Sexual Desire Dysfunction
			Female Sexual Arousal Dysfunction
			Female Orgasmic Dysfunction
			Female Genital-Pelvic Pain Dysfunction
			Persistent Genital Arousal Disorder
			Postcoital Syndrome (Postorgasmic Illness Syndrome)
			Hypohedonic Orgasm
			Painful Orgasm
		Epidemiology of Female Sexual Dysfunction
			Interest and Desire
			Arousal
			Orgasm
			Dyspareunia and Vaginismus
	Special Populations
		LGBTQ
		Gender Dysphoria and Hormonal Treatment
		Fertility in Transgender People
		Malignancies in Female Transgender Patients
		Sexuality and Disability
	Female Sexual Interest Disorder
		Definition
		Pathophysiology
		Evaluation
		Treatment
		Psychological Treatment
		Medical Treatment
			Hormones
			Bupropion
			Buspirone
			Flibanserin
			Others
		Female Orgasmic Disorder
		Assessment
		Psychosocial Treatment
			Education
			Directed Masturbation and Sensate Focus
			Mindfulness and Yoga
			Coital Alignment Technique
		Sexual Enhancement Products
		Medical Treatment
			Women With Female Orgasmic Disorder Together With Desire and Arousal Problems
			Phosphodiesterase Type 5 Inhibitors
			Hormones
			Women With Female Orgasmic Disorder Who Report Subjectively Sufficient Arousal
			Oxytocin
		Medication-Induced Female Orgasmic Disorder
	Female Sexual Arousal Disorder
		Interview Assessment of Sexual Arousal
		Potential Treatments for the Psychosocial Aspects of Female Sexual Arousal Disorder
	Pharmacotherapy for Female Sexual Arousal Disorder
		Hormonal Therapy
			Testosterone and Selective Tissue Estrogenic Activity Regulator
		Nonhormonal Therapy
			Phosphodiesterase Type 5 Inhibitors
			Prostaglandins
			l-Arginine
			Dopamine Agonists
			Bupropion
			Oxytocin
		Female Persistent Genital Arousal Disorder
			Psychosocial Characterization and Etiologic Factors
		Treatment Targets
	Genitopelvic Pain and Penetration Disorder
		Pain and Sex
		Provoked Vestibulodynia
			Primary
			Secondary
			Pathogenesis
		Clitoris and Clitorodynia
		Clinical Presentation (Fig. 74.10)
			Menopause and Dyspareunia
		Previous Genitourinary Surgery
		Treatment
			Education
			Biofeedback
		Dilators and Insertion Techniques
		Electrical Stimulation
		Manual Therapy
		Multimodal Physical Therapy
		Topical Therapy
		Surgery
		Multidisciplinary and Multimodality Approaches
	Lower Urinary Tract Dysfunction and Female Sexual Dysfunction
		Sexual Lifestyle and Communication
			Epidemiology
			Etiology and Classification
			Clinical Signs and Investigations
	Lower Urinary Tract Symptoms and Female Sexual Dysfunction: Links and Treatments
		Urinary Incontinence and Overactive Bladder
		Pelvic Organ Prolapse
		Bladder Pain Syndrome/Interstitial Cystitis
	Self-Image/Body Image Connected to Female Sexual Dysfunction and Lower Urinary Tract Symptoms
	Conclusion
	References
	References
VII Male Genitalia
	75 Surgical, Radiographic, and Endoscopic Anatomy of the Retroperitoneum
		Body Surface Landmarks
		Posterior Abdominal Wall
			Flank Muscles (Figs. 75.4 to 75.7 and Table 75.2)
			Psoas, Iliacus, Quadratus Lumborum, and Erector Spinae (Fig. 75.8; also see Figs. 75.4 to 75.7 and Table 75.2)
			Spine
			10th, 11th, and 12th Ribs
		Lumbodorsal Fascia
		Retroperitoneal Fasciae and Spaces
			Transversalis Fascia and Posterior Pararenal Space
			Gerota Fascia (Renal Fascia) and Perirenal Space
			Anterior Pararenal Space and Inner Stratum
		Gastrointestinal Viscera and Mesentery
		Vasculature
			Arterial System
			Venous System
		Lymphatic System
		Nervous Structures
			Autonomic Nervous System
			Somatic Nervous System
		Suggested Readings
		References
		References
76 Neoplasms of the Testis
	Germ Cell Tumors
		Epidemiology
		Risk Factors
		Pathogenesis and Biology
		Histologic Classification
			Germ Cell Tumor Neoplasia in Situ
			Seminoma
			Spermatocytic Tumor
			Embryonal Carcinoma
			Choriocarcinoma
			Yolk Sac Tumor
			Teratoma
		Initial Presentation
			Signs and Symptoms
			Physical Examination
			Differential Diagnosis
			Diagnostic Delay
		Diagnostic Testing and Initial Management
			Scrotal Ultrasound
			Magnetic Resonance Imaging
			Serum Tumor Markers
			Radical Inguinal Orchiectomy
			Testis-Sparing Surgery
			Contralateral Testis Biopsy
			Suspected Extragonadal Germ Cell Tumor
		Clinical Staging
			Staging Imaging Studies
			Clinical Staging of the Abdomen and Pelvis
			Pathological Staging of the Abdomen and Pelvis
			Chest Imaging
			Serum Tumor Markers
			Prognostic Classification of Advanced Germ Cell Tumor
			Sperm Cryopreservation
		Treatment
			Therapeutic Principles
			Contrasting Seminoma and Nonseminoma Germ Cell Tumor
			Germ Cell Neoplasia in Situ
		Nonseminoma Germ Cell Tumor
			Clinical Stage I Nonseminoma Germ Cell Tumor
				Risk Assessment.
				Surveillance.
				Retroperitoneal Lymph Node Dissection.
				Primary Chemotherapy.
				Treatment Selection for Clinical Stage I Nonseminoma Germ Cell Tumor.
			Clinical Stage IS Nonseminoma Germ Cell Tumor
			Clinical Stage IIA and IIB Nonseminoma Germ Cell Tumor
			Clinical Stage IIC and III Nonseminoma Germ Cell Tumor
				Chemotherapy for Good-Risk Nonseminoma Germ Cell Tumor.
				Chemotherapy for Intermediate- and Poor-Risk Nonseminoma Germ Cell Tumor.
				Management of Post-Chemotherapy Residual Masses in Nonseminoma Germ Cell Tumor.
			Relapsed Nonseminoma Germ Cell Tumor
				Chemotherapy-Naïve Nonseminoma Germ Cell Tumor Relapse.
				Post-Chemotherapy Nonseminoma Germ Cell Tumor Relapse—Early.
				Management of Post-Salvage Chemotherapy Residual Masses.
				Desperation Surgery.
				Post-Chemotherapy Nonseminoma Germ Cell Tumor Relapse—Late.
		Seminoma
			Clinical Stage I Seminoma
				Primary Radiotherapy.
				Surveillance.
				Primary Chemotherapy With Single-Agent Carboplatin.
			Clinical Stage IIA and IIB Seminoma
			Clinical Stage IIC and III Seminoma
				Management of Post-Chemotherapy Residual Masses.
			Relapsed Seminoma
				Chemotherapy-Naïve Seminoma Relapse.
				Post-Chemotherapy Seminoma Relapse—Early.
				Post-Chemotherapy Seminoma Relapse—Late.
		Brain Metastases
		Treatment Sequelae
			Early Toxicity
			Late Toxicity
	Non–Germ Cell Tumors
		Sex Cord-Stromal Tumors
			Leydig Cell Tumors
			Sertoli Cell Tumor
			Granulosa Cell Tumors
			Gonadoblastoma
		Miscellaneous Testis Neoplasms
			Dermoid and Epidermoid Cyst
			Adenocarcinoma of the Rete Testis
				Testicular “Tumor” of the Adrenogenital Syndrome.
		Secondary Tumors of the Testis
			Lymphoma
			Leukemic Infiltration
			Metastases
	Tumors of the Testicular Adnexa
		Adenomatoid Tumor
			Cystadenoma
			Mesothelioma
			Sarcoma
	Suggested Readings
	References
	References
77 Surgery of Testicular Tumors
	Management of Testis Mass
		History and Physical Examination, Ultrasonography, and Preorchiectomy Evaluation
			Radical Orchiectomy
			Technique
		Partial Orchiectomy
			Technique
		Delayed Orchiectomy
		Postorchiectomy Evaluation
	Retroperitoneal Lymph Node Dissection
		Preoperative Planning
		Surgical Technique
			Exposure of the Retroperitoneum
			Split and Roll Technique (Video 77.1)
			Left Para-Aortic Packet
			Interaortocaval Packet
			Right Paracaval Packet
			Gonadal Vein
			Nerve Sparing
			Closure and Postoperative Care
	Auxiliary Procedures
		Nephrectomy
		Major Vascular Reconstruction
			Inferior Vena Cava Resection
			Aortic Reconstruction
		Hepatic Resections
		Pelvic Resections
		Management of Supradiaphragmatic Disease
			Resection of Retrocrural Disease
	Surgical Decision Making
		Management of Clinical Complete Remission to Induction Chemotherapy
		Use of Modified Templates in Primary Retroperitoneal Lymph Node Dissection
		Use of Modified Templates in Retroperitoneal Lymph Node Dissection After Chemotherapy
		Adjuvant Chemotherapy for Pathologic Stage II Disease at Primary Retroperitoneal Lymph Node Dissection
	Histologic Findings at Post-Chemotherapy Retroperitoneal Lymph Node Dissection and Survival Outcomes
		Outcomes by Histology
			Fibrosis/Necrosis
			Teratoma
			Viable Malignancy
		Adjuvant Chemotherapy
	Post-Chemotherapy Retroperitoneal Lymph Node Dissection in High-Risk Populations
		Salvage Retroperitoneal Node Dissection
		Desperation Retroperitoneal Node Dissection
		Reoperative Retroperitoneal Node Dissection
		Late Relapse
	Surgical Outcomes, Functional Considerations, and Complications of Retroperitoneal Lymph Node Dissection
		Lymph Node Counts
		Retroperitoneal Lymph Node Dissection and Fertility
			Fertility in Patients Undergoing Retroperitoneal Lymph Node Dissection
			Ejaculatory Dysfunction and Retroperitoneal Lymph Node Dissection
		Complications of Retroperitoneal Lymph Node Dissection
			Pulmonary Complications
			Ileus
			Lymphocele
			Chylous Ascites
			Venous Thromboembolism
			Neurologic Complications
			Mortality
	Retroperitoneal Lymph Node Dissection in Unique Situations
		Post-Chemotherapy Retroperitoneal Node Dissection for Seminoma
		Post-Chemotherapy Retroperitoneal Node Dissection for Sex Cord Stromal Tumors
	Conclusion
	References
	References
78 Laparoscopic and Robotic-Assisted Retroperitoneal Lymphadenectomy for Testicular Tumors
	Rationale and Evolution
	Staging Laparoscopic Retroperitoneal Lymph Node Dissection and Controversy
	Duplication of Open Retroperitoneal Lymph Node Dissection
	Development of Robotic-Assisted Retroperitoneal Lymph Node Dissection
	Surgical Technique
		Preoperative Patient Preparation and Technical Considerations
		Laparoscopic Approach
		Patient Positioning and Port Placement for Laparoscopic Retroperitoneal Lymph Node Dissection
		Right-Sided Dissection
			Spermatic Cord Dissection
			Lymphadenectomy
		Left-Sided Dissection
			Spermatic Cord Dissection
			Lymphadenectomy
		Bilateral Laparoscopic Retroperitoneal Lymph Node Dissection
		Robotic-Assisted Retroperitoneal Lymph Node Dissection Port Placement and Technique
	Postoperative Care
	Prospective Nerve-Sparing Techniques
	Complications
	Results and Current Status
		Laparoscopic Retroperitoneal Lymph Node Dissection for Clinical Stage I Disease
		Laparoscopic Retroperitoneal Lymph Node Dissection for Clinical Stage II
	Summary
	Suggested Readings
	References
	References
79 Tumors of the Penis
	Premalignant Cutaneous Lesions
		Non–Human Papillomavirus–Related Penile Premalignant Lesions
			Cutaneous Horn
			Pseudoepitheliomatous Keratotic and Micaceous Balanitis
			Male Lichen Sclerosus (Balanitis Xerotica Obliterans)
		Virus-Related Penile Lesions
			Human Papillomavirus in Malignant Transformation
			Buschke-Löwenstein Tumor (Giant Condyloma Acuminatum)
		Carcinoma in situ (Penile Intraepithelial Neoplasia)
			Kaposi Sarcoma
	Squamous Cell Carcinoma
		Invasive Carcinoma
		Etiology
		Prevention
		Natural History
		Modes of Presentation
			Signs
			Symptoms
		Diagnosis
			Delay
			Examination
			Biopsy
			Histologic Features
			Laboratory Studies
			Radiologic Studies
				Primary Penile Tumor.
				Inguinal and Pelvic Region
					Current Imaging Strategies Among Clinical Node-Negative Patients.
					Current Imaging Strategies Among Clinical Node-Positive Patients.
			Penile Cancer Staging
				Eighth Edition TNM Penile Staging System.
				Tumor Grading.
				Definition of the Primary Tumor
					Stage Ta Definition.
					Stage T1 Definition: Anatomic Detail.
					Stage T1 Definition: Inclusion of Perineural Invasion.
					Stage T2-T4 Definition Changes.
					Pathologic Stage N1-N2 Definitions.
			Differential Diagnosis
	Surgical Management of the Primary Tumor
		Organ Preservation
		Circumcision and Limited Excision Strategies
			Mohs Micrographic Surgery
			Laser Ablation
			Contemporary Penile Amputation
	Treatment of the Inguinal Nodes
		Contemporary Indications for Inguinal Lymphadenectomy
			Prognostic Significance of the Presence and Extent of Metastatic Disease
			Presence of Palpable Adenopathy as a Selection Factor for Inguinal Dissection
		Evolving Indications for Lymphadenectomy in Patients Without Palpable Adenopathy
			Immediate Versus Delayed Surgery
			Morbidity Versus Benefit
		Impact of Primary Tumor Histologic Features on Predicting Occult Nodal Metastasis
		Molecular Prognostic Markers
		Evolving Indications for Expectant Management of the Inguinal Region
		Indications for Modified and Traditional Inguinal Procedures
			Modified Procedures
				Fine-Needle Aspiration Cytology.
				Sentinel Lymph Node Biopsy, Extended Sentinel Lymph Node Dissection, and Node Biopsy.
				Dynamic Sentinel Node Biopsy.
				Superficial and Modified Complete Inguinal Dissection.
				Minimally Invasive Inguinal Lymphadenectomy Using Laparoscopy or Robotic Techniques.
			Traditional Inguinal and Ilioinguinal Lymphadenectomy
		Risk-Based Management of the Inguinal Region
			Very Low-Risk Patients
			Low- to Intermediate-Risk Patients (American Joint Committee on Cancer Stage T1a)
			High-Risk Patients (American Joint Committee on Cancer Stage T1b or Higher)
			Bulky Adenopathy and Fixed Nodal Metastasis
	Radiation Therapy
		Radiation Therapy for the Primary Lesion
			External-Beam Radiotherapy
			Brachytherapy
				Low-Dose Rate Brachytherapy.
				Brachytherapy: High-Dose Rate Interstitial.
			Brachytherapy: Surface Mold
			Adverse Effects Associated With Radiotherapy
		Radiation Therapy for the Inguinal Areas
	Chemotherapy
		Active Single Agents, Combination Strategies, and Post-Chemotherapy Surgery
		Single-Agent Chemotherapy
		Combination Chemotherapy
		Adjuvant Chemotherapy
		Post-Chemotherapy Surgical Consolidation
	Nonsquamous Penile Malignant Neoplasms
		Basal Cell Carcinoma
		Melanoma
		Sarcomas
		Extramammary Paget Disease
		Adenosquamous Carcinoma
		Lymphoreticular Malignant Neoplasm
		Metastases
	References
	References
80 Tumors of the Urethra
	Benign Urethral Tumors
		Leiomyoma
		Hemangioma
		Fibroepithelial Polyp
	Male Urethral Cancer
		Epidemiology, Etiology, and Clinical Presentation
		Pathology
			Evaluation and Staging
		Male Anterior Urethral Cancer
			Prognosis
			Treatment
			Carcinoma of the Pendulous Urethra
			Carcinoma of the Bulbar Urethra
		Male Posterior Urethral Cancer
	Female Urethral Cancer
		Epidemiology, Etiology, and Clinical Presentation
		Anatomy and Pathology
			Evaluation and Staging
			Prognosis
			Treatment
	Urethral Recurrence After Radical Cystectomy
		Male Urethra
			Total Urethrectomy After Cutaneous Diversion
			Total Urethrectomy After Orthotopic Diversion
		Female Urethra
	Acknowledgments
	References
	References
81 Inguinal Node Dissection
	Introduction
	Anatomic Background
		Penile Lymphatics
		Urethral Lymphatics
	Inguinal Anatomy
	Endoscopic Anatomy of Inguinal Area
	Imaging Evaluation of Inguinal Area
		Ultrasonography With Fine-Needle Aspiration Cytology
		Computed Tomography and Magnetic Resonance Imaging
		Magnetic Resonance Imaging With Nanotechnology
		Positron Emission Tomography
	Penile Cancer: Surgical Management of Regional Lymph Nodes
	Penile Cancer: Nonpalpable Inguinal Adenopathy
		Sentinel Lymph Node Biopsy
		Dynamic Sentinel Lymph Node Biopsy
		Technique
		Follow-Up
		Superficial Inguinal Lymph Node Dissection (SILND)
		Modified Inguinal Lymph Node Dissection
		Endoscopic and Robotic Inguinal Lymphadenectomy
			Background
		Surgical Technique
	Penile Cancer: Palpable Inguinal Adenopathy or Positive Inguinal Lymph Nodes
		Surgery for Curative Purposes
		Radical Inguinal Lymph Node Dissection
		Adjuvant Chemotherapy
		Surgery for Palliative Purposes
	Preparation of the Patient Before Surgery
		Antibiotics
		Anticoagulation
		Bowel Cleansing
	Postoperative Care of Patients After Inguinal Lymphadenectomy
		Bed Rest
		Dietary Considerations
		Antibiotics
		Anticoagulation (see Preparation of the Patient Before Surgery)
			Compressive Dressings and Stockings
		Drainage
	Complications of Inguinal Lymphadenectomy
	Oncologic Results and Follow-Up After Surgery
		Oncologic Control
		Follow-Up
	References
	References
82 Surgery for Benign Disorders of the Penis and Urethra
	Generalities of Reconstructive Surgical Techniques
	Principles of Reconstructive Surgery
		Grafts
			Split-Thickness Skin Graft
			Full-Thickness Skin Graft
			Dermal Graft
			Oral Mucosa Grafts
			Vein Grafts
			Other Grafts
		Flaps
			Random Flaps
			Axial Flaps
			Peninsular Flap
			Island Flap
	Surgical Anatomy of the Penis and Male Perineum
		Penile Anatomy
			Urethral Anatomy
			Sphincteric Anatomy
			Blood Supply
				Venous Drainage.
				Arterial System.
			Lymphatics
			Nerve Supply
		Perineum
			Colles Fascia
			Superficial Perineal Space
				Central Perineal Tendon (Perineal Body).
				Deep Perineal Space.
	Selected Processes
		Urethral Hemangioma
		Reactive Arthritis/Reiter Syndrome
		Lichen Sclerosus
		Amyloidosis
		Urethrocutaneous Fistula
		Urethral Diverticulum: Male
		Paraphimosis, Balanitis, and Phimosis
		Urethral Meatal Stenosis
		Circumcision
		Transitional Urologic Care for the Patient With Failed Hypospadias and Epispadias Repair
			Failed Hypospadias Repair
		Failed Epispadias Repair
	Urethral Stricture Disease
		Urethral Anatomy
		Etiology
			Iatrogenic
			Traumatic
			Inflammatory
			Idiopathic
			Congenital
		Diagnosis and Evaluation
		Decision Making
		Treatment
			Dilation
			Internal Urethrotomy
		Lasers
			Stents
			Open Reconstruction
				Excision and Reanastomosis.
				Vessel-Sparing Technique.
				Graft Onlay.
				Flap Onlay.
				Augmented Anastomosis.
				Perineal Urethrostomy.
	Pelvic Fracture Urethral Injuries
		Evaluation
		Repair
		Postoperative Management
		Summary
	Vesicourethral Distraction Defects (Vesicourethral Stenosis)
	Complex Fistula of the Posterior Urethra
	Curvatures of the Penis
		Types of Congenital Curvature of the Penis
		Chordee Without Hypospadias in Young Men
		Congenital Curvatures of the Penis
		Acquired Curvatures of the Penis
			Acquired Curvatures of the Penis From Causes Other Than Peyronie Disease
	Penile Transplantation
		General
		Reconstruction After Trauma
		Female-to-Male Transgender
	Suggested Readings
	References
	References
83 Surgery of the Scrotum and Seminal Vesicles
	Surgical Anatomy of the Scrotum
		Scrotal Wall
		Scrotal Contents
		Vasculature
		Innervation
	Preoperative Considerations
		Surgical Approaches to Scrotal Contents
			Access Into the Scrotum
	Surgeries of the Scrotum
		Scrotal Wall
			Cyst/Tumor Excision
			Partial/Total Scrotectomy
			Scrotal Reconstruction
		Testis
			Hydrocelectomy
				Lord Plication.
				Jaboulay (Winkelman) Technique.
				Bottleneck Technique.
				Window Technique.
			Aspiration and Sclerotherapy
			Technique
			Simple Orchiectomy
			Technique
			Testicular Prosthesis Placement
	Epididymis
		Excision of Epididymal Cysts and Spermatoceles
		Epididymal Tumor Excision
	Vas Deferens
		Vasectomy
			Methods of Vas Isolation
			Conventional Vasectomy
			Minimally Invasive Vasectomy
			No-Scalpel Vasectomy
			Vasectomy Reversal
	Surgical Management of Chronic Scrotal Pain
		Surgical Management of Intrascrotal Pain
			Acute and Chronic Epididymitis
			Epididymectomy for Palpable Abnormalities of the Epididymis
			Microsurgical Spermatic Cord Denervation
			Varicocelectomy
		Retractile Testis and Intermittent Testicular Torsion
			Technique
				Testicular Fixation With Suture.
				Dartos Pouch Procedure.
	Complications of Scrotal Surgery
		Bleeding and Postoperative Hematoma
		Chronic Scrotal Pain
		Early/Late Vasectomy Failure
		Epididymal/Vasal Injury or Ligation With Resulting Infertility
		Hydrocele Recurrence
		Infection
		Sperm Granuloma
	Anatomy and Embryology of Seminal Vesicles
	Surgical Approaches to Seminal Vesicles
		Anterior
		Perineal
		Posterior
	Surgeries of the Seminal Vesicles
		Seminal Vesicle Cyst Management
		Transurethral Endoscopic Treatments
			Transrectal Ultrasound–Guided Aspiration
			Seminal Vesicle Tumor Excision
	Complications of Seminal Vesicle Surgery
		Bladder Injury
		Endoscopic Surgery Complications
		Laparoscopic/Robotic Surgery Complications
		Neurovascular Bundle Injury
		Rectal Injury
		Ureteral Injury
	Suggested Readings
	References
	References
VIII Renal Physiology and Pathophysiology
	84 Surgical, Radiologic, and Endoscopic Anatomy of the Kidney and Ureter
		Kidneys
			Surface Anatomy and Relationships
			Gross and Microscopic Anatomy
			Radiologic Anatomy of the Renal Parenchyma
			Renal Vasculature
			Lymphatic Drainage of the Kidney
			Innervation of the Kidney
		Pelvicalyceal System
			Radiologic Anatomy of the Collecting System
		Ureters
			Radiologic Anatomy of the Ureter
			Arteries, Veins, and Lymphatic Drainage of the Ureters
			Nerve Supply of the Ureter
			Microscopic Anatomy of the Ureter
			Endoscopic Anatomy of the Ureter and Pelvicalyceal System
		Suggested Readings
		References
		References
85 Physiology and Pharmacology of the Renal Pelvis and Ureter
	Cellular Anatomy
	Development of the Ureter
	Electric Activity
		Resting Potential
		Action Potential
		Pacemaker Potentials and Pacemaker Activity
		Propagation of Electric Activity
	Contractile Activity
		Contractile Proteins
		Calcium and Excitation-Contraction Coupling
		Urothelial Effects on Contractile Activity
		Second Messengers
	Role of the Nervous System in Ureteral Function
		Parasympathetic Nervous System
		Sympathetic Nervous System
		Sensory Innervation and Peptidergic Agents in the Control of Ureteral Function
		Purinergic Nervous System
	Mechanical Properties
		Force-Length Relations
		Force-Velocity Relations
		Pressure-Length-Diameter Relations
	Urine Transport
		Physiology of the Ureteropelvic Junction
		Propulsion of Urinary Bolus
		Effect of Diuresis on Ureteral Function
		Effects of Bladder Filling and Neurogenic Vesical Dysfunction on Ureteral Function
		Physiology of the Ureterovesical Junction
	Pathologic Processes Affecting Ureteral Function
		Effect of Obstruction on Ureteral Function
			General
			Physiologic Methodologies for Assessing Clinical Obstruction
		Relation Between Vesicoureteral Reflux and Ureteral Function
		Effect of Infection on Ureteral Function
		Effect of Calculi and Stents on Ureteral Function
		Effect of Diabetes on Ureteral Function
		Effect of Age on Ureteral Function
	Effect of Pregnancy on Ureteral Function
	Effect of Drugs on the Ureter
		Histamine and Its Antagonists
		Serotonin
		Kinins
		Angiotensin
		Narcotic Analgesics
		Prostaglandins
	Cardiac Glycosides
		Calcium Antagonists
		Potassium Channel Openers
		Endothelins
		Antibiotics
	Suggested Readings
	References
	References
86 Renal Physiology and Pathophysiology Including Renovascular Hypertension
	Glomerular Filtration
		Nephron Anatomy
		Filtrate Transport
			Sodium
			Potassium
			Water
			Calcium
			Acid-Base Balance
			Additional Solutes
		Renal Hormone Effects
			Vasoconstriction
			Vasodilation
			Red Blood Cell Production
			Bone Mineralization
	Pathophysiology and Management of Renovascular Hypertension
		Pathophysiology
		Diagnosis
		Management
			Medical Therapy
			Percutaneous Intervention
			Surgical Treatment
	Suggested Readings
		Hormonal
		Renal Tubular Function
		Sodium, Water, and Potassium Imbalances
		Acid-Base
		Renovascular Hypertension
	References
	References
87 Renal Insufficiency and Ischemic Nephropathy
	Acute Kidney Injury
		Prerenal Kidney Injury
		Postrenal Kidney Injury
		Intrinsic Kidney Injury
			Acute Tubular Necrosis Resulting From Ischemic Injury
		Contrast Nephropathy
		Pigment-Related Kidney Injury
		Tumor Lysis Syndrome
		Drug Toxicity as a Cause of Acute Kidney Injury
		Renal Vein Thrombosis
		Clinical Approach to the Differential Diagnosis of Acute Kidney Injury
		Management of Acute Kidney Injury
	Chronic Kidney Disease
		Glomerulonephritis
		End-Stage Renal Disease Demographics and Treatment Options
		Atherosclerotic Renal Artery Stenosis
			Pathophysiology of Hypertension in Atherosclerotic Renal Artery Stenosis
				Basic Concepts in Arterial Physiology.
			Pathophysiology of Ischemic Nephropathy in Atherosclerotic Renal Artery Stenosis
			Diagnostic Evaluation of Atherosclerotic Renal Artery Stenosis
				Clinical Features.
			Laboratory Features
			Radiographic Assessment of Atherosclerotic Renal Artery Stenosis
			Therapeutic Options for Atherosclerotic Renal Artery Stenosis
				Medical Management.
				Procedural Management.
		Nonatherosclerotic Renal Artery Diseases
			Fibromuscular Dysplasia
				Epidemiology of Renal Artery Fibromuscular Dysplasia.
				Histopathology of Fibromuscular Dysplasia.
				Clinical Presentation.
				Diagnostic Evaluation.
				Management of Fibromuscular Dysplasia.
	Suggested Readings
	References
	References
88 Urologic Complications of Renal Transplantation
	Hematuria
	Ureteral Stent Management
		Timing of Stent Removal
		Retained Stent
		Prevention
		Diagnosis and Treatment
	Urinary Leak
		Diagnosis
		Treatment
	Ureteral Stricture
		Diagnosis
		Treatment
	Vesicoureteral Reflux
		Diagnosis
		Treatment
	Lymphocele
		Diagnosis
		Treatment
	Nephrolithiasis
		Treatment
	Lower Urinary Tract Complications
		Voiding Dysfunction
		Small Bladder After Transplant
		Benign Prostatic Hyperplasia
		Urine Incontinence
	Genitourinary Malignancies
		Renal Cell Carcinoma
		Prostate Cancer
		Bladder Cancer
	Conclusion
	Suggested Readings
	References
	References
IX Upper Urinary Tract Obstruction and Trauma
	89 Management of Upper Urinary Tract Obstruction
		Evaluation of Upper Tract Obstruction
		Ureteropelvic Junction Obstruction
			Pathogenesis
			Patient Presentation and Diagnostic Studies
			Indications and Options for Intervention
				Options for Intervention
					Endourologic Management.
					Percutaneous Antegrade Endopyelotomy
						Indications and Contraindications.
					Patient Preparation.
					Technique.
					Postoperative Care.
					Results.
					Complications.
					Special Considerations.
					Retrograde Ureteroscopic Endopyelotomy.
						Indications and Contraindications.
						Technique.
						Results.
						Complications.
					Other Retrograde Techniques.
				Operative Interventions
					Historical Notes.
					Dismembered Pyeloplasty
						Indications.
						Technique.
				Surgical Approaches for Pyeloplasty
					Open Surgery.
					Laparoscopic and Robotic Intervention.
					Indications and Contraindications.
					Techniques.
						Transperitoneal Laparoscopic Approach.
						Transmesenteric Modification of the Transperitoneal Approach.
						Vascular Transposition.
						Retroperitoneal Laparoscopic Approach.
						Anterior Extraperitoneal Laparoscopic Approach.
						Robotic-Assisted Laparoscopic Approach.
						Laparoendoscopic Single-Site Surgery Approach.
						Postoperative Care and Complications.
					Results
						Open Approach.
						Minimally Invasive Approaches.
				Special Situations of Laparoscopic and Robotic-Assisted Laparoscopic Management of Ureteropelvic Junction Obstruction
					Laparoscopic and Robotic-Assisted Laparoscopic Ureterocalicostomy.
					Laparoscopic and Robotic-Assisted Pyeloplasty With Concomitant Pyelolithotomy.
					Laparoscopic Dismembered Tubularized Flap Pyeloplasty.
					Laparoscopic Calicovesicostomy.
				Other Reconstructive Procedures Involving the Ureteropelvic Junction (Non–Anderson-Hynes)
					Flap Procedures
						Foley Y-V-Plasty
							Indications.
							Technique.
						Culp-DeWeerd Spiral Flap
							Indications.
							Technique.
						Scardino-Prince Vertical Flap
							Indications.
							Technique.
						Intubated Ureterotomy
							Indications.
							Technique.
						Ureterocalicostomy
							Indications.
							Technique.
					Salvage Procedures.
					Postoperative Care and Management of Complications.
		Retrocaval Ureter
			Etiology and Diagnosis
			Operative Intervention
				Laparoscopic Surgical Management
		Ureteral Stricture Disease
			Etiology
			Diagnostic Studies and Indications for Intervention
			Endourologic Options for Intervention
				Ureteral Stent Placement
				Balloon Dilation
					Retrograde Balloon Dilation.
					Antegrade Balloon Dilation.
					Results.
				Endoureterotomy
					Retrograde Ureteroscopic Approach.
						Results.
					Antegrade Approach.
					Combined Retrograde and Antegrade Approach.
			Surgical Repair
				Ureteroureterostomy
					Open Approach.
					Laparoscopic or Robotic Approach.
					Postoperative Care.
				Ureteroneocystostomy
				Psoas Hitch
				Boari Flap
				Renal Descensus
				Transureteroureterostomy
				Ileal Ureteral Substitution
				Minimally Invasive Ileal Ureteral Substitution
				Buccal Mucosa Grafting
				Autotransplantation
		Ureteroenteric Anastomotic Stricture
			Incidence and Etiology
			Evaluation
			Initial Management and Intervention
				Endourologic Management
		Retroperitoneal Fibrosis
			Presentation and Etiology
			Evaluation
			Management
				Initial Management
				Medical Management
				Surgical Management
				Outcomes of Ureterolysis
		Suggested Readings
		References
		References
90 Upper Urinary Tract Trauma
	Renal Injuries
		Presentation and History
			Hematuria
		Classification
			Indications for Renal Imaging
			Imaging Studies
			Angioembolization
		Nonoperative Management
		Operative Management
			Renal Exploration
				Is Early Vessel Isolation Necessary?
			Renal Reconstruction
				Renovascular Injuries.
			Damage Control
			Indications for Nephrectomy
		Complications
	Ureteral Injuries
		Cause
			External Trauma
			Surgical Injury
				Vascular Surgery.
				Robotic and Laparoscopic Surgery.
				Avoiding and Detecting Ureteral Injury.
				Tenuous Ureteral Blood Supply.
			Ureteroscopic Injury
		Diagnosis
			Gunshot and Stab Wounds
				Hematuria.
				Intraoperative Recognition.
				Imaging Studies
					Computed Tomography.
					Retrograde Ureterography.
					Antegrade Ureterography.
					Intravenous Pyelography.
		Management
			General Principles
			External Trauma
				Contusion.
				Upper Ureteral Injuries
					Ureteroureterostomy.
					Autotransplantation.
					Bowel Interposition.
					Monitoring After Ureteral Repair.
					Nephrectomy.
				Midureteral Injuries.
					Transureteroureterostomy.
				Lower Ureteral Injuries
					Ureteroneocystostomy.
					Psoas Bladder Hitch.
					Boari Flap.
					Partial Transection.
					Damage Control.
			Surgical Injury
				Timing of Repair.
				Ligation.
				Transection
					Immediate Recognition.
					Delayed Recognition.
			Ureteroscopy Injury
				Avulsion.
				Perforation.
	Suggested Readings
	References
	References
X Urinary Lithiasis and Endourology
	91 Urinary Lithiasis
		Epidemiology of Renal Calculi
			Gender
			Race and Ethnicity
			Age
			Geography
			Climate
			Occupation
			Obesity, Diabetes, and Metabolic Syndrome
			Cardiovascular Disease
			Chronic Kidney Disease
			Water
		Physicochemistry and Pathogenesis
			State of Saturation
			Nucleation and Crystal Growth, Aggregation, and Retention
			Inhibitors and Promoters of Crystal Formation
			Matrix
		Mineral Metabolism
			Calcium
			Phosphorus
			Magnesium
			Oxalate
		Pathophysiology of Upper Urinary Tract Calculi
			Classification of Nephrolithiasis
			Calcium Stones
				Hypercalciuria
					Absorptive Hypercalciuria.
					Renal Hypercalciuria.
					Resorptive Hypercalciuria.
					Hypercalcemic-Induced Hypercalciuria
						Sarcoid and Granulomatous Disease.
						Malignancy-Associated Hypercalcemia.
						Glucocorticoid-Induced Hypercalcemia.
				Hyperoxaluria
					Primary Hyperoxaluria.
					Enteric Hyperoxaluria.
					Dietary Hyperoxaluria.
					Idiopathic Hyperoxaluria.
				Hyperuricosuria
				Hypocitraturia
				Low Urine pH
				Renal Tubular Acidosis
					Type 1 (Distal) Renal Tubular Acidosis.
					Type 2 (Proximal) Renal Tubular Acidosis.
					Type 4 (Distal) Renal Tubular Acidosis.
				Hypomagnesiuria
			Uric Acid Stones
				Pathogenesis of Low Urine pH
				Hyperuricosuria
				Low Urinary Volume
			Cystine Stones
			Infection Stones
				Pathogenesis
				Bacteriology
				Epidemiology
			Miscellaneous Stones
				Xanthine and Dihydroxyadenine Stones
				Ammonium Acid Urate Stones
				Matrix Stones
				Medication-Related Stones
					Medications That Directly Promote Stone Formation
						Antiretroviral Agents.
						Triamterene.
						Guaifenesin and Ephedrine.
						Silicate Stones.
					Medications That Indirectly Promote Stone Formation.
			Anatomic Predisposition to Stones
				Ureteropelvic Junction Obstruction
				Horseshoe Kidneys
				Caliceal Diverticula
				Medullary Sponge Kidney
			Stones in Pregnancy
		Suggested Readings
		References
		References
92 Evaluation and Medical Management of Urinary Lithiasis
	Evaluation of Urinary Lithiasis
	Epidemiology and Morbidity From Urinary Lithiasis
	Imaging for Urinary Lithiasis
		Computed Tomography
		Radiography (KUB and IVP)
		Ultrasound
		Other Imaging Modalities
	Metabolic Evaluation
		First-Time Stone Formers
		Defining the High-Risk Stone Former
		Screening Evaluation for Newly Diagnosed Stone Formers
		Metabolic Evaluation for High-Risk and Recurrent Stone Formers
		24-Hour Urine Collection
		Economics of Metabolic Evaluation
	Stone Analysis
	Classification of Nephrolithiasis
		General Recommendations for Stone Formers
			Fluid Recommendations
			Animal Protein
	Calcium-Based Calculi
		Role of Dietary Calcium
	Hypercalciuria (>200 mg/day)
		Clinical Considerations
		Resorptive Hypercalciuria (Primary Hyperparathyroidism)
		Sarcoidosis and Granulomatous Disease
		Idiopathic Causes of Hypercalciuria
		Calcium Supplementation
		Conservative Strategies for Hypercalciuria
			Sodium and Hypercalciuria
		Medical Therapy for Hypercalciuria
			Thiazides and Thiazide-Like Diuretics
			Orthophosphate
			Sodium Cellulose Phosphate
	Hypocitraturia (<550 mg/day Female, <450 mg/day Male)
		Clinical Considerations
		Conservative Strategies for Hypocitraturia
			Citrus Juices
		Medical Therapy for Hypocitraturia
			Idiopathic Hypocitraturic Calcium Nephrolithiasis
		Distal Renal Tubular Acidosis (Type 1)
			Chronic Diarrheal States
		Thiazide-Induced Hypocitraturia
	Hyperoxaluria (>40 mg/day)
		Clinical Considerations
		Enteric Hyperoxaluria
		Primary Hyperoxaluria
			Conservative Strategies for Hyperoxaluria
			Medical Therapy for Hyperoxaluria
			Enteric Hyperoxaluria: Medical Therapy
			Medical Therapy for Primary Hyperoxaluria
		Other Causes of Calcium Stone Formation
			Hyperuricosuric Calcium Oxalate Nephrolithiasis
			Hypomagnesuric Calcium Nephrolithiasis (<80 mg)
		Uric Acid Stones
			Clinical Considerations
			Low Urine pH
		Diabetes, Obesity, and Metabolic Syndrome
			Diagnosis
		Conservative Treatment for Uric Acid Stone Prevention
		Medical Treatment for Uric Acid Stone Prevention
	Cystinuria
		Clinical Considerations
		Conservative Strategies for Cystine Stone Prevention
		Medical Therapy for Cystine Stone Prevention
		Follow-Up
		Compliance and Quality of Life
		Infection Calculi
		Miscellaneous and Drug-Induced Stones
		Drug-Containing Calculi
		Drugs That Induce Metabolic Stone Formation
		Ammonium Acid Urate Stones
		Medical Management of Bladder Calculi
		Follow-Up Considerations in the Medical Management of Urinary Lithiasis
	References
	References
93 Strategies for Nonmedical Management of Upper Urinary Tract Calculi
	Kidney Calculi
	Ureteral Calculi
	Rise of Endourology
		Ureterorenoscopy
		Percutaneous Stone Removal
		Extracorporeal Shock Wave Lithotripsy
	Renal Calculi
		Natural History
			Nonstaghorn Renal Calculi
			Staghorn Calculi
		Pretreatment Assessment
			Medical History
			Imaging
			Laboratory Tests
		Stone Factors
			Treatment Decision by Stone Burden
				Kidney Stone Burden Up to 1 cm.
				Kidney Stone Burden Between 1 and 2 cm.
				Kidney Stone Burden Greater Than 2 cm.
			Staghorn Stones
			Treatment Decision by Stone Localization
			Treatment by Stone Composition
			Matrix
				Cystine.
				Brushite.
				Medication-Precipitated Stones.
		Renal Anatomic Factors
			Ureteral Pelvic Junction Obstruction
			Calyceal Diverticula
			Horseshoe Kidneys and Renal Ectopia
				Horseshoe Kidneys.
				Renal Ectopia.
			Lower Pole Calculi
	Ureteral Calculi
		Natural History
		Pretreatment Assessment
		Stone Factors
			Treatment Decision by Localization
				Proximal and Mid-Ureter.
				Distal Ureter.
				All Locations.
			Treatment Decision by Stone Burden
			Treatment by Stone Composition
		Ureteral Anatomic Factors
			Megaureter
			Duplicated Collecting System
			Ureteral Stricture or Stenosis
		Technical Factors
		Clinical Factors for Upper Urinary Tract Calculi
			Urinary Tract Infection
			Renal Function
			Solitary Kidney
			Morbid Obesity
			Old Age and Frailty
			Spinal Deformity or Limb Contractures
			Uncorrected Coagulopathy
			Prior Renal Surgery
			Urinary Diversion
			Renal Transplants
			Duration of Ureteral Stone Presence
		Evaluation of Outcome
			Assessment and Fate of Residual Fragments
	Suggested Readings
	References
	References
94 Surgical Management for Upper Urinary Tract Calculi
	Extracorporeal Shock Wave Lithotripsy
		Methods and Physical Principles
			Generator Type
				Electrohydraulic (Spark Gap) Generator.
				Electromagnetic Generator.
				Piezoelectric Generator.
			Imaging Systems
				Fluoroscopy Alone.
				Ultrasonography Alone.
				Combination of Ultrasonography and Fluoroscopy.
			Stone Fragmentation
		Bioeffects: Clinical Studies
			Acute Extrarenal Damage
			Acute Renal Injury: Structural and Functional Changes
			Chronic Renal Injury: Structural and Functional Changes
			Mechanism for Tissue Injury
		Techniques to Optimize Shock Wave Lithotripsy Outcome
			Adjuncts to Improve Shock Wave Lithotripsy Outcomes
		Future Direction
	Percutaneous Nephrolithotomy
		Preparation of the Patient
			Antibiotics
			Anesthesia
		Stone Removal
			Technique Modifications
		Special Situations
			Calyceal Diverticula
			Horseshoe Kidney
			Transplantation and Pelvic Kidneys
			Staghorn Calculi or Complex Stones
			Morbid Obesity
		Complications
	Ureteroscopic Stone Management
		Complications
			Perforation
			Stricture
			Submucosal Stone and Lost Stone
			Avulsion
	Intracorporeal Lithotripsy
		Flexible Lithotripters
			Electrohydraulic Lithotripsy
				Advantages and Disadvantages.
			Laser Lithotripsy
				Advantages and Disadvantages.
				Technique.
				Laser Lithotripsy Approaches
					Fragmentation and Extraction.
					Dusting.
		Rigid Lithotripters
			Ballistic Lithotripsy
				Advantages and Disadvantages.
				Technique.
			Ultrasonic Lithotripsy
				Advantages and Disadvantages.
				Technique.
		Combination Ballistic and Ultrasonic Devices
	Laparoscopic and Robotic Stone Removal
	References
	References
95 Lower Urinary Tract Calculi
	History
	Etiopathogenesis of Bladder Calculi
	Presentation of Bladder Stones
	Management of Bladder Stones
		Medical Management
		Extracorporeal Shock Wave Lithotripsy
		Endourologic Approach to Bladder Stone
		Open Surgery for Bladder Stones
	Lower Tract Calculi in Special Situations
		Bladder Outlet Obstruction With Bladder Lithiasis
		Bladder Calculi in Urinary Diversions and Augmented Bladder
		Bladder Calculi in Patients With Spinal Cord Injury
		Bladder Calculi After Renal Transplantation
	Urethral Calculi
		Pathogenesis and Composition of Urethral Calculi
		Primary Urethral Calculi
		Clinical Presentation and Evaluation
		Treatment
		Unusual Lower Tract Urolithiasis
			Preputial Calculi
			Prostatic Calculi
				Etiopathogenesis and Composition.
				Clinical Presentation.
				Evaluation and Management.
	Suggested Readings
	References
	References
XI Neoplasms of the Upper Urinary Tract
	96 Benign Renal Tumors
		Diagnosis
		Renal Cysts
			Epidemiology, Etiology, and Pathophysiology
			Natural History
			Evaluation
			Management Options
		Oncocytoma
			Epidemiology and Etiology
			Pathophysiology
			Evaluation
			Management
		Angiomyolipoma
			Epidemiology
			Pathophysiology
			Diagnosis
			Management
		Papillary Adenoma of the Kidney
		Metanephric Adenoma
		Mixed Mesenchymal and Epithelial Tumors
			Cystic Nephroma
		Mixed Epithelial and Stromal Tumors
		Leiomyoma
		Other Benign Renal Tumors
		Suggested Readings
		References
		References
97 Malignant Renal Tumors
	Historical Considerations
	Classification
		Imaging and Clinical Risk Stratification of Renal Masses
	Radiographic Evaluation of Renal Masses
		Evaluation of Cystic Renal Lesions
	Renal Cell Carcinoma
		Incidence
		Etiology
		Familial Renal Cell Carcinoma and Molecular Genetics
			von Hippel-Lindau Disease, VHL Gene, and Genetics of Clear Cell RCC
			Hereditary Papillary Renal Carcinoma Syndrome
			Hereditary Leiomyomatosis and Renal Cell Carcinoma
			Succinate Dehydrogenase Renal Cell Carcinoma
			Birt-Hogg-Dube Syndrome
			Cowden Syndrome
			Tuberous Sclerosis Complex
			Microphthalmia-Associated Transcription Factor–Associated Cancer Syndrome
		Tumor Biology and Clinical Implications
			Resistance to Cytotoxic Therapy
			Immunobiology and Immune Tolerance
			Angiogenesis and Targeted Pathways
			Cancer Genome Research
			Other Signal Transduction and Cell Cycle Regulation Pathways
		Pathology
			Clear Cell Renal Cell Carcinoma
			Papillary Renal Cell Carcinoma
			Chromophobe Renal Cell Carcinoma
			Collecting Duct Carcinoma
			Renal Medullary Carcinoma
			Sarcomatoid and Rhabdoid Differentiation
			Unclassified Renal Cell Carcinoma
		Clinical Presentation
		Screening and Clinical Associations
		Staging
		Prognosis
	Treatment of Localized Renal Cell Carcinoma
		American Urological Association Guidelines for Renal Mass and Localized Renal Cancer
		Risk Stratification and Renal Mass Biopsy
		Renal Function After Partial or Radical Nephrectomy: Survival Implications
		Radical Nephrectomy
		Partial Nephrectomy
		Tumor Enucleation
		Thermal Ablative Therapies
		Active Surveillance
		Nephron-Sparing Surgery in von Hippel-Lindau and Other Forms of Familial Renal Cell Carcinoma
	Treatment of Locally Advanced Renal Cell Carcinoma
		Inferior Vena Cava Involvement
		Locally Invasive Renal Cell Carcinoma
		Lymph Node Dissection for Renal Cell Carcinoma
		Local Recurrence After Radical Nephrectomy or Nephron-Sparing Surgery
		Neoadjuvant and Adjuvant Therapy for Renal Cell Carcinoma
	Other Malignant Renal Tumors
		Sarcomas of the Kidney
		Renal Lymphoma and Leukemia
		Metastatic Tumors
		Other Malignant Tumors of the Kidney
	Suggested Readings
	References
	References
98 Urothelial Tumors of the Upper Urinary Tract and Ureter
	Epidemiology
		Incidence
			Gender, Race, Age Variations, and Familial Predisposition
		Mortality Rate
	Risk Factors
		Genetic Predisposition
		Environmental Factors
			Tobacco Exposure
			Coffee, Tea, and Yerba Mate
			Occupation
			Aristolochic Acid Nephropathy
			Analgesics
			Arsenic
			Chronic Inflammation and Infection
			Iatrogenic Factors
	Histopathology
		Normal Upper Tract Urothelium
			Renal Pelvis and Calyces
			Ureter
		Urothelial Neoplasms
			Benign Lesions: Papillomas and von Brunn Nests
			Metaplastic and Dysplastic Lesions
			Urothelial Malignant Lesions
				Urothelial Carcinoma.
				Micropapillary Variant of Urothelial Carcinoma.
			Nonurothelial Malignant Lesions
				Squamous Cell Carcinoma.
				Adenocarcinoma.
				Other Tumors.
	Diagnosis
		Endoscopy of the Lower Tract
			Cystoscopy
		Endoscopy of the Upper Tract
			Ureterorenoscopic Evaluation
			Antegrade Endoscopic Evaluation
			Radiologic Imaging
		Cytology and Tumor Markers
	Staging and Classification
		Natural History
			Recurrence
			Involvement of the Ureter or Renal Collecting System
			Synchronous and Asynchronous Localizations
				Upper Tract Recurrence After Bladder Cancer.
				Bladder Recurrence After Upper Tract Tumors.
				Carcinoma in Situ.
			Metastatic Potential of Upper Urinary Tract Carcinoma
				Dissemination of Disease.
				Lymphatic.
				Hematogenous.
				Epithelial.
				Panurothelial Disease.
	Prognosis
		TNM Classification
		Histologic Grading
		Prognostic Factors
			Preoperative Factors
				Age-Sex-Ethnicity.
				Tobacco Consumption.
				Tumor Location.
				Surgical Delay.
				Other.
			Postoperative Factors
				Tumor Stage and Grade.
				Lymph Node Involvement.
				Lymphovascular Invasion.
		Surgical Margins
			Molecular Markers
				Cell Cycle Markers.
				Apoptosis.
				Cell Migration and Invasion.
				Angiogenesis.
				Cell Proliferation.
				Cell Differentiation.
				Mitosis.
			Other Markers
			Predictive Tools
			Risk Stratification
	References
	References
99 Surgical Management of Upper Urinary Tract Urothelial Tumors
	Diagnosis
		Ureteroscopic Evaluation and Biopsy
	Treatment Algorithm
	Surgical Management
		Radical Nephroureterectomy
			Indications
			Techniques
				Open Radical Nephrectomy.
				Management of Distal Ureter and Bladder Cuff.
				Traditional Open Distal Ureterectomy.
				Transvesical Ligation and Detachment Technique.
				Transurethral Resection of the Ureteral Orifice.
				Intussusception (Stripping) Technique.
				Total Laparoscopic Technique.
		Laparoscopic Radical Nephroureterectomy
			Indications
			Technique
				Transperitoneal Laparoscopic Nephroureterectomy
					Laparoscopic Removal of Kidney Down to Mid-Ureter.
					Proximal Ureteronephrectomy.
					Open Distal Ureterectomy With Excision of Bladder Cuff.
					Dissection of the Distal Ureter.
				Robot-Assisted Laparoscopic Nephroureterectomy.
			Results
		Lymphadenectomy
			Results
		Segmental Ureteral Resection
			Open Segmental Ureterectomy
				Ureteroureterostomy
					Indications.
					Technique.
				Distal Ureterectomy and Direct Neocystostomy or Ureteroneocystostomy With a Bladder Psoas Muscle Hitch or a Boari Flap.
			Ileal Ureteral Replacement
			Laparoscopic or Robotic Distal Ureterectomy and Reimplantation
			Results
	Endourologic Management
		Basic Attributes
		Retrograde Ureteroscopic
			Ureteroscopy and Ureteropyeloscopy
				Technique and Instrumentation.
				Endoscopic Evaluation and Collection of Urine Cytology Specimen.
			Tumor Confined to the Intramural Ureter
				Biopsy and Definitive Treatment.
				Ureteroscopic Techniques.
		Results
		Antegrade Nephroureteroscopic
			Technique and Instrumentation
				Establishment of the Nephrostomy Tract.
				Biopsy and Definitive Therapy.
				Second-Look Nephroscopy.
			Results
			Consideration for Urinary Diversions
		Management of Positive Upper Tract Urinary Cytology and Carcinoma in situ
			Evaluation
			Carcinoma in situ of the Upper Urinary Tracts
			Expectant Management
			Adjuvant Topical Therapy
				Adjuvant Intravesical Topical Chemotherapy After Nephroureterectomy to Decrease Bladder Recurrence.
			Technique
			After Organ-Sparing Therapy
				Instillation Therapy.
			Results
				Systemic Chemotherapy.
		Treatment of Lymph Node–Positive and Metastatic Disease
			Chemotherapy
			Immunotherapy
				Anti–PD-1 Approved Therapies.
				Anti–PD-L1 Approved Therapies.
			Molecular Alterations and Future of Genomic-Driven Therapy
			Radiotherapy
	Follow-Up
		Issues in Assessing for Recurrence
		General Procedures
		Specific Procedures
		Metastatic Restaging
	References
	References
100 Retroperitoneal Tumors
	Overview
	Anatomic Considerations of the Retroperitoneum
	Initial Evaluation of the Retroperitoneal Mass
	Differential Diagnosis
		Germ Cell/Gonadal Origins
		Germ Cell Tumor
		Sex Cord Stromal Tumor
		Mesodermal Origins
		Liposarcoma
		Pleomorphic Liposarcoma
		Leiomyosarcoma
		Malignant Fibrous Histiocytoma/Undifferentiated Pleomorphic Sarcoma
		Synovial Sarcoma
		Solitary Fibrous Tumor
		Ewing and Ewing-Like Sarcoma
		Desmoplastic Small Round Cell Tumors
		Unclassified Sarcomas
		Perivascular Epitheliod Cell Tumor
		Desmoid Tumor
		Neurogenic Origins
		Tumors of Sympathetic Ganglia
		Tumors of Paraganglionic System
		Tumors of Nerve Sheath Origin
		Hematologic Conditions/Lymphomas of the Retroperitoneum
		Lymphomas
		Plasmacytoma
		Cystic Masses
		Cystic Lymphangioma
		Mucinous Cystadenoma
		Cystic Mesothelioma
		Cystic Change of Solid Retroperitoneal Tumors
		Retroperitoneal Cancer of Unknown Primary Origin
	Surgical Management of the Retroperitoneal Tumor
		Preoperative Considerations
		Surgical Technique
			Exposure of the Retroperitoneum
			Approach to the Retroperitoneum
				Split-and-Roll Technique.
				Left Para-Aortic Region.
				Interaortocaval Region.
				Right Paracaval Region.
		Surgical Modifications
			Template Considerations for Management of Metastatic Germ Cell Tumors
				Primary Retroperitoneal Lymph Node Dissection.
				Postchemotherapy Retroperitoneal Lymph Node Dissection.
				Nerve-Sparing RPLND.
			Auxiliary Procedures
				Nephrectomy.
		Vascular Reconstruction
			Aortic Replacement
			Vena Caval Resection
			Tumor Thrombectomy
		Complications
			Ejaculatory Function
			Vascular
			Lymphatic
				Lymphocele.
				Chylous Ascites.
			Neurologic
		Postoperative Care
	Disease-Specific Neoadjuvant and Adjuvant Therapies
		Radiation
		Chemotherapy and Systemic Therapies
	Conclusions
	References
	References
101 Open Surgery of the Kidney
	Historical Perspective
	Preoperative Evaluation and Preparation
		Prophylactic Measures
		Surgical Instruments
	Surgical Approaches
		Flank Approaches
			Subcostal Flank Approach
			Supracostal Flank Approach
		Dorsal Lumbotomy Approach
		Thoracoabdominal Approach
		Anterior Approaches
			Anterior Midline Approach
			Anterior Subcostal Approach
			Chevron Incision (Bilateral Anterior Subcostal Approach)
	Surgery for Benign Diseases
		Simple Nephrectomy
		Partial Nephrectomy for Benign Disease
		Open Nephrostomy
		Extracorporeal Renal Surgery
			Preoperative Considerations
			Surgical Procedure
	Surgery for Malignancy
		Radical Nephrectomy
			Surgical Procedure
			Regional Lymphadenectomy for Renal Cancer
			Wound Closure
			Intra- and Postoperative Complications
				Damage During Suprahilar and Retrocrural Lymphadenectomy.
				Injury to the Vasculature of the Gut.
				Injury to the Liver and Spleen.
				Injury to the Duodenum.
				Injury to the Pancreas.
				Pulmonary Complications.
		Partial Nephrectomy for Malignant Disease
			Preoperative Considerations
				Hyperfiltration Injury.
				Renal Ischemia and Hypothermia.
				Enucleation and Surgical Margin.
				Multifocality and Tumor Size.
				Hereditary Renal Malignancy.
			Enucleation for Small Cortical Tumors
			Wedge Resection for Large Cortical Tumors
			Segmental Nephrectomy for Large Polar Tumors
			Complications Associated With Partial Nephrectomy
				Urinary Fistulae.
				Postoperative Bleeding.
				Renal Insufficiency.
		Vena Caval Thrombectomy
			Preoperative Considerations
				Pulmonary Embolism, Anticoagulation, and IVC Filters.
				Tumor Thrombus Level.
			Level I Vena Caval Thrombectomy: Right-Sided Tumor
			Level II Vena Caval Thrombectomy: Left-Sided Tumor
			Level III-IV Vena Caval Thrombectomy: Intra-Abdominal Approach
			Level III-IV Vena Caval Thrombectomy: Combined Intra-Abdominal and Intrathoracic Approach
			Bypass Techniques for Inferior Vena Caval Surgery
				Venovenous Bypass.
				Cardiopulmonary Bypass With and Without Deep Hypothermic Arrest.
			Patching, Replacing, and Interrupting the Inferior Vena Cava
				Patch Cavoplasty.
				Vena Caval Replacement.
			Inferior Vena Cava Filtration and Permanent Interruption for Bland Thrombus
			Perioperative Complications
				Air Embolism.
				Acute Pulmonary Embolism.
				Massive Hemorrhage.
				Hepatic Dysfunction.
				Organ Ischemia.
	Suggested Readings
	References
	References
102 Laparoscopic and Robotic Surgery of the Kidney
	Patient Evaluation and Preparation
		Anesthetic Considerations for Laparoscopy
		Considerations in Obese Patients
		Considerations in Elderly Patients
	Surgical Approaches and Obtaining Access
		Transperitoneal Approach
			Patient Positioning and Trocar Placement
		Retroperitoneal Approach
			Patient Positioning and Trocar Placement
		Hand-Assisted Laparoscopy
			Patient Positioning and Trocar Placement
		Robotic-Assisted Laparoscopy
			Patient Positioning and Trocar Placement
		Laparoendoscopic Single-Site Surgery and Natural Orifice Transluminal Endoscopic Surgery
			Patient Positioning and Trocar Placement
	Simple Nephrectomy
		Procedure
			Reflection of the Colon
			Dissection of the Ureter
			Identification of the Renal Hilum
			Securing the Renal Blood Vessels
			Dissection of the Upper Pole
			Organ Entrapment and Extraction
			Postoperative Management
		Results
	Surgery for Renal Cystic Disease
		Procedure
		Results
	Renal Biopsy for Medical Renal Disease
		Procedure
		Results
	Nephropexy
		Procedure
		Results
	Calyceal Diverticulectomy
		Procedure
		Results
	Nephrolysis
		Procedure and Results
	Radical Nephrectomy
		Transperitoneal
			Procedure
			Results
		Retroperitoneal
			Procedure
			Results
		Hand-Assisted
			Procedure
			Results
		Special Considerations
			Large Tumors
			En Bloc Hilar Vessel Stapling
			Tumor Seeding and Port-Site Recurrence
			Specimen Extraction
			Lymphadenectomy
			Local Recurrence
			Renal Vein and Caval Tumor Thrombus
			Cytoreductive Nephrectomy
			Surgical Salvage After Failed Ablative Therapies
	Partial Nephrectomy
		Indications
			Clinical Stage T1b and Greater Tumors
			Laparoscopic Heminephrectomy
			Central and Hilar Tumors
			Tumor in a Solitary Kidney
			Multiple Tumors
			Repeat Partial Nephrectomy
			Other Indications
		Procedure
			Transperitoneal Laparoscopic Partial Nephrectomy
			Retroperitoneal Laparoscopic Partial Nephrectomy
			Robotic-Assisted Laparoscopic Partial Nephrectomy
			Tumor Localization and Excision
			Hemostasis
			Collecting System Repair
			Renal Hypothermia
			Warm Ischemia and Hilar Control
				Off-Clamp Partial Nephrectomy.
				Selective Arterial Clamping.
				Parenchymal Compression.
		Results
			Positive Surgical Margins
	Laparoscopic Ablative Techniques
		Cryoablation
		Radiofrequency Ablation
			Results
		Complications
	Laparoendoscopic Single-Site Surgery of the Kidney
		Renal Laparoendoscopic Single-Site Surgery
		Robotic Laparoendoscopic Single-Site Surgery
	Complications ff Laparoscopic Renal Surgery
		Vascular Complications
		Urinary Complications
		Visceral and Bowel Complications
		Other Complications
	Minimally Invasive Renal Surgery in Urologic Practice
	Summary
	Suggested Readings
	References
	References
103 Nonsurgical Focal Therapy for Renal Tumors
	Cryoablation
		Background and Mode of Action
			Treatment Temperature
			Freeze-Thaw Cycles
			Duration of Treatment
	Radiofrequency Ablation
		Background and Mode of Action
			Variations in Radiofrequency Ablation Equipment
			Treatment Temperature
			Intraoperative Monitoring
	Surgical Technique
		Transperitoneal and Retroperitoneal Laparoscopic Renal Cryoablation and Radiofrequency Ablation
		Percutaneous Renal Cryoablation and Radiofrequency Ablation (See Video 103.1)
	Treatment Success and Follow-Up Protocol After Tumor Ablation
		Radiographic Interpretation of Success
		Recommended Radiographic Follow-Up Protocol
		Role of Preablation and Postablation Biopsy
	Oncologic Outcomes
		Local Recurrence-Free Survival
		Metastatic Recurrence-Free Survival
		Cancer-Specific Survival
		Overall Survival
		Cryoablation Versus Radiofrequency Ablation
		Laparoscopic Versus Percutaneous Renal Tumor Ablation
	Complications
	New Ablation Modalities
		High-Intensity Focused Ultrasonography
		Radiation Therapy
		Microwave Ablation
		Irreversible Electroporation
		Targeted Embolization and Ablation
	Conclusion
	Suggested Readings
	References
	References
104 Treatment of Advanced Renal Cell Carcinoma
	Prognostic Factors
	Surgical Management of Metastatic Renal Cell Carcinoma
		Debulking or Cytoreductive Nephrectomy in Patients With Metastatic Renal Cell Carcinoma
		Resection of Metastases
		Palliative Surgery
	Immunologic Approaches in the Management of Advanced Clear Cell Renal Cell Carcinoma
		Interferons
		Interleukin-2
		Allogeneic Hematopoietic Stem Cell Transplantation
		Immune “Checkpoint” Inhibitors
	Molecular Basis for Targeted Approaches in Clear Cell Renal Cell Carcinoma
	Targeted Molecular Agents in Clear Cell Renal Cell Carcinoma
		Antagonists of the Vascular Endothelial Growth Factor Pathway
			Bevacizumab
			Sorafenib
			Sunitinib
			Pazopanib
			Axitinib
		Newer VEGFR-Based Targeted Therapy Strategies
			Cabozantinib
			Lenvatinib
		Inhibitors of the Mammalian Target of Rapamycin
		Combination and Sequential Therapy With Agents Targeting the VHL Pathway
	Immune “Checkpoint” Inhibitor–Based Combination Strategies
	Other Treatment Options in Patients With Clear Cell Renal Cell Carcinoma
		Chemotherapy
		Hormonal Therapy
	Systemic Therapy for Non–Clear Cell Variants of Renal Cell Carcinoma
	Suggested Readings
	References
	References
XII The Adrenals
	105 Surgical and Radiographic Anatomy of the Adrenals
		Anatomic Relationships
		Surgical Landmarks
		Adrenal Vasculature
		Adrenal Nerves
		Embryology
		Histology
		Radiology
			Computed Tomography
			Magnetic Resonance Imaging
			Ultrasonography
			Angiography
		Conclusion
		Suggested Readings
		References
		References
106 Pathophysiology, Evaluation, and Medical Management of Adrenal Disorders
	Historical Background
	Adrenal Anatomy and Embryology
		Overview
		Embryology
		Anatomy
		Histology
	Adrenal Physiology
		Adrenal Cortex Physiology
			Zona Glomerulosa
			Zona Fasciculata
			Zona Reticularis
		Adrenal Medulla Physiology
	Adrenal Disorders
		Disorders of Increased Adrenal Function
			Cushing Syndrome
				Overview and Epidemiology.
				Pathophysiology.
					Normal Hypothalamic-Pituitary-Adrenal Axis Physiology.
					Overview of Cushing Syndrome.
					Exogenous Cushing Syndrome.
					Adrenocorticotropic Hormone–Dependent Cushing Syndrome
						Overview.
					Cushing Disease.
					Ectopic Adrenocorticotropic Hormone Syndrome.
					Ectopic Corticotropin-Releasing Hormone.
					Adrenocorticotropic Hormone–Independent Cushing Syndrome.
					Adrenal Tumors.
					Adrenocorticotropic Hormone–Independent Macronodular Adrenal Hyperplasia.
					Primary Pigmented Nodular Adrenocortical Disease.
				Clinical Characteristics
					Classical Cushing Syndrome.
					Autonomous Cortisol Secretion (Subclinical Cushing Syndrome).
				Diagnostic Tests.
					Establishing the Diagnosis of Cushing Syndrome.
					Identifying the Cause of Cushing Syndrome.
				Treatment.
					Exogenous Cushing Syndrome.
					Adrenocorticotropic Hormone–Dependent Disease
						Cushing Disease.
					Ectopic Adrenocorticotropic Hormone Syndrome.
					Adrenocorticotropic Hormone-Independent Disease.
					Medical Treatment of Hypercortisolism.
				Prognosis.
				Summary.
			Primary Aldosteronism
				Overview and Epidemiology.
				Pathophysiology.
				Clinical Characteristics.
				Diagnostic Tests.
					Screening.
					Confirmatory Testing.
					Subtype Differentiation.
				Treatment and Prognosis.
				Summary.
			Pheochromocytoma
				Overview and Epidemiology.
				Pathophysiology
					Overview.
					Pathophysiology of Hereditary Pheochromocytoma.
					Pathophysiology of Malignant Pheochromocytoma.
				Clinical Characteristics
					Overview.
					Clinical Characteristics of Hereditary Pheochromocytoma.
					Clinical Characteristics of Malignant Pheochromocytoma.
				Diagnostic Tests.
					Imaging.
					Cross-Sectional Imaging.
					Functional Imaging
						Positron Emission Tomography.
					Metaiodobenzylguanidine Scintigraphy.
					Other Functional Imaging Modalities.
					Biochemical Evaluation
						Overview.
					Catecholamine Testing.
					Metanephrine Testing.
					Vanillylmandelic Acid Testing.
					Clonidine Suppression Testing.
					Chromogranin A Testing.
					Screening for Hereditary Pheochromocytoma.
				Treatment
					Overview.
				Preoperative Management
					Overview.
					α-Blockade.
					β-Blockade.
					Catecholamine Synthesis Blockade.
					Calcium Channel Blockade.
					Intravascular Volume Management.
					Postoperative Management.
					Follow-Up.
					Treatment of Hereditary Pheochromocytoma.
					Treatment of Malignant Pheochromocytoma.
				Prognosis.
				Summary.
		Disorders of Decreased Adrenal Function
			Overview and Epidemiology
			Pathophysiology
			Clinical Characteristics
			Diagnostic Tests
			Treatment
			Prognosis
			Summary
		Disorders of Abnormal Adrenal Function
			Congenital Adrenal Hyperplasia
		Adrenal Lesions
			Malignant
				Adrenal Carcinoma
					Overview and Epidemiology.
					Pathophysiology.
					Clinical Characteristics.
					Diagnostic Tests.
					Pathologic Evaluation.
					Staging.
					Management.
					Surgery.
					Radiation.
					Medical Therapy.
					Prognosis.
					Pediatric Adrenocortical Carcinoma.
			Summary
				Neuroblastoma.
				Metastases
					Overview and Epidemiology.
					Pathophysiology and Clinical Characteristics.
					Diagnostic Tests.
					Treatment and Prognosis.
					Summary.
				Malignant Pheochromocytoma.
			Benign
				Adenoma
					Overview and Epidemiology.
					Pathophysiology and Clinical Characteristics.
					Diagnostic Tests.
					Treatment.
					Prognosis.
					Summary.
				Oncocytoma
					Overview and Epidemiology.
					Pathophysiology and Clinical Characteristics.
					Diagnostic Tests and Treatment.
					Prognosis.
					Summary.
				Myelolipoma
					Overview and Epidemiology.
					Pathophysiology.
					Clinical Characteristics.
					Diagnostic Tests.
					Treatment.
					Prognosis.
					Summary.
				Ganglioneuroma
					Overview and Epidemiology.
					Pathophysiology/Clinical Characteristics.
					Diagnostic Tests.
					Treatment and Prognosis.
					Summary.
				Adrenal Cysts
					Overview and Epidemiology.
					Pathophysiology.
					Clinical Characteristics.
					Diagnostic Tests.
					Treatment.
					Prognosis.
					Summary.
				Benign Pheochromocytoma.
	Evaluation of Adrenal Lesions in Urologic Practice
		Overview of the Adrenal Incidentaloma
		Imaging of Adrenal Masses
			Imaging Modalities
				Ultrasonography.
				Computed Tomography and Magnetic Resonance Imaging.
					Unenhanced Computed Tomography.
					Enhanced Computed Tomography.
					Computed Tomography Washout Study.
					Magnetic Resonance Imaging.
				Functional Imaging.
			Size and Growth
		Biopsy of Adrenal Masses
			Overview
			Test Characteristics of Biopsy
			Complications of Biopsy
			Clinical Usefulness of Biopsy
		Assessment of Function of Adrenal Masses
			Overview
			Testing for Cortisol Hypersecretion
				Overnight Low-Dose Dexamethasone Suppression Test.
				Late-Night Salivary Cortisol.
				24-Hour Urinary Free Cortisol Evaluation.
			Testing for Aldosterone Hypersecretion
			Testing for Adrenal Sex Steroid Hypersecretion
			Testing for Catecholamine Hypersecretion
				Plasma Free Metanephrines.
				24-Hour Urinary Fractionated Metanephrines.
			Follow-Up
		Summary of Surgical Indications
	Conclusions
	Suggested Readings
	References
	References
107 Surgery of the Adrenal Glands
	Evolution of Adrenal Surgery
	Surgical Anatomy
	Clinical Indications for Adrenalectomy
	Indications and Contraindications for Laparoscopic Adrenalectomy
		Past Surgical and Medical History
		Tumor Size
		Adrenal Cortical Carcinoma
	Preoperative and Perioperative Management
		Pheochromocytoma
		Conn Syndrome
		Cushing Syndrome
	Open Adrenalectomy
		Flank Retroperitoneal Approach
			Positioning
			Incision
			11th Rib Excision
			Creating the Retroperitoneal Space
			Dissection of Adrenal Gland
			Closure
		Posterior Lumbodorsal Approach
			Positioning
			Incision and Rib Excision
			Dissection of Adrenal Gland
		Anterior Transabdominal Approach
			Left Adrenalectomy
				Positioning and Incision.
				Approach to Left Adrenal Gland.
				Closure.
			Right Adrenalectomy
		Thoracoabdominal Approach
			Positioning.
			Incision and Dissection of Adrenal Gland.
			Closure.
	Laparoscopic Adrenalectomy
		Transperitoneal Approach
			Transperitoneal Lateral Approach: Left Adrenalectomy
				Positioning and Ports Placement.
				Mobilization of Colon and Spleen.
				Ligation of Left Adrenal Vein and Mobilization of the Left Adrenal Gland.
				Closure.
			Transperitoneal Lateral Approach: Right Adrenalectomy
			Gasless Laparoscopic Transperitoneal Approach
		Retroperitoneal Approach
			Retroperitoneal Lateral Adrenalectomy: Left Adrenalectomy
				Positioning and Ports Placement.
				Ligation of Left Adrenal Vein and Mobilization of Left Adrenal Gland.
				Closure.
			Retroperitoneal Lateral Adrenalectomy: Right Adrenalectomy
	Robot-Assisted Adrenalectomy
		Robot-Assisted Lateral Transperitoneal Adrenalectomy
	Robot-Assisted Posterior Retroperitoneal Adrenalectomy
	Hand-Assisted Surgery
	Laparoendoscopic Single-Site Adrenalectomy
	Natural Orifice Transluminal Endoscopic Surgery–Assisted Laparoscopic Adrenalectomy
	Partial Adrenalectomy
	Outcomes
		Open Versus Laparoscopic Adrenalectomy
		Laparoscopic Transperitoneal Versus Retroperitoneal Approach
		Laparoscopic Versus Robot-Assisted Adrenalectomy
	Complications
		Intraoperative
		Postoperative
	Ablative Therapy for Adrenal Tumors
	Future of Adrenal Surgery
	Suggested Readings
	References
	References
XIII Urine Transport, Storage, and Emptying
	108 Surgical, Radiographic, and Endoscopic Anatomy of the Female Pelvis
		Surgical Anatomy of the Female Pelvis
			Bony Pelvis
			Fascia and Peritoneum
			Spaces Among Pelvic Organs
			Ligaments
			Muscles of the Pelvic Floor
				Pelvic Sidewalls
				Pelvic Floor
			Vasculature
				Arterial Supply
				Venous Supply
				Lymphatic Drainage
			Nerves of the Pelvis
				Somatic Innervation
				Autonomic Innervation
			Perineum
			Anal Perineum
			External Genitalia
			Female Pelvic Organs
			Pelvic Organ Support
			Urethra
		Radiographic Anatomy of the Female Pelvis
			Ultrasound
			Pelvic Magnetic Resonance Imaging
			Fluoroscopy
			Endoscopic Anatomy
		References
		References
109 Surgical, Radiographic, and Endoscopic Anatomy of the Male Pelvis
	Bony Pelvis
	Lower Abdominal Wall
		Skin and Subcutaneous Fascia
		Musculature
		Inguinal Canal
		Internal Peritoneal Elevations
	Soft Tissues of the Pelvis
		Musculature
		Pelvic Fascia
	Perineum
		Perineal Fascia
		Anal Triangle
		Urogenital Triangle
	Pelvic Circulation
		Arterial Supply
		Venous Supply
		Pelvic Lymphatics
		Pelvic Innervation
		Motor Nerves
		Autonomic Nerves of the Pelvis
	Pelvic Viscera
		Rectum
		Bladder
		Ureterovesical Junction
		Blood Supply and Lymphatic Drainage of the Bladder
		Innervation of the Bladder
		Pelvic Ureter
	Endoscopic Anatomy
	Radiographic Anatomy
		Pelvic Radiographs and Fluoroscopy
		Computed Tomography
		Magnetic Resonance Imaging
	References
	References
110 Physiology and Pharmacology of the Bladder and Urethra
	Lower Urinary Tract Anatomy
	Bladder Compartments
		Urothelium
		Lamina Propria and Vasculature
		Stroma
		Bladder Wall Collagen
		Bladder Wall Elastin and Matrix
		Smooth Muscle
	Overview of the Urethra
		Male Urethra
		Female Urethra
		Anatomy Common to Both Genders
		Fiber Types of Urethral Striated Muscle
	Urothelial Physiology
		Barrier Function
		Urethral Tone
		Ionic Transport
		Sensor-Transducer Function of the Urothelium
		Suburothelial Interstitial Cells
	Smooth Muscle Physiology
		Contractile Proteins
		Actinomyosin Cross-Bridge Cycling
		Membrane Electrical Properties and Action Potentials
		Excitation-Contraction Coupling
		Calcium Signaling in Detrusor Myocyte
		Propagation of Electrical Responses
		Detrusor Interstitial Cells
	Bladder Mechanics
		Urinary Storage (Filling)
		Voiding Mechanics
		Motor Sensory Network in Detrusor Muscle
	Neural Control of the Lower Urinary Tract
		Peripheral Nervous System
			Parasympathetic Pathways
			Sympathetic Pathways
			Somatic Pathways
			Afferent Pathways
				Overview: Properties of Afferent Neurons.
				Pathways to the Spinal Cord.
				Functional Properties of Bladder Afferents.
				Modulators of Afferent Sensitivity.
				Nitric Oxide.
				Purinergic Signaling.
				Transient Receptor Potential Cation Channels.
				Cannabinoids.
					Opioid Peptides.
				Pelvic Organ Interactions: Crosstalk Between Bladder and Bowel.
			Efferent Pathways to the Bladder
				Terminal Nerve Fibers.
				Spinal Ascending and Descending Influences: Transmitters
					Glutamate.
					Glycine and γ-Aminobutyric Acid.
				Serotonin.
					Adrenergic Transmitters.
					Purinergic Transmitters.
				Reflex Circuitry Controlling Continence and Micturition.
					Storage Phase of the Bladder.
					Sphincter to Bladder Reflexes.
					Somatic to Visceral Reflexes.
					Emptying Phase of the Bladder.
					Urethra to Bladder Reflexes.
			Supraspinal Pathways
				Pontine Micturition Center and Brainstem Modulatory Mechanisms.
				Central Circuitry Regulating Bladder Function by Transneuronal Tracing.
				Neurotransmitters and Modulators Within Brainstem Networks.
				Human Brain Imaging Studies.
				Cerebral Control of Voiding.
				Additional Regions.
				Model of Brain-Bladder Control and Normal Continence Mechanism.
	Pharmacology
		Muscarinic Mechanisms
			Muscarinic Selectivity
			Cognitive Impairment With Antimuscarinic Agents
		Adrenergic Mechanisms
			β-Adrenergic Receptors
			α-Adrenergic Receptors
		Urethral Tone in Women
		Afferent Neuropeptides
			Tachykinins
			Prostanoids
			Endothelins
		Sex Steroids
	Clinical Relevance
		Mechanisms of Idiopathic Detrusor Overactivity and Overactive Bladder
		Stress Urinary Incontinence
		Spinal Cord Injury and Neurogenic Detrusor Overactivity
		Nocturia
		Bladder Outlet Obstruction
		Underactive Bladder
		Bladder Pain Syndrome and Interstitial Cystitis
		Aging
		Neuromodulation
			Hypothesis of Mechanism of Action of Sacral Neuromodulation
			Rationale for Neuromodulation to Facilitate Voiding
			Rationale for Neuromodulation to Inhibit the Overactive Bladder
			Pudendal Nerve Stimulation
			Inhibitory and Excitatory Stimulation Frequencies of the Pudendal-Bladder Reflexes
			Activation of Somatic Afferents in the Foot
			OnabotulinumtoxinA Neuromodulation
	Future Research
	References
	References
111 Pathophysiology and Classification of Lower Urinary Tract Dysfunction
	Normal Lower Urinary Tract Function: Overview
		Two-Phase Concept of Function: Filling/Storage and Emptying/Voiding
		Mechanisms Underlying the Two Phases of Function: Overview
		Bladder Response During Filling
		Outlet Response During Filling
		Voiding With a Normal Bladder Contraction
		Urinary Continence During Abdominal Pressure Increases
		Sensory Aspects
	Micturition Cycle: Simplification and Overview
		Filling/Storage
		Emptying/Voiding
	Abnormalities of Filling/Storage and Emptying/Voiding: Overview of Pathophysiology
		Filling and Storage Failure
			Bladder Overactivity
			Filling and Storage Failure Resulting From Altered Sensation
			Outlet Underactivity
		Emptying and Voiding Failure
			Bladder Underactivity
			Outlet Overactivity or Obstruction
	Classification Systems
		Functional System
		Urodynamic Classification
		Lapides Classification
		Hald-Bradley Classification
		Bradley Classification
	Suggested Readings
	References
	References
112 Evaluation and Management of Women With Urinary Incontinence and Pelvic Prolapse
	Definition and Impact of Pelvic Floor Disorders
		Introduction
	Diagnostic Evaluation
		General Considerations
		History
		History of Present Illness
		Past Medical and Surgical History
		Medications
		Other
	Physical Examination
	Supplemental Evaluation
		Symptom Quantification Instruments
			Voiding Diaries
		Questionnaires and Quality of Life Instruments
		Pad Tests
		Dye Testing
		Urinalysis
		Postvoid Residual
		Cystoscopy
		Urodynamics
		Radiographic Imaging
			Voiding Cystourethrogram
		Ultrasonography
		Magnetic Resonance Imaging
	Management
		Incontinence Treatment Overview
		Pelvic Prolapse Treatment Overview
	Conclusion
	Suggested Readings
	References
	References
113 Evaluation and Management of Men With Urinary Incontinence
	Types of Urinary Incontinence
		Stress Urinary Incontinence
		Urgency Urinary Incontinence
		Mixed Urinary Incontinence
		Nocturnal Enuresis
		Continuous Urinary Incontinence
		Incontinence Associated With Chronic Retention
		Other Types of Urinary Incontinence
	Evaluation
		History
		Physical Examination
		First-Line Investigations
			Measurement of Height and Weight to Calculate Body Mass Index
			Urinalysis
			Bladder Diary
			Quality-of-Life Questionnaires and Patient-Reported Outcome Measures
			Pad Testing
			Urine Flow Rate and Postvoid Residual
			Measurement of Prostate-Specific Antigen
			Blood Tests
			Advanced Investigations
				Imaging.
				Endoscopy.
				Urodynamic Studies.
	Principal Methods of Treating Men With Urinary Incontinence
	Management of Different Urinary Incontinence Types in Men
		Treatment of Urgency Urinary Incontinence
		Treatment of Stress Urinary Incontinence
		Treatment of Mixed Urinary Incontinence
		Treatment of Other Types of Urinary Incontinence
			Enuresis
			Post-Micturition Dribble
		Algorithms for Management of Men With Urinary Incontinence
	Conclusion
	Suggested Readings
	References
	References
114 Urodynamic and Video-Urodynamic Evaluation of the Lower Urinary Tract
	Role of Urodynamics in Clinical Practice
	Conducting a Urodynamic Study: Patient and Technical Factors
		Functional Classification of Voiding Dysfunction
		Preparing for Urodynamic Studies: Clinician, Patient, and Facility
			Defining the Clinical Question
			Patient Preparation
			Facility Setup
			Additional Factors
	Components of the Urodynamic Study
	Urodynamic Equipment
		Urodynamic Systems
		Signal Transmission and Transducers
		Uroflowmeters
		Electromyography
	The Urodynamic Study: Analysis and Interpetation
		Filling and Storage Phase
		Normal Filling and Storage
		Abnormalities of Bladder Filling: Detrusor Overactivity and Impaired Compliance
		Leak Point Pressures
		Stress-Induced Detrusor Overactivity
		Occult Stress Incontinence
		Urethral Pressure Profilometry
		Voiding and Emptying Phase
			Normal Voiding and Emptying
			Voiding Pressure-Flow Studies
		Bladder Outlet Obstruction and Detrusor Underactivity in Men
		Bladder Outlet Obstruction in Women
		Sphincter Coordination
			The External Sphincter
			The Internal Sphincter
	Videourodynamics
	Ambulatory Urodynamics
		Clinical Utility of Ambulatory Urodynamics
	Clinical Applications of Urodynamic Studies: Evidence-Based Review and Guidelines Pertaining to Urodynamics
		Guidelines
		Evaluation of Women With Stress Incontinence
		Evaluation of Men and Women With Lower Urinary Tract Symptoms
		Evaluation of Neurogenic Lower Urinary Tract Dysfunction
	Future Directions
	References
	References
115 Urinary Incontinence and Pelvic Prolapse
	Definition and Classification of Urinary Incontinence
		Introduction and Overview of the Lower Urinary Tract
		Signs, Symptoms, and Urodynamic Observations of Urinary Incontinence
	Terminology of Lower Urinary Tract Symptoms and Incontinence
		Incontinence
		Bladder Storage and Sensation
	Epidemiology of Urinary Incontinence in Women
		General Comments
	Risk Factors for Urinary Incontinence in Women
		Aging
		Pregnancy
			Aspects of Delivery
			Parity
		Race and Ethnicity
		Hormonal Therapy
		Obesity
		Smoking
		Diet
		Medical Conditions
	Epidemiology of Urinary Incontinence in Men
		Prevalence, Incidence, Remission Rates
		Risk Factors for Urinary Incontinence in Men
	Definitions and Classification of Pelvic Organ Prolapse
		Symptoms of Pelvic Organ Prolapse
		Physical Examination of Pelvic Organ Prolapse
	Epidemiology of Pelvic Organ Prolapse
		Risk Factors for Pelvic Organ Prolapse
	Relationship Between Urinary Incontinence and Pelvic Organ Prolapse
	Consequences of Urinary Incontinence and Prolapse
		Societal Costs of Urinary Incontinence
		Social Impact of Urinary Incontinence
		Impact of Pelvic Organ Prolapse on Quality of Life
		Financial Impact of Pelvic Organ Prolapse
	Physiology of Urinary Continence
		Overview of Normal Continence Mechanisms
		Neural Control of the Lower Urinary Tract
		Bladder: an Organ Capable of Significant Expansion at Low Pressures
		Bladder Outlet and Sphincteric Mechanisms
			Male Sphincteric Mechanisms
			Female Sphincteric Mechanisms
	Pathophysiology of Urinary Incontinence: General Principles
		Factors Affecting Bladder Storage
		Factors Affecting Sphincteric Function
	Pathophysiology of Stress Urinary Incontinence in Women
		Loss of Urethral Support
		Intrinsic Sphincteric Deficiency
	Pathophysiology of Insensible Incontinence
	Pelvic Floor Support Mechanism
	Pathophysiology of Pelvic Organ Prolapse
	Suggested Readings
	References
	References
116 Neuromuscular Dysfunction of the Lower Urinary Tract
	Objectives
	Patterns of Neuropathic Voiding Dysfunction
		Neuroplasticity
	Diseases at or Above the Brainstem
		Cerebrovascular Disease
			Cerebrovascular Accident (Stroke)
			Brainstem Stroke
		Dementia
		Traumatic Brain Injury
		Brain Tumor
		Cerebellar Ataxia
		Normal-Pressure Hydrocephalus
		Cerebral Palsy
		Parkinson Disease
		Multiple System Atrophy
		Progressive Supranuclear Palsy
	Diseases Primarily Involving the Spinal Cord
		Multiple Sclerosis
		Spinal Cord Injury
			Epidemiology, Morbidity, General Concepts
			Spinal Shock
			Suprasacral Spinal Cord Injury
			Sacral Spinal Cord Injury
			Neurologic and Urodynamic Correlation
			Autonomic Dysreflexia
			Vesicoureteral Reflux
			Urinary Tract Infection
			Spinal Cord Injury in Women
			Spinal Cord Injury (Neurogenic Bladder) and Bladder Cancer
			Follow-Up
		Cervical Myelopathy
		Acute Transverse Myelitis
		Neurospinal Dysraphism
		Tabes Dorsalis, Pernicious Anemia
		Subacute Combined Degeneration
		Poliomyelitis
	Disease Distal to the Spinal Cord
		Disk Disease
		Spinal Stenosis
		Radical Pelvic Surgery
		Simple and Radical Hysterectomy
		Childbirth
		Herpesvirus Infections
		Diabetes Mellitus
		Guillain-Barré Syndrome
	Miscellaneous Neurologic Diseases Causing Lower Urinary Tract Dysfunction
		Amyotrophic Lateral Sclerosis
		Lyme Disease
		Hereditary Spastic Paraplegia
		Tropical Spastic Paraparesis
		Acquired Immunodeficiency Syndrome
		Acute Disseminated Encephalomyelitis
		Syringomyelia
		Schistosomal Myelopathy
		Systemic Lupus Erythematosus
		Reflex Sympathetic Dystrophy
		Tuberculosis
	Miscellaneous Conditions Definitely, Probably, or Possibly Related to Neuromuscular Dysfunction
		Detrusor Sphincter Dyssynergia
		Dysfunctional Voiding
		Bladder Neck Dysfunction
		Bladder Outlet Obstruction in Women
		Low-Pressure and Low-Flow Voiding in Younger Men: Paruresis (Bashful Bladder)
		Urinary Retention: Fowler Syndrome in Young Women
		Postoperative Urinary Retention
		Hyperthyroidism
		Schizophrenia
		Gastroparesis
		Myasthenia Gravis
		Isaacs Syndrome
		Wernicke Encephalopathy
		Systemic Sclerosis (Scleroderma)
		Ehlers-Danlos Syndrome
		Myotonic Dystrophy
		Corticobasal Degeneration
		Sacrococcygeal Teratoma
		Williams-Beuren Syndrome
		Amyloidosis
		Machado-Joseph Disease
		Radiation
		Defunctionalized Bladder
		Disorders of Sexual Differentiation
		Aging
		Benign Joint Hypermobility Syndrome
		Attention-Deficit/Hyperactivity Disorder
		Other Conditions
	Treatment of Neurogenic Lower Urinary Tract Dysfunction: Overview
	Suggested Readings
	References
	References
117 Overactive Bladder
	Terminology and Definitions
		Mixed Symptoms Incorporating Urinary Urgency
		Distinguishing Overactive Bladder From Bladder Pain Syndrome
	Epidemiology and Economics
		Prevalence of Overactive Bladder and Related Lower Urinary Tract Symptoms
		Incidence and Progression of Overactive Bladder
		Health Burden of Overactive Bladder
	Pathophysiology and Etiology
		Afferent Mechanisms in Overactive Bladder
			Mechanisms of Increased Afferent Activity
				Other Mechanisms of Increased Afferent Signaling.
				Abnormal Handling of Afferent Signals.
		Other Pathophysiologic Mechanisms
		Etiology and Attributable Risk Factors
	Clinical Assessment
		Initial Evaluation
			History
		Physical Examination
		Laboratory Examination
		Advanced Evaluation
	Management
		First-Line Therapy
		Second-Line Therapy
		Third-Line Therapy
		Fourth-Line Therapy
		Approach
	Suggested Readings
	References
	References
118 The Underactive Detrusor
	Terminology, Definitions, and Symptoms
	Epidemiology
	Etiopathogenesis
		Myogenic Factors
		Neurogenic Factors
			Brain Circuits
			Bladder Efferent Pathways
			Bladder and Urethral Afferent Pathways
		Specific Etiologic Factors
			Bladder Outlet Obstruction
			Diabetes Mellitus
			Neurologic Disease or Injury
			Pelvic Arterial Ischemia
	Diagnosis
		Detrusor Contraction Strength
		Detrusor Contraction Speed
		Detrusor Contraction Duration
		Bladder Sensation
		Ambulatory Urodynamics
	Management
		Initial Assessment
		Conservative Management
		Pharmacotherapies
			Parasympathomimetics for Underactive Bladder
			α-Adrenoreceptor Antagonists
			Prostanoids
			Future Prospects in Pharmacotherapy
		Electrical Stimulation
		Botulinum Toxin
		Surgery
			Bladder Outlet Surgery
		Urinary Diversion
		Reconstructive Surgery
	Regenerative Medicine
	Conclusions
	Suggested Readings
	References
	References
119 Nocturia
	Rationale for Evaluation and Management
		Nocturia Is Bothersome
		Nocturia Is Common
		Association of Nocturia With Early Mortality
		Costs to Society
	Evaluation
	Cause and Management
		Nocturnal Polyuria
			Epidemiology and Causes
		Management
		Diminished Global and Nocturnal Bladder Capacity
			Causes
			Management
		Mixed Nocturnal Polyuria and Diminished Global and Nocturnal Bladder Capacity
		Polyuria
			Etiology
			Management
	Suggested Readings
	References
	References
120 Pharmacologic Management of Lower Urinary Tract Storage and Emptying Failure
	Introduction
	Pharmacologic Therapy to Facilitate Bladder Filling and Urine Storage
		Inhibiting Bladder Contractility, Decreasing Sensory Input, Increasing Bladder Capacity
			Bladder Contraction
			Muscarinic Receptors
			Prevalence of Lower Urinary Tract Symptoms
			Antimuscarinic (Anticholinergic) Agents
				Mechanism of Action.
				Pharmacologic Properties.
				Clinical Use.
				Adverse Effects.
			Antimuscarinics With “Pure” Action
				Atropine Sulfate.
				Darifenacin Hydrobromide.
				Assessment.
				Fesoterodine Fumarate.
				Assessment.
				Imidafenacin.
				Assessment.
				Propantheline Bromide.
				Assessment.
				Solifenacin Succinate.
				Assessment.
				Tolterodine Tartrate.
				Assessment.
				Trospium Chloride.
				Assessment.
			Antimuscarinics With “Mixed” Action
				Oxybutynin Chloride.
				Immediate-Release Oxybutynin.
				Extended-Release Oxybutynin.
				Transdermal Oxybutynin.
				Oxybutynin Topical Gel.
				Other Administration Forms.
				Effects on Cognition.
				Assessment.
				Propiverine Hydrochloride.
					Assessment.
				Flavoxate Hydrochloride.
				Assessment.
			Drugs Acting on Membrane Channels
				Calcium Antagonists.
				Potassium Channel Openers.
			α-Adrenoceptor Antagonists
			β-Adrenoceptor Agonists
				Background.
				Clinical Use.
			Mirabegron
				Pharmacokinetics.
				Efficacy.
				Tolerability and Adverse Effects.
		New Developments
			Phosphodiesterase Inhibitors
			Antidepressants
				Imipramine.
				Doxepin.
				Milnacipran Hydrochloride and Paroxetine Hydrochloride.
				Duloxetine.
				Side Effects and Cardiovascular Risks.
			Cyclooxygenase Inhibitors
			Other Drugs
				Dimethyl Sulfoxide.
				Baclofen.
			Combinations
				α1A-AR Antagonists With Antimuscarinics.
				β3-AR Agonist With Antimuscarinics.
				β3-AR Agonist With α1A-AR Antagonists.
				Combined Antimuscarinics.
				Antimuscarinics and 5α-Reductase Inhibitors.
				α1-AR Antagonists With 5α-Reductase Inhibitors.
			Toxins
				Botulinum Toxin
					Mechanism of Action.
					Clinical Use.
					Efficacy.
					Adverse Effects.
				Capsaicin and Resiniferatoxin (Vanilloids).
					Rationale for Intravesical Vanilloids.
					Intravesical Capsaicin.
					Resiniferatoxin in Neurogenic Detrusor Overactivity.
					Resiniferatoxin in Idiopathic Detrusor Overactivity.
					Resiniferatoxin and Urgency.
			Estrogens for Urgency Urinary Incontinence and Overactive Bladder Symptoms
				Evidence Regarding Estrogens and Incontinence From Large Clinical Trials.
			Other Hormones and Desmopressin
				Desmopressin.
			Drug Treatment of Overactivity in Augmented or Intestinal Neobladders
			Future Possibilities
				Peripherally Acting Drugs
					Vitamin D3-Receptor Analogues.
					Transient Receptor Potential Channel Antagonists.
					Prostanoid-Receptor Agonists and Antagonists.
				Intraprostatically Injected Drugs
					NX-1207.
					PRX302.
					Cannabinoids.
				Centrally Acting Drugs.
					Gonadotropin-Releasing Hormone Antagonists.
					Gabapentin.
					Tramadol.
					NK1-Receptor Antagonists.
		Increasing Outlet Resistance
			Drugs Used for Treatment of Stress Incontinence in Women
				Estrogens
					Estrogens and the Continence Mechanism.
					Estrogens for Stress Urinary Incontinence.
				α-AR Agonists.
				β-AR Agonists
					Clenbuterol.
				β-AR Antagonists.
				Serotonin-Noradrenaline Uptake Inhibitors
					Imipramine.
					Duloxetine.
			Drugs Used for Treatment of Stress Urinary Incontinence in Men
	Pharmacologic Therapy to Facilitate Bladder Emptying
		Increasing Intravesical Pressure and Bladder Contractility
			Parasympathomimetic Agents
		Prostaglandins
			Blockers of Inhibition
			Opioid-Receptor Antagonists
		Decreasing Outlet Resistance
			At a Site of Anatomic Obstruction
			At the Level of the Smooth Sphincter
				α-Adrenoceptor Antagonists.
					Phenoxybenzamine.
					Prazosin.
					Terazosin and Doxazosin.
					Alfuzosin and Tamsulosin.
					Silodosin.
				Nitric Oxide.
			At the Level of the Striated Sphincter
				Benzodiazepines.
				Baclofen.
				Dantrolene.
				Botulinum Toxin.
	Suggested Readings
	References
	References
121 Conservative Management of Urinary Incontinence
	Indications
	Assessment Before Behavioral Treatments
	Patient Education
	Pelvic Floor Muscle Training
		Assessment of Pelvic Floor Muscle Function
		Teaching Pelvic Floor Muscle Control
		Pelvic Floor Muscle Exercise Regimens
		Use of Pelvic Floor Muscle Contraction to Prevent Stress Incontinence
		Evidence for Pelvic Floor Muscle Training
			Antenatal Urinary Incontinence
			Postpartum Urinary Incontinence
			Post-Prostatectomy Urinary Incontinence
		Vaginal Cones for Pelvic Floor Muscle Training
		Other Pelvic Floor Muscle Training Devices
	Behavioral Training With Urge Suppression
	Role of Biofeedback
	Pelvic Floor Muscle Electrical Stimulation
	Bladder Training and Scheduled Voiding Regimens
		Bladder Training
			Evidence for Bladder Training
		Other Scheduled Voiding Regimens
			Timed Voiding
			Habit Training
			Prompted Voiding
				Challenges of Caregiver-Administered Voiding Schedules.
			Delayed Voiding
	Behavioral Treatment for Voiding and Pelvic Floor Dysfunction
		Lifestyle Modifications
			Fluid Management
				Excessive Fluid Intake.
				Inadequate Fluid Intake.
				Timing of Fluid Intake.
				Evidence for Fluid Management.
			Caffeine Reduction
			Other Dietary Irritants
		Bowel Function
		Obesity and Weight Reduction
		Adherence to Conservative Treatment
	Prevention of Urinary Incontinence
		Older Women
		Childbearing Women
		Men Undergoing Prostatectomy
		Future of Lower Urinary Tract Symptom Prevention and Bladder Health Promotion Research
	Vaginal and Urethral Mechanical Devices for Incontinence
		Intravaginal Devices
	Models of Delivery
	Suggested Readings
	References
	References
122 Electrical Stimulation and Neuromodulation in Storage and Emptying Failure
	History of Electrical Stimulation
	Neurophysiology Relevant to Electrical Stimulation for Storage and Voiding Disorders
	Sacral Anterior Root Stimulation and Sacral Dorsal Rhizotomy
		Stimulator
		Technique of Post-Stimulus Voiding
	Goal and Effect of Dorsal Rhizotomy of the Sacral Nerves
		Patient Selection
		Surgical Implantation Technique
		Clinical Results
	Current and Future Perspectives for Neurostimulation
	Working Mechanism of Electrical Stimulation in Non-Neurogenic Storage and Voiding Disorders
	Techniques of Electrostimulation of the Lower Urinary Tract
		Intravesical Stimulation
		Transcutaneous Electrostimulation
			Transcutaneous Tibial Nerve Stimulation
			Transcutaneous Sacral Dermatome Stimulation
		Percutaneous Tibial Nerve Stimulation
			History of Percutaneous Tibial Nerve Stimulation
			Technique of Percutaneous Tibial Nerve Stimulation
			Clinical Results of Percutaneous Tibial Nerve Stimulation
			Percutaneous Tibial Nerve Stimulation Compared With Other Treatments
			Prognostic Factors for Percutaneous Tibial Nerve Stimulation
			Implantable Percutaneous Tibial Nerve Stimulation
			Conclusions
		Pudendal Nerve Stimulation
		Dorsal Genital Nerve Stimulation
		Sacral Nerve Stimulation
			Current Indications and Outcomes for Sacral Neuromodulation
			Overactive Bladder With or Without Urinary Incontinence
			Nonobstructive Chronic Underactive Bladder (Voiding Dysfunction)
			Other Indications
			Sacral Neuromodulation Patient Selection and Implantation Procedure
				Percutaneous Nerve Evaluation Test.
				Staged Implant Procedure.
			Future Perspectives of Sacral Neuromodulation
	Constant Versus Intermittent Stimulation
	Rechargeable Neurostimulator
	Other Issues
	Suggested Readings
	References
	References
123 Retropubic Suspension Surgery for Incontinence in Women
	Therapeutic Options
	Choice of Surgical Technique
		Differentiating Relative Contributions of Hypermobility and Intrinsic Sphincter Deficiency
		Surgical Procedures
			Degree of Urethral Elevation
			Configuration of the Suspensions
			Tissue Approximation
	Assessing Outcomes of Therapy
		Duration of Follow-Up
		Issue of Intrinsic Sphincter Deficiency
		Definition of Cure
		Patient’s Versus the Physician’s Perspective
	Indications for Retropubic Repair
		Specific Indications
		Potential Contraindications
		Vaginal Versus Retropubic Surgery
	General Technical Issues
		Retropubic Dissection
		Suture Material
		Bladder Drainage
		Drains
	Marshall-Marchetti-Krantz Procedure
		Technique
		Results
	Burch Colposuspension
		Technique
		Results
		Prophylactic Colposuspension
		Reoperative Surgery
	Paravaginal Repair
		Technique
		Results
	Vagino-Obturator Shelf Repair
		Technique
		Results
	Laparoscopic Retropubic Suspension
	Complications of Retropubic Repairs
		Postoperative Voiding Difficulty
		Bladder Overactivity
		Vaginal Prolapse
	Comparisons of Incontinence Procedures
		Retropubic Repair Versus Needle Suspension and Anterior Repair
		Retropubic Repair Versus Pubovaginal Sling
		Burch Colposuspension Versus Marshall-Marchetti-Krantz Procedure Versus Paravaginal Repair
		Tension-Free Vaginal Tape Procedure Versus Colposuspension
	World Without Mesh
	Suggested Readings
	References
	References
124 Vaginal and Abdominal Reconstructive Surgery for Pelvic Organ Prolapse
	Preparing the Patient for Prolapse Surgery
		Preoperative Counseling of Patient for Vaginal Pelvic Organ Prolapse Surgery
	Use of Mesh in Vaginal Surgery: Current Controversy
	Surgical Management of Pelvic Organ Prolapse
		Anterior Compartment
			Anterior Colporrhaphy
				Anterior Colporrhaphy Technique (Fig. 124.2).
				Anterior Colporrhaphy Repairs Results.
				Anterior Colporrhaphy Complications.
			Procedures for Lateral and Combined Defects
				Vaginal Paravaginal Repair.
					Technique (Fig. 124.3).
					Vaginal Paravaginal Repair Results (See Table 124.3).
			Anterior Compartment Repairs Using Grafts Technique
			Anterior Polypropylene Mesh Results
			Anterior Repair With Cadaveric Fascia Results
			Anterior Repair With Porcine Dermis Results
			Biologics Versus Mesh Results
			Mesh-Related Complications
			Other Procedures to Correct Anterior Compartment Defects
				Abdominal Paravaginal Repair Technique (Fig. 124.8).
				Abdominal Paravaginal Results (See Table 124.4).
				Anterior Compartment Repair With Sling.
		Apical Compartment
			Apical Vaginal Vault Prolapse Repairs via Uterosacral Ligament Suspension
				Surgical Anatomy of the Uterosacral Ligaments.
				High Uterosacral Vaginal Vault Suspension Technique.
				Abdominal Approach to the Uterosacral Ligaments.
				Uterosacral Ligaments Results.
			Sacrospinous Ligament Fixation
				Surgical Anatomy of the Sacrospinous Ligament Fixation.
				Sacrospinous Ligament Fixation Technique.
				Sacrospinous Ligament Fixation Results (Table 124.6).
				Sacrospinous Ligament Fixation Complications.
			Iliococcygeus Suspension
				Iliococcygeus Suspension Technique and Results.
			Abdominal Sacrocolpopexy
				Open Abdominal Sacrocolpopexy Technique.
				Robotic-Assisted Laparoscopic Sacrocolpopexy Technique.
				Laparoscopic Sacrocolpopexy Technique.
				Sacrocolpopexy Complications.
				Results of Sacrocolpopexy.
				Abdominal Sacrocolpopexy Versus Laparoscopic Sacrocolpopexy (Table 124.9).
				Laparoscopic Sacrocolpopexy Versus Robotic-Assisted Sacrocolpopexy Versus Abdominal Sacrocolpopexy (Table 124.10).
				Laparoscopic Sacrocolpopexy Versus Robotic-Assisted Colpopexy.
				Learning Curve.
				Cost.
		Comparison of Apical Procedures
			Colpocleisis
				Partial Colpocleisis—Technique.
				Total Colpocleisis: Technique (Fig. 124.33).
				Colpocleisis Results.
				Partial Colpocleisis Results.
			Uterine Prolapse
			Vaginal Hysterectomy With McCall Culdoplasty Technique
				Vaginal Hysterectomy Complications.
			Uterine Sparing and Hysteropexy
				Transvaginal Uterine-Sparing Techniques.
					Manchester Procedure.
						Manchester Procedure Complications.
						Manchester Procedure Results.
					Transvaginal Uterosacral Ligament Hysteropexy Technique.
						Transvaginal Uterosacral Ligament Hysteropexy Complications.
						Transvaginal Uterosacral Ligament Hysteropexy Results.
					Sacrospinous Hysteropexy Technique.
						Sacrospinous Hysteropexy Complications.
						Sacrospinous Hysteropexy Results.
					Minimally Invasive Uterosacral Hysteropexy Technique.
						Minimally Invasive Uterosacral Hysteropexy Complications.
						Minimally Invasive Uterosacral Hysteropexy Results.
					Open Abdominal Sacrohysteropexy Technique.
						Minimally Invasive Sacrohysteropexy Technique.
						Minimally Invasive Sacrohysteropexy Complications.
						Sacrohysteropexy Results.
		Posterior Compartment Repair
			Posterior Colporrhaphy Technique
				Site Specific Repair: Technique.
				Perineorrhaphy: Technique.
					Posterior Colporrhaphy Results (Table 124.18).
			Interposition Graft Repairs of the Posterior Compartment
	References
	References
125 Slings
	The Evolution of Slings
	Pathophysiology of Stress Urinary Incontinence and Sling Mechanism of Action
	The Age of the Mid-Urethral Sling
	Preoperative Assessment
	Alternative Treatment Options
	Pubovaginal Sling (PVS)
		Anatomy and Mechanics of a Pubovaginal Sling
		Pubovaginal Sling Materials
			Autologous Pubovaginal Slings
			Pubovaginal Sling Allograft Materials
			Pubovaginal Sling Xenograft Materials
			Pubovaginal Sling Synthetic Prosthetic Materials
	Pubovaginal Sling Operative Procedure
		Counseling
		Anesthesia, Patient Positioning, and Preparation
		Graft Harvest for Autologous Pubovaginal Sling
		Pubovaginal Sling Vaginal Dissection
		Pubovaginal Sling Placement and Fixation
		Pubovaginal Sling Postoperative Care
	Outcomes of Pubovaginal Slings for Predominantly Stress Urinary Incontinence
		Autologous Pubovaginal Slings
		Allograft Pubovaginal Slings
		Synthetic Pubovaginal Slings
		Xenograft Pubovaginal Slings
	Outcomes of Autologous Pubovaginal Slings for Mixed Urinary Incontinence
	Outcomes of Autologous Pubovaginal Slings for Urethral Reconstruction
	Voiding Dysfunction Secondary to Bladder Outlet Obstruction After Pubovaginal Sling Surgery
		Surgical Management of Voiding Dysfunction After Pubovaginal Sling Surgery
	Complications of Pubovaginal Slings
		Pubovaginal Sling Perforation and Exposure
		Pubovaginal Sling Nonurologic Complications
	Mid-Urethral Slings
		Mechanics, Anatomy, and Materials of Mid-Urethral Slings
			Mechanics of the Mid-Urethral Sling
			Anatomy of the Retropubic Mid-Urethral Sling
			Anatomy of the Transobturator Mid-Urethral Sling
			Anatomy of the Single-Incision Mid-Urethral Slings
		Mid-Urethral Sling Materials
	Mid-Urethral Sling Operative Procedures
		Mid-Urethral Sling Patient Counseling
		Mid-Urethral Sling Anesthesia, Patient Positioning, and Preparation
			Surgical Approach for Retropubic Mid-Urethral Slings
			Surgical Approach for Transobturator Outside-in Slings
			Surgical Approach for Transobturator Inside-Out Slings
			Surgical Approach for Single-Incision Slings
		Outcomes of Mid-Urethral Slings for Predominantly Stress Urinary Incontinence
		Outcomes for Retropubic Mid-Urethral Slings in Patients With Predominantly Stress Urinary Incontinence
		Outcomes for Transobturator Mid-Urethral Slings in Patients With Predominantly Stress Urinary Incontinence
		Outcomes for Single-Incision Mid-Urethral Slings in Patients With Predominantly Stress Urinary Incontinence
		Outcomes of Mid-Urethral Slings for Mixed Urinary Incontinence
		Outcomes of Mid-Urethral Slings for Intrinsic Sphincteric Deficiency
		Outcomes of Mid-Urethral Slings for Recurrent Stress Urinary Incontinence
		Outcomes of Mid-Urethral Slings in Patients With Pelvic Organ Prolapse
		Outcomes of Mid-Urethral Slings in Elderly Women
		Outcomes of Mid-Urethral Slings in Obese Patients
	Complications of Retropubic, Transobturator, and Single-Incision Mid-Urethral Slings
		Mid-Urethral Sling Mesh Exposure
			Management of Mid-Urethral Sling Mesh Exposure
	Mid-Urethral Sling Trocar Injury to the Urinary Tract
		Urethral Perforation During Mid-Urethral Sling Mesh Placement
			Management of Mid-Urethral Sling Mesh Perforation of the Urethra
		Mid-Urethral Sling Mesh Perforation of the Bladder
			Management of Mid-Urethral Sling Mesh Perforation of the Bladder
		Infection and Pain After Mid-Urethral Sling Surgery
			Management of Severe Infection or Pain After Mid-Urethral Sling
		Voiding Dysfunction After Mid-Urethral Sling Surgery
			Management of Voiding Dysfunction After Mid-Urethral Sling Surgery
	Sexual Dysfunction After Mid-Urethral Sling Surgery
	Other Complications After Mid-Urethral Sling Surgery
		Management of Recurrent or Persistent Stress Urinary Incontinence After Mid-Urethral Sling Surgery
		Regulatory and Legal Issues Related to Sling Mesh Complications
	Suggested Readings
	References
	References
126 Complications Related to the Use of Mesh and Their Repair
	Mesh and Its Properties
	Mesh Slings for Stress Urinary Incontinence
	Risk Factors for Mesh Sling Complications
	Mesh Complications Among the Three Slings
		Bladder Outlet Obstruction and New Urgency and Urgency Incontinence
		Vaginal Mesh Exposure and Extrusion
		Vaginal, Pelvic, and Thigh Pain
		Groin Pain
		Complications of Vaginal Mesh Removal
		Bladder Injury and Perforation/Extrusion
		Mesh Perforation/Extrusion at Bladder Neck or Urethra
		Transvaginal (Anterior and Posterior Wall) Mesh Complications
			Treatment of Prolapse Mesh Complications
		Surgical Mesh Removal
		Apical Mesh Complications
			Treatment of Mesh Exposure
	Male Mesh Slings
	References
	References
127 Additional Therapies for Storage and Emptying Failure
	Additional Therapies for Storage Failure at the Bladder Level
		Augmentation Cystoplasty
			Historical Perspective
			Indications for Augmentation Cystoplasty
				Bladder Compliance.
				Capacity.
				Detrusor Overactivity.
			Augmentation Cystoplasty Techniques
			Contraindications to Augmentation Cystoplasty
	Additional Therapies for Storage Failure at the Bladder Outlet
		Urethral Bulking Agents
			Use of Injectable Agents for Female Stress Urinary Incontinence
			Patient Selection, Indications, and Contraindications
			Injection Techniques
				Periurethral Technique.
				Transurethral Techniques.
			Periprocedure Care
			Efficacy of Urethral Injection Therapy for Female Stress Urinary Incontinence
			Adverse Events
			Summary of Specific Agents
				Glutaraldehyde Cross-Linked (GAX) Bovine Collagen (Contigen).
				Carbon-Coated Zirconium Beads (Durasphere).
				Silicone Microimplants (Macroplastique).
				Calcium Hydroxylapatite (Coaptite).
				Agents Available Outside the United States.
		Adjustable Continence Therapy
			Outcomes
			Complications
		Cell-Based Therapy
			Human Studies
			Use of Injectable Agents for Male Stress Urinary Incontinence
				Injection Techniques
					Retrograde Injection.
					Antegrade Injection.
				Collagen.
				Silicone Microimplants (Macroplastique).
				Cell-Based Therapy.
			Use of Injectable Agents After Urinary Diversion
		Bladder Outlet Closure: Functional and Complete
	Additional Therapies for Emptying
		Continent Catheterizable Channels
		Catheterization
			Clean Intermittent Catheterization
			Continuous Catheterization
		Increasing Intravesical Pressure or Facilitating Bladder Contractility
			External Compression (Credé) and Valsalva Maneuver
			Promotion or Initiation of Reflex Contractions
			Intraurethral Valve-Pump for Women With Impaired Detrusor Contractility
			Stimulated Myoplasty for Bladder Emptying
	Additional Therapies for Storage and Emptying Failure: Circumventing the Problem
		External Collecting Devices
		Absorbent Products
	Summary
	Suggested Readings
	References
	References
128 Aging and Geriatric Urology
	Biology and Principles of Aging
		Physiologic Aging
		Aging and the Lower Urinary System
	Demographics of Aging
		Aging and Population Trends
		Global Implications for Urologic Health Care
	Clinical Evaluation of the Geriatric Urology Patient
		Functional Assessment
			Activities of Daily Living
			Instrumental Activities of Daily Living
			Mobility
			Cognition
			Depression
		Surgical Risk and Medical Optimization
			Anesthesia
			Prehabilitation
			Comprehensive Geriatric Assessment
		Major Geriatric Syndromes and Urology
			Frailty
			Delirium
			Falls
			Pressure Ulcers
			Polypharmacy and Medication Optimization
		Urinary Incontinence
			Geriatric Specific Risk Factors for Urinary Incontinence
			Costs of Incontinence
			Negative Impacts of Urinary Incontinence
			Established Versus Transient Incontinence
				Established Urinary Incontinence.
				Transient Versus Established Urinary Incontinence.
					Transient Urinary Incontinence.
				Types of Established Urinary Incontinence.
			Incontinence in the Nursing Home Setting
				Clinical Evaluation of Incontinence.
					History.
				Physical Examination.
				Assessment of Postvoid Residual Volume.
				Voiding Diaries.
				Laboratory Testing.
				Urodynamics.
				Treatment of Incontinence.
					Behavioral Therapies.
					Pharmacotherapies.
					Surgical Therapies.
					Urine Containment and Absorbent Products.
		Other Lower Urinary Tract Dysfunction, Urinary Tract Infections, Pelvic Floor Conditions, and Genitourinary Trauma
			Bladder Outlet Obstruction
			Underactive Bladder, Neurogenic Bladder, and Urinary Retention
			Nocturia
			Bowel Dysfunction and Fecal Incontinence
			Continence Promotion and Advocacy
			Pelvic Organ Prolapse
			Urinary Tract Infections and Asymptomatic Bacteriuria
			Hematuria
			Genitourinary Trauma
		Genitourinary Malignancies
			Prostate Cancer
			Bladder Cancer
			Kidney Cancer
			Testis Cancer
			Urologic Cancers and Other Health Issues in Older Adults
		Sexual Health in Elderly Women and Men
		Discharge Planning and Care Coordination
		Elder Mistreatment
	End-of-Life Care and Urology
	Summary
	Suggested Readings
	References
	References
129 Urinary Tract Fistulae
	General Considerations
		Prevention of Fistula
		Preparation and Optimization of Patient
		Medicolegal Aspects
	Vesicovaginal Fistulae
		Etiology and Prevalence
		Obstetric Fistulae
	Iatrogenic Fistulae
		Intraoperative Risk Factors for Iatrogenic Vesicovaginal Fistulae
			Evaluation and Diagnosis
			Presentation
			Physical Examination
			Cystoscopy
			Imaging
			Other Studies
		Classification of Fistulae
		Treatment
			Conservative and Minimally Invasive Therapy
			Surgical Repair
			Timing: Immediate Versus Delayed Repair
			Approach: Abdominal Versus Vaginal
			Handling of Fistula Tract: Excision Versus No Excision
			Use of Adjuvant Flaps or Grafts: Type and Application
			Other Considerations
			Preoperative Counseling and Indications for Surgery
			Vaginal Techniques
				Vaginal Flap or Flap-Splitting Technique.
				Complications.
				Other Transvaginal Techniques.
			Abdominal Techniques
				Suprapubic Intraperitoneal or Extraperitoneal Approach.
				Transvesical.
			Laparoscopic and Robotic Approaches
			Adjuvant Procedures in the Repair of Vesicovaginal Fistulae: Tissue Interposition
				Martius Flap.
				Peritoneal Flap.
				Greater Omentum.
				Other Flap and Graft Techniques.
				Vesicovaginal Fistulae and Urinary Diversion.
			Outcomes of Vesicovaginal Fistula Repair
	Ureteric Fistulae
		Etiology and Presentation
		Diagnosis and Management
	Vesicouterine Fistulae
		Etiology and Presentation
		Diagnosis and Management
	Urethrovaginal Fistulae
		Etiology and Presentation
		Diagnosis
		Treatment of Urethrovaginal Fistulae
			Vaginal Approach
			Labial and Vaginal Flaps and Neourethra
				Martius Flap.
				Rectus Muscle Flap.
				Other Interposition Material.
			Posterior Approach
			Abdominal Approach
			Complications
			Follow-Up
			Operative Technique
	Uroenteric Fistulae
		Etiology and Presentation
	Pyeloenteric Fistulae
		Diagnosis
		Management
	Rectourethral Fistulae
		Etiology and Presentation
		Management
	Urovascular Fistulae
	Renovascular and Pyelovascular Fistulae
	Ureterovascular Fistulae
	Oncologic and Radiation Fistulae
	Cancer Surgery
	Radiation Fistulae
		Management of Radiation Fistulae: Diversion Procedures
		Management of Radiation Fistulae: Repair Techniques
		Other Management Approaches
		Recommendations
		Chemotherapy
		Combination Therapies
	Other Urinary Fistulae
		Urinary Leak After Renal Preservation Surgery
		Urinary Leak After Renal Transplantation
	Acknowledgments
	Suggested Readings
	References
	References
130 Bladder and Female Urethral Diverticula
	Bladder Diverticula
		Classification, Pathophysiology, and Etiology
		Diagnosis
			Presentation and Evaluation
			Imaging
			Urodynamics
			Endoscopic Examination
		Associated Conditions
			Bladder Outlet Obstruction
			Malignancy
			Other Associated Conditions
		Management
			Observation and Nonsurgical Management
			Indications for Intervention
			Endoscopic Management
			Operative Excision
	Female Urethral Diverticula
		Anatomy of the Female Urethra
	Urethral Diverticula
		Pathophysiology and Etiology
		Prevalence
		Diverticular Anatomy and Histology
		Presentation
		Evaluation and Diagnosis
			History and Physical Examination
			Urine Studies
			Cystourethroscopy
			Urodynamics
		Imaging
			Diagnostic Contrast Radiography
				Ultrasonography.
				Magnetic Resonance Imaging.
			Differential Diagnosis: Periurethral Masses Other Than Urethral Diverticula
				Vaginal Leiomyoma.
				Skene Gland Abnormalities.
				Gartner Duct Abnormalities.
				Vaginal Wall Cysts.
				Urethral Mucosal Prolapse.
				Urethral Caruncle.
				Periurethral Bulking Agents.
			Classification of Urethral Diverticula
		Surgical Repair of Female Urethral Diverticula
			Indications for Repair
		Urethral Diverticula and Stress Urinary Incontinence
			Techniques for Repair
				Alternative Techniques.
				Excision and Reconstruction.
				Preoperative Preparation.
				Procedure.
				Postoperative Care.
				Complications.
				Persistence or Recurrence of Symptoms After Urethral Diverticulectomy.
	Suggested Readings
		Bladder Diverticula
		Urethral Diverticula
	References
	References
131 Surgical Procedures for Sphincteric Incontinence in the Male
	Classification, Pathophysiology, and Etiology
		History and Development of Devices
		Innovations and Emerging Concepts in Device Design
		Mechanisms of Continence With Surgical Devices
		Evaluation and Diagnosis
			History
			Patient-Reported Measures
			Physical Examination
			Laboratory
			Cystoscopy
			Urodynamics
			Evaluation of Persistent Incontinence After Artificial Urinary Sphincter and Sling
	Indications for Surgery
	Technique of Device Implantation
		Operative Preparation
		Artificial Urinary Sphincter
		Pressure-Regulating Balloon
		Control Pump Placement
		Making the Connections
		Tandem Cuff Artificial Urinary Sphincter
		Transcorporal Artificial Urinary Sphincter Cuff
		Trans-Scrotal Artificial Urinary Sphincter
		Bladder Neck Artificial Urinary Sphincter
		Transobturator Bulbourethral Sling
		Four-Arm Sling
	Artificial Urinary Sphincter Complications
		Urinary Retention
		Artificial Urinary Sphincter Infection
		Urethral Erosion
		Urethral Atrophy
		Mechanical Failure
		Special Circumstances
		Sling Complications
	Long-Term Results of Artificial Urinary Sphincters and Slings
	Future Directions
		Improving the Quality of Evidence
		Training Paradigms
	Summary
	Acknowledgment
	Suggested Readings
	References
	References
XIV Benign and Malignant Bladder Disorders
	132 Bladder Surgery for Benign Disease
		Bladder Anatomy and Surgical Considerations
		Bladder Diverticulectomy
			Description
			Evaluation and Surgical Indications
			Surgical Technique
				Open Technique
					Intravesical Approach.
					Combined Intra-Extravesical Approach.
				Laparoscopic and Robotic Techniques
			Postoperative Care and Complications
				Outcomes
		Ureteral Reimplantation
			Description
			Evaluation and Surgical Indications
			Surgical Technique
				Open Technique
					Ureteral Mobilization.
					Bladder Mobilization.
			Nonrefluxing Ureteral Reimplantation—Extravesical Approach (Modified Lich-Gregoir)
			Nonrefluxing Ureteral Reimplantation—Transvesical Approach (Modified Politano-Leadbetter)
			Refluxing Ureteral Reimplantation—Extravesical Approach
			Refluxing Ureteral Reimplantation—Transvesical Approach
				Laparoscopic and Robotic Techniques
			Nonrefluxing Ureteral Reimplantation—Extravesical Approach (Modified Lich-Gregoir)
			Refluxing Ureteral Reimplantation—Extravesical Approach
				Postoperative Care and Complications
				Outcomes
		Psoas Hitch and Boari Flap
			Description
			Evaluation and Surgical Indication
			Surgical Technique
				Open Technique
					Psoas Hitch.
					Boari Flap.
				Laparoscopic and Robotic Technique
					Psoas Hitch.
					Boari Flap.
					Advancement Flap.
					Laparoendoscopic Single-Site (LESS) Surgery Boari Flap.
				Postoperative Care and Complications
				Outcomes
		Enterocystoplasty
			Description
			Evaluation and Surgical Indication
			Surgical Technique
				Open Technique
				Laparoscopic and Robotic Techniques
			Postoperative Care and Complications
				Outcomes
		Partial Cystectomy and Urachal Surgery
			Description
			Evaluation and Surgical Indications
				Leiomyoma
				Paraganglioma
				Endometriosis
				Urachal Abnormalities
			Surgical Technique
				Open
				Extraperitoneal Approach to Partial Cystectomy
				Transperitoneal Approach to Partial Cystectomy
				Urachal Surgery
			Laparoscopic and Robotic Techniques
				Transperitoneal Approach to Partial Cystectomy
				Urachal Surgery
				Postoperative Care and Complications
				Outcomes
		Bladder Stones and Foreign-Body Removal
			Description
			Evaluation and Surgical Indication
			Surgical Technique
				Open
				Laparoscopic and Robotic
				Percutaneous
			Postoperative Care and Complications
		References
		References
			Bladder Diverticulectomy
			Ureteral Reimplantation
			Ureteral Reconstruction
			Enterocystoplasty
			Partial Cystectomy and Urachal Surgery
			Bladder Stone and Foreign-Body Removal
133 Genital and Lower Urinary Tract Trauma
	Injuries of the External Genitalia
		Penis
			Fracture
				Etiology.
				Diagnosis and Imaging.
				Management.
				Outcome and Complications.
			Gunshot and Penetrating Injuries
				Gunshot Wounds.
				Animal and Human Bites.
				Penile Amputation.
				Zipper Injuries.
				Strangulation Injuries.
		Testis
			Etiology
			Diagnosis
			Management
			Outcome and Complications
		Genital Skin Loss
			Etiology
			Diagnosis and Initial Management
		Penile Reconstruction
		Scrotal Reconstruction
	Bladder Injury
		Etiology
		Diagnosis and Radiographic Imaging
		Clinical Signs and Symptoms
		Management
		Outcomes and Complications
	Urethral Injury
		Posterior Urethral Injuries
			Etiology
			Diagnosis
				Examination.
				Urethrography.
			Initial Management
				Initial Management: Suprapubic Cystostomy With Planned Delayed Reconstruction.
				Initial Management: Primary Realignment.
			Delayed Reconstruction
				Preoperative Evaluation.
			Endoscopic Treatment
			Surgical Reconstruction
				Complications: Erectile Dysfunction.
				Complications: Recurrent Stenosis.
				Complications: Incontinence.
		Anterior Urethral Injuries
			Etiology
			Initial Management
			Delayed Reconstruction
	Suggested Readings
	References
	References
		Injuries of the External Genitalia
		Bladder Injuries and Urethral Injuries
134 Special Urologic Considerations in Transgender Individuals
	Urologic Issues in Gender Nonconforming Youths
	Urologic Issues in Male-to-Female Transsexuals (Transwomen)
		Effects of Sex Reassignment Surgery on Bladder Sphincter Function
		Fate of the Prostate in Transwomen
			Prostatitis
			Benign Prostatic Hyperplasia
			Prostate Cancer
	Urologic Issues in Female-to-Male Transsexuals (Transmen)
		Diagnosis and Preoperative Care
			Diagnosis
			Preoperative Care
		Sex Reassignment Surgery
		Removal of Female Anatomic Structures
			Mastectomy, Hysterectomy, and Ovariectomy
			Vaginectomy
		Genitoperineal Transformation
			Urethroplasty
		The Phallic Urethra
		Scrotoplasty
		Phalloplasty
		Metoidioplasty
		Testicular Implants and Erectile Prosthesis
	Postoperative Care, Follow-Up, and Urethral Complications
		Early Postoperative Care
		Transurethral Catheterization in Transmen
		Urethral Complications in Transmen
			Urethral Fistula
			Urethral Stricture
				Incidence.
				Diagnosis.
				Management.
			Urethral Dilation
			Endoscopic Incision (Direct Vision Internal Urethrotomy)
		Urethral Reconstruction
			Meatotomy
			Heineke-Mikulicz Urethroplasty
			Excision and Primary Anastomosis
			Free Graft Urethroplasty
			Two-Stage Urethroplasty
			Flap Urethroplasty
			Definitive Perineostomy
			Urethral Hair Growth
			Postvoid Dribbling
	Conclusion
	Suggested Readings
	References
	References
135 Tumors of the Bladder
	Epidemiology
		Incidence, Prevalence, Mortality
		Gender, Racial, and Age Differences
	Economic Impact
	Risk Factors
		Genetics
		Hereditary
		Smoking
		Body Mass Index
		Occupational Risk
		Medical Conditions
		Schistosomiasis
		Recurrent Infection
		Indirect Medical Risk Factors
			Pioglitazone
			Radiation
			Chemotherapy
			Environmental Pollution
		Diet
			Fluids
			Foods
			Dietary Supplements
	Detection of Urothelial Carcinoma
		Cystoscopy
		Urine Cytology
		Fluorescence in Situ Hybridization
		Bladder Tumor Antigen
		Immunocyt
		CxBladder
	Pathology
		Epithelial Metaplasia
		Papilloma and Inverted Papilloma
		Nephrogenic Adenoma
		Leukoplakia
		Cystitis Cystica and Glandularis
		Precursor Malignant Lesions
		Malignant Lesions
		Staging
		Molecular Biology
	Histologic Variants of Urothelial Carcinoma
		Micropapillary Variant
		Sarcomatoid Variant
		Plasmacytoid Variant
		Nested Variant
		Urothelial Carcinoma With Divergent Differentiation
		Nonurothelial Malignancy
			Small Cell
			Squamous Cell Cancer
			Adenocarcinoma
			Urachal Adenocarcinoma
	References
	References
136 Management Strategies for Non–Muscle-Invasive Bladder Cancer (Ta, T1, and CIS)
	Pathology: Grading and Staging
		Pathological Staging
		Pathological Grading
		Tumor Biology
		Pathological Characteristics by Stage and Implications for Clinical Management
	Endoscopic Surgical Management
		Procedures
		Complications of Transurethral Resection of Bladder Tumor and Bladder Biopsy
		Repeat Transurethral Resection of Bladder Tumor
		Random Bladder Biopsies
		Laser Resection
		Office-Based Endoscopic Management
		Enhanced Cystoscopic Techniques: Fluorescence Cystoscopy, Narrow Band Imaging, Optical Coherent Tomography, and Confocal Laser Endomicroscopy
	Intravesical Therapy
		Perioperative Intravesical Therapy
		Intravesical Immunotherapy
			Bacille Calmette-Guérin
			Mechanism of Action
			Bacille Calmette-Guérin Treatment of Carcinoma in Situ
			Bacille Calmette-Guérin Treatment of Residual Tumor
			Bacille Calmette-Guérin Prophylaxis to Prevent Recurrence
			Impact of Bacille Calmette-Guérin on Progression
			Determining Optimum Bacille Calmette-Guérin Treatment Schedule
			Interferon
			Investigational Immunotherapeutic Agents
		Intravesical Chemotherapy
			Thiotepa
			Doxorubicin
			Valrubicin
			Mitomycin C
			Other Intravesical Therapeutic Agents
			Combination Therapy
	Refractory High-Grade Disease
		Management of Refractory High-Grade Disease
		Role of Alternative Options for Refractory Disease
		Role of “Early” Cystectomy
	Surveillance and Prevention
		Cystoscopic Surveillance
		Urine Cytology
		Tumor Markers
		Extravesical Surveillance
		Secondary Prevention Strategies
	Suggested Readings
	References
	References
137 Management of Muscle-Invasive and Metastatic Bladder Cancer
	Clinical Presentation, Diagnosis, and Evaluation
		Natural History
		Histology
		Clinical Staging
		Pathologic Staging
	Radical Cystectomy and Pelvic Lymph Node Dissection for Muscle-Invasive Bladder Cancer
		Bilateral Pelvic Lymph Node Dissection
		Anatomic Extent of Pelvic Lymph Node Dissection and Landing Zones
		Number of Lymph Nodes Identified at the Time of Cystectomy
		Lymph Node Density and Extracapsular Nodal Extension
		Intraoperative Decision Making
			Grossly Positive Nodes and T4b Disease
			Intraoperative Frozen Sections of the Ureter
			Prostatic Urothelial Carcinoma and Management of the Distal Urethra
			Managing the Female Urethra
		Oncologic Outcomes Following Radical Cystectomy
	Neoadjuvant Therapy for Muscle-Invasive Bladder Cancer
	Adjuvant Therapy for Muscle-Invasive Bladder Cancer
		Randomized Trials of Adjuvant Chemotherapy
			Adjuvant Chemoradiation
			Bladder Preservation
		Trimodal Therapy for Surgically Fit Patients
		Trimodality Therapy for Surgically Unfit Patients
		Single-Modality Treatment
			Radiation Monotherapy
			Radical Transurethral Resection
			Partial Cystectomy
			Chemotherapy Monotherapy
	Prognostic Nomograms for Muscle-Invasive Bladder Cancer
	Management of Metastatic Bladder Cancer
		Randomized Trials in Metastatic Bladder Cancer
		Second-Line Chemotherapy
		Single-Agent Second-Line Chemotherapy
		Multiagent Second-Line Chemotherapy
		Immune Checkpoint Inhibitor Therapy
			Second-Line Immune Checkpoint Inhibitor Therapy
			First-Line Immune Checkpoint Inhibitor Therapy in Cisplatin-Ineligible Patients
		FDA-Approved Agents and Future Directions
		Targeted Therapy
			Vascular Endothelial Growth Factor Inhibitor Therapy
			Epidermal Growth Factor Receptor Therapy
			Fibroblast Growth Factor Receptor Therapy
	Suggested Readings
	References
	References
138 Surgical Management of Bladder Cancer
	Transurethral Resection of Bladder Tumors
	Patient Preparation
	Surgical Technique
	Pelvic Lymphadenectomy
	Radical Cystectomy: Male
	Radical Cystectomy: Female
	Partial Cystectomy
	Robotic Radical Cystectomy
		Background
		Patient Selection
		Patient Positioning
		Port and Assistant Placement
		Instrumentation
		Sigmoid Release and Posterior Dissection
		Lateral Space of Retzius and Anterior Vascular Pedicle Dissection
		Extended Pelvic Lymphadenectomy
			External Iliac Lymphadenectomy
			Obturator Lymphadenectomy
			Hypogastric Lymphadenectomy
			Common Iliac Lymphadenectomy
			Presacral Lymphadenectomy
		Ureteral Control and Posterior Pedicle Dissection
			Male Apical Dissection
			Female Radical Cystectomy
		Postoperative Care
	Acknowledgments
	Suggested Readings
	References
	References
139 Use of Intestinal Segments in Urinary Diversion
	Surgical Anatomy
		Stomach
		Small Bowel
		Colon
	Selecting the Segment of Intestine
		Stomach
		Jejunum
		Ileum and Colon
	Preparing the Bowel for Surgery and Postoperative Recovery
		Mechanical Bowel Preparation
		Antibiotic Bowel Preparation
		Diarrhea and Pseudomembranous Enterocolitis
		Enhanced Recovery After Surgery
	Intestinal Anastomoses
		Surgical Principles
		Types of Anastomoses
			Enteroenterostomy by a Two-Layer Suture Anastomosis
			Enteroenterostomy by a Single-Layer Suture Anastomosis
			End-to-Side Ileocolic Sutured Anastomosis
			Ileocolonic End-to-End Sutured Anastomosis With Discrepant Bowel Sizes
		Stapled Anastomoses
			Ileocolonic Anastomosis with the Circular Stapling Device
			Side-to-Side Stapled Anastomosis: Ileal-Ileal or Ileocolonic Anastomosis
		Laparoscopic and Robotic Anastomoses
		Compression Anastomoses and the Biofragmentable Ring
		Complications of Intestinal Anastomoses
			Fistulas
			Sepsis and Other Infectious Complications
			Bowel Obstruction
			Hemorrhage
			Intestinal Stenosis
			Pseudo-Obstruction
		Complications of the Isolated Intestinal Segment
			Intestinal Stricture
			Elongation of the Segment
		Abdominal Stomas
			Nipple (Rosebud) Stoma
			Flush Stoma
			Loop End Ileostomy
		Complications of Intestinal Stomas
	Ureterointestinal Anastomoses
		Ureterocolonic Anastomoses
			Combined Technique of Leadbetter and Clarke
			Transcolonic Technique of Goodwin
			Strickler Technique
			Pagano Technique
			Cordonnier and Nesbit Techniques
		Small Bowel Anastomoses
			Bricker Anastomosis
			Wallace Technique
			Tunneled Small Bowel Anastomosis
			Split-Nipple Technique
			Le Duc Technique
			Hammock Anastomosis
			Ureteral Dipping Technique
			Ureter–Small Bowel Anastomosis Using Serosal Compression of the Extramural Ureter as an Antireflux Mechanism
		Intestinal Antireflux Valves
			Intussuscepted Ileocecal Valve
			Intussuscepted Ileal Valve
			Nipple Valve
		Complications of Ureterointestinal Anastomoses
			Urinary Fistula
			Stricture
			Pyelonephritis
	Renal Deterioration
		Renal Function Necessary for Urinary Intestinal Diversion
	Urinary Diversion
		Ileal Conduit
			Procedure
			Complications
			Jejunal Conduit
			Procedure
			Complications
		Colon Conduit
			Procedure
				Transverse Colon.
				Sigmoid Colon.
				Ileocecal Conduit.
			Complications
		Ileal Vesicostomy
		Management Common to All Conduits
	Metabolic and Neurochemical Problems of Urinary Intestinal Diversion
		Metabolic Complications
			Electrolyte Abnormalities
			Altered Sensorium
			Abnormal Drug Absorption
			Osteomalacia
			Growth and Development
			Infection
			Stones
			Intestinal Motility, Short Bowel, and Nutritional Problems
			Cancer
		Neuromechanical Aspects of Intestinal Segments
			Volume-Pressure Considerations
			Motor Activity
	Summary
	References
	References
140 Cutaneous Continent Urinary Diversion
	General Considerations
	Patient Selection
	Patient Preparation
	Cystectomy
	Postoperative Care and Comments
	Continent Urinary Diversion
		Rectal Bladder Urinary Diversion
			Folded Rectosigmoid Bladder
				Postoperative Care and Comments.
			Augmented Valved Rectum
			Hemi-Kock and T Pouch Procedures with Valved Rectum
				Postoperative Care and Comments.
			Sigma-Rectum Pouch, Mainz II
				Postoperative Care and Comments.
		Continent Catheterizing Pouches
			General Procedural Methodology
			General Care
			Continent Ileal Reservoir (Kock Pouch)
				Procedure.
			Double T Pouch
				Procedure.
				Postoperative Care and Comments.
			Mainz Pouch I
				Procedure.
				Postoperative Care and Comments.
			Right Colon Pouches With Intussuscepted Terminal Ileum
			Indiana Pouch
				Procedure.
				Postoperative Care and Comments.
			Penn Pouch
				Procedure.
				Postoperative Care and Comments.
			Gastric Pouches
				Procedure.
				Postoperative Care and Comments.
	Quality-of-Life Assessments
	Variations in Operative Technique
		Minimally Invasive Continent Cutaneous Diversion
		Conduit Conversion to a Continent Reservoir
		Absorbable Stapling Techniques in Continent Urinary Diversion
		Surgical Techniques
			Right Colon Pouch
			Stapled Sigmoid Reservoir
			W-Stapled Reservoir
				Postoperative Care and Comments.
	Summary
	Suggested Readings
	References
	References
141 Orthotopic Urinary Diversion
	History of Orthotopic Urinary Diversion
	Basic Principles of Continent Orthotopic Urinary Diversion
	Patient Selection
		Oncologic Factors
			Risk for Urethral Recurrence in Men
			Risk for Urethral Recurrence in Women
			Locally Advanced Tumor Stage
		Patient-Related Factors
			Age
			Renal Function
			Body Habitus
			Manual Dexterity and Willingness to Do Self-Catheterization
			Urethral Stricture Disease or External Sphincter Damage
			Prior Pelvic Radiation
			Prior Prostate Surgery or Bowel Resection
	Continence Mechanism in Patients Undergoing Orthotopic Diversion
	Surgical Techniques for Continence Preservation During Radical Cystectomy
		Anterior Apical Dissection in the Male Patient
		Preservation of the Urethra in the Female Patient
	Techniques for Orthotopic Bladder Substitution
		Choice of Bowel Segment
		Need to Prevent Reflux
		General Perioperative Management
		Surgical Techniques
			Ileal Reservoirs
			Camey II
			Orthotopic Kock Ileal Reservoir (Hemi-Kock)
			Serous-Lined Extramural Tunnel
			Ileal Neobladder (Hautmann Pouch)
			Studer Pouch
			T Pouch Modification
		Colon and Ileocolic Pouches
			Orthotopic Mainz Pouch (Mainz III)
			Right Colon Pouch
			Sigmoid Pouch
			Padua Pouch (Vesica Ileale Padovana)
		Use of Minimally Invasive Techniques for Orthotopic Diversion
	Results and Complications of Orthotopic Urinary Diversion
		Early and Late Complications
		Continence
		Urinary Retention
		Follow-Up for Patients With Orthotopic Diversion
		Quality of Life After Orthotopic Urinary Diversion
	Suggested Readings
	References
	References
142 Minimally Invasive Urinary Diversion
	Incorporation of Robot-Assisted Approach
	Patient Selection
	Surgeon Choice
	Preoperative Care
		Enhanced Recovery After Surgery
	Patient Position and Port Placement
	Anatomic Considerations in Men
	Anatomic Considerations in Women
	Ileal Conduit
		Transfer of Left Ureter and Selection of Bowel
		Marionette Stitch
		Isolation of the Bowel Segment and Creation of the Ileal Conduit
		Ureteroileal Anastomosis
		Restoration of the Bowel
		Pre-Stoma Preparation
	Intracorporeal Neobladder
		Modified Studer Neobladder: The Karolinska Institute Technique
			Configuration and Setup
			Neobladder-Urethral Anastomosis
			Detubularization of Bowel
			Creation of Neobladder
			Uretero-Neobladder Anastomosis
			Closure of the Neobladder
		Modified Studer Neobladder: The USC Institute of Urology Technique
			Configuration and Setup
			Rotation of Pouch, Neobladder-Urethral Anastomosis, and Cross-Folding of the Pouch
			Uretero-Neobladder Anastomosis
		Pyramid Neobladder: The University College London Hospital Technique
			Configuration and Setup
			Formation of the Pyramid Neobladder
			Uretero-Neobladder Anastomosis
		Modified Y Neobladder: The Clinique Saint-Augustin Technique
			Configuration and Setup
			Creation of the Neobladder
			Uretero-Neobladder Anastomosis
		Padua Neobladder
			Configuration and Setup
			Uretero-Neobladder Anastomosis
		Florin: Florence Robotic Intracorporeal Neobladder
			Configuration and Setup
			Uretero-Neobladder Anastomosis
		Modified “W” Hautmann Neobladder: The Roswell Park Comprehensive Cancer Center Technique
			Configuration and Setup
			Creation of the Neobladder
			Uretero-Neobladder Anastamosis
				Restoration of the Bowel.
				Maneuvers Facilitating Neobladder-Urethral Anastomosis.
		Robot-Assisted Intracorporeal Continent Cutaneous Diversion
			Colon Mobilization, Isolation, and Ileocolic Anastomosis
			Creation of the Colonic Pouch
			Uretero-Colonic Anastomosis
			Tapering of the Ileum and Imbricating the Ileocecal Valve
			Postoperative Care
		Outcomes
		Operative Time
		Learning Curve
		Complications
		Reoperations After Robot-Assisted Radical Cystectomy
			Uretero-Enteric Strictures
			Fistula and Bowel Obstruction
			Abdominal Wall–Related Complications
			Functional Outcomes
				Continence After Creation of Neobladder.
			Intracorporeal Versus Extracorporeal Diversion
	Future Directions
	Suggested Readings
	References
	References
XV The Prostate
	143 Development, Molecular Biology, and Physiology of the Prostate
		Developmental and Cell Biology
			Prostate
				Regional Differentiation of the Lower Urinary Tract
				Prostate Budding
				Cytodifferentiation
				Molecular Features of Prostate Development
					Induction of Prostate Budding.
					Epithelial Budding.
					Nkx3.1 and Sox9.
					Fibroblast Growth Factors.
					Wnt Signaling Pathway.
					Hedgehog Signaling Pathway.
					Transforming Growth Factor-β Superfamily.
					Prostate Zonal and Lobar Anatomy.
				Prostate Cell Types
					Luminal Epithelial Cells.
					Basal Cells.
					Prostate Epithelial Stem Cells.
					Intermediate Cells.
					Neuroendocrine Cells.
				Stroma and Tissue Matrix
			Seminal Vesicles and Their Development
		Endocrine Control of Prostate Growth
			Androgen Production by the Testes
			Adrenal Androgens
			Estrogens in the Male
			Androgen-Binding Proteins in the Plasma
			Regulation of Prostate Growth by Steroids and Protein Growth Factors
			Androgen Action at the Cellular Level
			5α-Reductase and Androgen Metabolism Within the Prostate
			Androgen Regulation of Stromal-Epithelial Interactions
			Cell Adhesion Molecules
			Regulation of Prostate Growth at the Molecular Level: Steroid Receptors
				Androgen Receptor
					Chaperonin Binding.
					DNA-Binding Domain.
					Ligand-Binding Domain.
					Dimerization.
					Post-Translational Modifications.
					Nuclear Localization.
					Transcriptional Activation Domains.
			Androgen Receptor–Dependent Chromatin Remodeling
				Role of the Nuclear Matrix in Androgen Action.
		Prostatic Secretions and Proteins
			Prominent, Nonpeptide Components of Prostatic Secretions
				Citric Acid
				Fructose
				Polyamines
				Phosphorylcholine
				Prostaglandins
				Zinc
			Prostatic Secretory Proteins
				Prostate-Specific Antigen
				Prostate-Specific Antigen Derivatives
				Human Kallikrein 2
				Human Kallikrein L1
				Human Kallikrein 11
				Human Kallikrein 14
				Prostate-Specific Transglutaminases
					Semenogelins I and II.
					Prostate-Specific Membrane Antigen.
					Prostate Stem Cell Antigen.
					Prostatic Acid Phosphatase.
					Prostate-Specific Protein 94 (β-Microseminoprotein and β-Inhibin).
					Protein C Inhibitor.
					Leucine Aminopeptidase.
					Lactate Dehydrogenase.
					Immunoglobulins, C3 Complement, and Transferrin.
					Zinc α2-Glycoprotein.
					Seminal Vesicle Secretory Proteins.
			Coagulation and Liquefaction of Semen
			Prostatic Secretions and Drug Transport
		Suggested Readings
		References
		References
144 Benign Prostatic Hyperplasia
	Etiology of Benign Prostatic Hyperplasia
		Hyperplasia
		The Role of Androgens
			Androgen Receptors
			Dihydrotestosterone and Steroid 5α-Reductase
		The Role of Estrogens
		Regulation of Programmed Cell Death
		Stromal-Epithelial Interaction
		Growth Factors
		Other Signaling Pathways
			The Potential Role of Inflammatory Pathways and Cytokines in Benign Prostatic Hyperplasia
		Genetic and Familial Factors
		Other Etiologic Factors
	Pathophysiology
		Pathology
			Anatomic Features
			Histologic Features
		Importance of Prostatic Smooth Muscle
		The Bladder’s Response to Obstruction
	Epidemiology and Natural History
		Definitions
		Descriptive Epidemiologic Studies
			Histologic or Autopsy Prevalence
			Cross-Sectional Studies of Clinical Prevalence
			Symptom Severity and Frequency
			Bother, Interference, and Health-Related Quality of Life
			Prostate Size
			Measures of Obstruction
		Analytical Epidemiologic Studies
			Religion
			Socioeconomic Factors
			Sexual Activity and Vasectomy
			Alcohol and Liver Cirrhosis
			Hypertension
			Smoking
			Physical Activity, Diet, Obesity, Body Mass Index, and the Metabolic Syndrome
			Medications
			Correlations Among Parameters
		Natural History of Untreated Benign Prostatic Hyperplasia
			Clinical Parameters and Outcomes of Interest
		Methods of Studying Natural History of Benign Prostatic Hyperplasia
			Watchful Waiting Studies
			Placebo and Sham Control Groups in Randomized Trials
				Placebo Control Groups.
				Sham Control Arms of Device Treatment Trials for BPH.
				Placebo/Sham Effect and Baseline Symptom Severity.
				Natural History and Disease Progression in Long-Term Placebo Arms.
				Relationship Between Placebo/Sham Effect and Perception of Improvement.
				Longitudinal Population-Based Studies.
	Complications of Benign Prostatic Hyperplasia
		Mortality
		Bladder Stones
		Bladder Decompensation
		Urinary Incontinence
		Urinary Tract Infections
		Upper Urinary Tract Deterioration and Azotemia
		Hematuria
		Acute Urinary Retention
			Descriptive Epidemiology (Table 144.16)
			Analytical Epidemiology
				Age.
				LUTS.
				Urodynamic Parameters.
				Prostate Volume and Serum PSA.
	Surgery for Benign Prostatic Hyperplasia
	Suggested Readings
	References
	References
145 Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia
	Diagnostic Evaluation
		Medical History
		Symptom Assessment
		Physical Examination
		Frequency-Volume Charts and Bladder Diaries
		Laboratory Tests
			Urinalysis
			Prostate-Specific Antigen
			Renal Function Assessment
		Instrumental Investigations
			Postvoid Residual Volume
			Uroflowmetry
			Urodynamics
			Filling Cystometry
			Pressure-Flow Study
			Imaging
			Upper-Tract Imaging
			Prostate and Bladder Imaging
			Cystourethrogram
			Cystourethroscopy
			Other Noninvasive Tests
			Practical Flowchart for the Evaluation of Patients With Lower Urinary Tract Symptoms
	Management of Lower Urinary Tract Symptoms Caused by Benign Prostatic Enlargement
		Conservative Management
		Watchful Waiting
		Lifestyle and Dietary Modifications
		Medical Therapy
			Impact and Trends of Medical Therapy Use for Lower Urinary Tract Symptoms
		Clinical Indications
		Assessment of Response to Medical Treatment: Outcome Measures
			Symptoms
			Bladder Outlet Obstruction
			Bladder Emptying
			Detrusor Overactivity
		Interpreting the Literature: Bias Associated With Trials on Medical Treatment of Lower Urinary Tract Symptoms
		Therapy With α1-Adrenergic Blockers
			Rationale
		Classification of α1-Blockers
			Nonselective α1-Blockers
			Selective α1-Blockers
		Review of the Literature on Currently Approved α1-Blockers for the Treatment of Lower Urinary Tract Symptoms
			Terazosin
			Doxazosin
			Alfuzosin
			Tamsulosin
			Silodosin
			Naftopidil
		Comparison of α-Adrenergic Blockers
		Safety Profile of α1-Blockers in Specific Patient Populations
		Hemodynamic Side Effects
		α-Blocker Therapy in Patients With Cardiovascular Diseases
		α1-Blockers in the Elderly
		α1-Blockers and Sexual Function
		Other Complications Associated with α-Blocker Therapy
		Summary
	Androgen Manipulation
		Rationale for Androgen Manipulation
		Classification of Pharmacologic Agents
		Interpreting the Literature on Androgen Manipulation
		Review of the Literature
		Finasteride
		Dutasteride
		Zanoterone
		Flutamide
		Cetrorelix
		Chlormadinone Acetate
		Aromatase Inhibitors
		Selective Estrogen and Androgen Receptor Modulators
		Tolerability and Safety of Androgen Manipulation Therapy for Benign Prostatic Hyperplasia
		5α-Reductase Inhibitors and Sexual Dysfunction
		Summary
	Muscarinic Receptor Antagonists
		Rationale and Indication for Patients With Benign Prostatic Hyperplasia
		Efficacy
		Tolerability and Safety Profile
		Summary
	β3-Agonist (Mirabegron)
		Indication, Efficacy, and Safety Profile
		Phosphodiesterase Type 5 Inhibitors
		Rationale and Efficacy of Phosphodiesterase Type 5 Inhibitors in Patients With Lower Urinary Tract Symptoms
		Combination Therapy for Lower Urinary Tract Symptoms
			α-Adrenergic Blockers and 5α-Reductase Inhibitors
		Medical Therapy of Prostatic Symptoms Trial
		Combination of Avodart and Tamsulosin Study
		α-Adrenergic Blockers and Anticholinergic Receptor Blockers
		α-Adrenergic Blockers and β3-Agonists
		α-Adrenergic Blockers and Phosphodiesterase Type 5 Inhibitors
	Phytotherapy
		Composition of Phytotherapy Extracts
		Mechanism of Action
		Current Role of Phytotherapy in the Treatment of Patients With Lower Urinary Tract Symptoms
		Serenoa Repens (Saw Palmetto Berry)
		Pygeum Africanum (African Plum)
		Hypoxis Rooperi (South African Star Grass)
		Other Plant Extracts and Lycopene
		Summary
	Prognosis of Patients Receiving Medical Treatment for Lower Urinary Tract Symptoms
	Acute Urinary Retention
		Management of Acute Urinary Retention
		Medical Therapy in the Prevention of Acute Urinary Retention
	Future Directions in Medical Treatment of Benign Prostatic Hyperplasia
	References
	References
146 Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia
	Introduction
	Epidemiology and Marketshare
		Marketshare
		Epidemiology of Surgical Treatment for Benign Prostatic Hyperplasia
			Increasing Age
			Effects of Medications for Benign Prostatic Hyperplasia
			Prostate Size
	Workup
	Defining Outcomes
		Response Rates
			Subjective
			Objective
		Need for Secondary Procedures
		Comparisons to Other Treatments
	Presurgical Factors
		Indications for Treatment
		Antibiotic Coverage
		Histologic Specimen
		Matching Treatment with Patient
	Specific Technologies
		Non-LASER Options
			Monopolar Transurethral Resection of the Prostate
				Technique (from Preoperative Area to Recovery Room)
					Preoperative.
					Intraoperative.
					Postoperative Care.
				Outcomes.
				TURP in the Anticoagulated Patient.
				Complications.
					Intraoperative and Perioperative Problems.
					Postoperative.
				Conclusion.
			Bipolar Transurethral Resection of the Prostate
				Concept.
				Technique.
				Outcomes
					Single-Cohort Studies.
					Comparative Studies.
				Complications.
					Intraoperative and Perioperative.
					Postoperative.
				Conclusion.
			Prostatic Urethral Lift
				Introduction.
				Outcomes
					Single-Cohort Studies.
					Comparative Studies.
				Complications.
				Conclusion.
			Convective Radiofrequency Water Vapor Thermal Therapy
				Introduction.
				Technique.
				Outcomes
					Single-Cohort Studies.
					Comparative Studies.
				Complications.
				Conclusion.
			Transurethral Vaporization of the Prostate
				Introduction and Concept.
				Technique
					Preoperative.
					Intraoperative.
					Postoperative.
				Outcomes.
					Animal/In Vitro Studies.
					Single-Cohort Studies.
					Comparative Studies
						Monopolar Studies.
						Bipolar Studies.
				Complications
					Intraoperative and Perioperative.
					Postoperative.
				Conclusion.
			Transurethral Microwave Therapy
				Introduction and Concept.
				Mechanism of Action.
					Nerve Degeneration/Sensory Changes.
					Morphology Changes.
				Technique
					Preoperative.
					Intraoperative and Perioperative.
					Postoperative.
				Outcomes.
					Predicting Outcomes.
					Single-Cohort Studies.
					Comparative Studies
						TUMT vs Sham.
						TUMT vs α-blocker.
					TUMT vs TURP.
				Complications
					Intraoperative and Perioperative.
					Postoperative.
				Conclusion.
			Transurethral Needle Ablation of the Prostate
				Introduction and Concept.
				Technique
					Preoperative.
					Intraoperative.
					Postoperative.
				Outcomes.
					Single-Cohort Studies.
					Comparative Studies.
						TUNA vs. other MISTs.
						TUNA vs TURP.
				Complications.
					Intraoperative and Perioperative.
					Postoperative.
				Conclusion.
			Transurethral Incision of the Prostate
				Introduction and Concept.
				Technique.
				Outcomes
					Single-Cohort Studies.
					Comparative Studies
						TUIP vs TURP.
				Complications
					Intraoperative and Perioperative.
					Postoperative.
				Summary.
			LASER Treatments
				LASER Safety.
				Holmium and Prostate Enucleation
					Introduction and Concept.
					Technique
						Preoperative.
						Intraoperative.
						Postoperative.
				Outcomes
					Single-Cohort Series.
					Comparative Series
						HoLEP vs. TURP.
						HoLEP vs. Open Prostatectomy.
						HoLEP in the Anticoagulated Patient.
				Complications
					Intraoperative and Perioperative.
					Postoperative.
				Conclusion.
			Prostate Ablation and Vaporization
				Concept and Introduction.
				Technique
					Preoperative.
					Intraoperative.
					Postoperative.
				Outcomes.
					Single-Cohort Studies.
					Comparative Studies.
					Use of Photoselective Vaporization in Anticoagulated Patients.
				Complications
					Intraoperative and Perioperative.
					Postoperative.
				Conclusion.
			Thulium
				Concept and Introduction.
				Technique.
				Outcomes
					Single-Cohort Series.
					Comparative Series
						Thulium Resection vs. TURP.
						Thulium Enucleation vs. HoLEP.
				Complications
					Intraoperative and Perioperative.
					Postoperative.
				Conclusion.
	Failed, Failing, and Future Directions
		Prostate Stents
			Concept
			Data
			Conclusion
		Temporary Implantable Nitinol Device
			Concept
			Data
			Verdict
		Aquablation (Aquabeam)
			Concept
			Data
			Verdict
		Prostate Embolization
			Concept
			Data
				Single-Cohort Studies.
				Comparative Studies.
			Verdict
		Prostatic Injections
			Concept
			Data
				PRX302.
				Anhydrous Ethanol.
				Botulinum Toxin.
			Verdict
	Conclusion
	Suggested Readings
	References
	References
147 Simple Prostatectomy:
	Indications for Simple Prostatectomy
	Preoperative Evaluation
	Operating Day Preparation
	Surgical Technique
		Anesthesia
		Open Simple Prostatectomy (Retropubic and Suprapubic Approach)
			Proper Positioning of the Patient
			Incision and Development of the Space of Retzius
		Retropubic Simple Prostatectomy
			Exposure of the Prostate
			Hemostatic Maneuvers
			Enucleation of the Adenoma
		Suprapubic Simple Prostatectomy
			Exposure of the Prostate
			Enucleation of the Adenoma
			Hemostatic Maneuvers
			Closure
	Postoperative Management
		Robotic-Assisted Laparoscopic Simple Prostatectomy (Video 147.1)
			Proper Positioning of the Patient
			Abdominal Access, Insufflation, and Trocar Placement
			Development of the Space of Retzius
			Bladder Neck Incision
			Enucleation of the Adenoma
			Hemostasis and Vesicourethral Anastomosis
			Adenoma Extraction and Closure
	Postoperative Management
	Complications of Simple Prostatectomy
	Summary
	Suggested Readings
	References
	References
148 Epidemiology, Etiology, and Prevention of Prostate Cancer
	Epidemiology
		Incidence and Mortality Trends
			Incidence
			Mortality
			Racial Differences
			Global Incidence and Mortality
			Age at Diagnosis
			Stage at Diagnosis
			Effect of Screening on Incidence and Mortality
	Risk Factors
		Familial and Germline Genetic Influences
		Inflammation and Infection
		Molecular Epidemiology
		Androgens
		Estrogens
		Insulin-like Growth Factor Axis
		Leptin
		Vitamin D, Vitamin D Receptor, and Calcium
			Other Influences
				Sexual Activity/Sexually Transmitted Diseases.
				Vasectomy.
				Smoking.
				Diet.
				Obesity.
				Alcohol Consumption.
	Etiology and Molecular Genetics
		The Influence of Androgens
		Stem Cells
		Somatic Genetic Changes Associated With Tumor Initiation and Progression
		The Cancer Genome Atlas and Its Findings
		Tumors Defined by Gene Fusions
			ETS Family Gene Fusions
			Other Gene Fusions
		Tumors Defined by Mutations (SPOP, FOXA1, IDH1)
			Epigenetic Changes
			Androgen Receptor
			DNA Repair Defects and Other Alterations
		Differences Between African-Americans and Caucasians
		An Integrated Model of Prostate Cancer Tumorigenesis
	Chemoprevention
		Rationale
	Pharmacologic Agents
		5α-Reductase Inhibitors
			Prostate Cancer Prevention Trial
		Reduction by Dutasteride of Prostate Cancer Events Trial
		Summary: PCPT and REDUCE
			Toremifene Citrate
			Other Pharmacologic Agents
	Vitamins and Micronutrients
		Selenium and Vitamin E
			The Selenium and Vitamin E Cancer Prevention Trial
	Conclusion
	References
	References
149 Prostate Cancer Biomarkers
	Biomarker Development
	Assessment of Biomarker Performance
	Blood-Based Biomarkers
		Prostate-Specific Antigen (PSA or hK3)
			Free Prostate-Specific Antigen
			Free Prostate-Specific Antigen Isoforms
		Prostate-Specific Membrane Antigen
		Human Kallikrein 2
		Circulating Tumor Cells and Circulating Tumor DNA
	Urine-Based Biomarkers
		PCA3
		Gene Fusions
		Other Urine Biomarkers
			Annexin A3
			miRNA
	Tissue-Based Biomarkers
		α-Methylacyl Coenzyme A Racemase
		Epigenetic Modifications
			Genomic Expression Profiles
			Inherited Genetic Markers
	Summary
	Suggested Readings
	References
	References
150 Prostate Biopsy
	Ultrasonographic Anatomy of the Prostate
	Gray-Scale Transrectal Ultrasonography
		Machine Settings
		Techniques
			Probe Manipulation
		Volume Calculations
		Cystic Lesions of the Prostate
		Prostate Cancer Imaging on Transrectal Ultrasonography
		Transrectal Ultrasonography Appearance After Treatment
		Transrectal Ultrasonography and Other Malignancies
	Prostate Biopsy: Techniques and Outcomes
		Indications for Prostate Biopsy
		Contraindications to Prostate Biopsy
		Preparing Patients for Biopsy
			Antibiotic Prophylaxis
			Cleansing Enema
			Analgesia
			Patient Positioning
		Transrectal Prostate Biopsy Techniques
			Sextant Biopsy
			Extended-Core Biopsy Techniques
			Repeat and Saturation Prostate Biopsy
		Transperineal Prostate Biopsy
		Transurethral Prostate Biopsy
		Risks and Complications of Prostate Biopsy
			Postbiopsy Infections
			Bleeding
			Other Complications
	Advanced and Investigational Techniques for Prostate Biopsy
		Color and Power Doppler Transrectal Ultrasonography
		Other Newer and Investigational Imaging and Biopsy Techniques
			Multiparametric Prostate Ultrasonography
			Multiparametric Magnetic Resonance Imaging of the Prostate
	Suggested Readings
	References
	References
151 Pathology of Prostatic Neoplasia
	Prostatic Intraepithelial Neoplasia
	Adenocarcinoma
		Staging Classification
		Location
		Spread of Tumor
		Tumor Volume
		Grade
		Assessment of Needle Biopsy Specimens
			Processing
			Differential Diagnosis
			Prognosis
		Assessment of Transurethral Resection Specimens
			Processing
			Differential Diagnosis
		Assessment of Radical Prostatectomy Specimens
			Assessment
			Prognosis
				Gleason Score.
				Lymph Node Metastases.
				Extraprostatic Extension and Seminal Vesicle Invasion.
				Margins.
				Tumor Volume.
				Perineural and Vascular Invasion.
		Adenocarcinoma With Treatment Effect
	Subtypes of Prostate Adenocarcinoma
		Mesenchymal Tumors
		Urothelial Carcinoma
		Miscellaneous Malignant Tumors
	Suggested Readings
	References
	References
152 Diagnosis and Staging of Prostate Cancer
	Diagnosis
		Screening
			General Concepts of Screening
			Randomized Trials
			Specialty Group Recommendations
		Diagnostic Modalities
			Digital Rectal Examination
			Prostate-Specific Antigen
				Factors Influencing Prostate-Specific Antigen.
				Clinical Use for Diagnosis.
				Triggers for Biopsy.
			Prostate-Specific Antigen Derivatives and Molecular Forms
				Volume-Based Prostate-Specific Antigen Parameters.
				Prostate-Specific Antigen Velocity.
				Free Prostate-Specific Antigen.
				Complexed Prostate-Specific Antigen.
				Prostate-Specific Antigens Isoforms.
				Human Kallikrein 2.
				Multiplex Tests.
			Other Markers
	Staging
		General Concepts of Staging
			Clinical Versus Pathologic Staging
			Classifications
		Prediction of Tumor Extent
			Prostate-Specific Antigen
			Digital Rectal Examination
		Prostate Needle Biopsy
		Combined Use of Pretreatment Parameters
		Imaging
		Molecular Staging
		Pelvic Lymphadenectomy
	Suggested Readings
	References
	References
153 Active Management Strategies for Localized Prostate Cancer
	Host Evaluation
		Longevity Assessment and Competing Risks for Mortality
		Baseline Urinary, Sexual, and Bowel Function
			Bladder Function
			Sexual Function
			Bowel Function and Other Conditions Affecting Treatment Choice
		Patient Preference and Biases
		Assessment of Prostate Cancer Risk
			Tools for Risk Stratification
			Definitions of Low, Intermediate, and High Risk
			Gleason Scoring and Grade Groups
			Epstein Criteria
			Staging
			Nomograms for Prediction of Stage
			Risk Stratification Nomograms
			Prostate Magnetic Resonance Imaging in Risk Assessment
			Genomic Tests for Risk Stratification
	Selection of Treatment: Comparative Studies
		Oncologic Outcomes
			Comparative Population-Based Studies
				Scandinavian Prostate Cancer Group Study Number 4.
				PIVOT.
				Prostate Cancer Outcomes Study.
				ProtecT.
			Functional Outcomes
				Prostate Cancer Outcomes Study.
				ProtecT.
				Comparative Effectiveness Analysis of Surgery and Radiation.
				Open versus Robotic Prostatecomy.
	Patient Counseling: a Stepwise Decision Approach
		Decision One: Observation versus Active Treatment
		Decision Two: Partial Gland versus Whole Gland Treatment
		Decision Three: Surgery vs. Radiation versus Whole-Gland Ablation
		Decision Four: Type of Treatment Delivery
	Conclusion
	References
	References
154 Active Surveillance of Prostate Cancer
	The Overdiagnosis and Overtreatment Problem
	The Natural History of Prostate Cancer
		Molecular Genetics of Gleason Pattern 3 Versus Patterns 4 and 5
		Natural History
	Outcome of Active Surveillance
		Patient Selection
		Watchful Waiting
		Management of Men on Active Surveillance
	Other Risk Factors
		Race
		Family History
		Monitoring
	Magnetic Resonance Imaging
		Biomarkers
			Genomic Classifier
			Genomic Prostate Score
			Cell Cycle Progression
	Caveats of Tissue-Based Genomics
	Psychological Aspects
	Lifestyle Management
		Smoking Cessation
		Exercise
		Weight Control
		Diet
		Micronutrients
	Pharmacologic Intervention
	Summary
	GAP 3
	Barriers to Active Surveillance
		Nomenclature
		Economics
	Research Questions
	Conclusion
	References
	References
155 Open Radical Prostatectomy
	Radical Retropubic Prostatectomy: Surgical Anatomy
		Venous and Arterial Anatomy
		Pelvic Plexus
		Striated Urethral Sphincter
		Pelvic Fascia
	Surgical Technique
		Preoperative Preparation
		Special Instruments
		Anesthesia, Incision, and Lymphadenectomy
		Exposure
		Incision in the Endopelvic Fascia
		Division of the Puboprostatic Ligaments
		Preservation of Accessory Pudendal Arteries
		Ligation and Division of the Dorsal Vein Complex
			Division of the Dorsal Vein Complex
			Division of the Urethra and Placement of Urethral Sutures
			Identification and Preservation of the Nerve Bundle
		Identification of the Neurovascular Bundle
			Standard Preservation of the Neurovascular Bundles
			High Anterior Release of the Neurovascular Bundles at the Apex
			Wide Excision of the Neurovascular Bundles
		Posterior Dissection and Division of the Lateral Pedicles
		Division of the Bladder Neck and Excision of the Seminal Vesicles
		Bladder Neck Reconstruction and Anastomosis
		Postoperative Management
	Complications
		Intraoperative Complications
		Postoperative Complications
			Thromboembolic Events
			Bladder Neck Contracture
			Urinary Incontinence
		Erectile Dysfunction
	Summary of Radical Retropubic Prostatectomy
	Suggested Readings
	References
	References
		Radical Retropubic Prostatectomy
		Radical Perineal Prostatectomy
156 Laparoscopic and Robotic-Assisted Laparoscopic Radical Prostatectomy and Pelvic Lymphadenectomy
	Evolution of Minimally Invasive Laparoscopic Prostatectomy
	Patient Selection
		Indications and Contraindications
		Use of Preoperative Multiparametric Magnetic Resonance Imaging
	Instrumentation
	Preoperative Preparation
		Patient Preparation
		Informed Consent
		Operating Room Personnel
		Patient Positioning
		Anesthesia Considerations
	Surgical Technique
		Robotic-Assisted Versus Pure Laparoscopic Approach
		Transperitoneal Approach
			Abdominal Access, Insufflation, and Trocar Placement
		Extraperitoneal Approach
		Pros and Cons of Extraperitoneal Versus Transperitoneal Approach
		Developing the Space of Retzius
		Ligation of the Deep Dorsal Venous Complex
		Bladder Neck Identification and Transection
		Dissection of the Seminal Vesicles and Vasa Deferentia
		Development of the Plane Between the Prostate and Rectum
		Prostatic Pedicle Control
		Preservation of the Neurovascular Bundle
		Apical Dissection
		Intraoperative Inspection of Prostate
		Pelvic Lymphadenectomy
		Entrapment of Specimens
		Bladder Neck Reconstruction
		Posterior Support of the Vesicourethral Anastomosis
		Vesicourethral Anastomosis
		Delivery of the Specimens and Exiting the Abdomen
	Postoperative Management
		Pain Management Post-Prostatectomy
		Diet
		Deep Venous Thrombosis Prophylaxis
		Pelvic Drain
		Urethral Catheter
		Return to Normal Activity
		Role of Continence Physiotherapy
		Role of Penile Rehabilitation
		Robotic Prostatectomy Outcomes
	Complications of Robotic Prostatectomy
		Patient Positioning: Neural Injury
		Blood Loss/Transfusion
		Bowel Injury
		Ureteral Injury
		Robotic Machine Failure
	Postoperative Complications
		Intraperitoneal Urine Leak
		Bladder Neck Stricture
		Pelvic Node Dissection Complications
		Quality-of-Life Outcomes After Radical Robotic Prostatectomy
	Functional Outcomes
		Urinary Continence After Robotic Radical Prostatectomy
		Erectile Dysfunction After Robotic Radical Prostatectomy
		Oncologic Outcomes of Robotic Radical Prostatectomy
	Salvage Robotic-Assisted Radical Prostatectomy
		Salvage Prostatectomy Technique
	Minimally Invasive Pelvic Lymph Node Dissection
		Indications
		Surgical Technique
		Complications
		Genomic Research on Fresh Prostatic Cancer Tissues and Tissue Banking
		Future of Robotic Surgery
	Summary
	References
	References
157 Radiation Therapy for Prostate Cancer
	Historical Perspective and Technological Advances
		High-Energy Linear Accelerators
		CT-Based Treatment Planning and Three-Dimensional Conformal Radiotherapy
		Intensity-Modulated Radiation Therapy
		Image-Guided Radiation Therapy and Treatment Margins
		Multiparametric Magnetic Resonance Imaging in Radiation Treatment Planning
		Transrectal Ultrasound-Guided Brachytherapy
	External Beam Radiation Treatment (Also See Outcomes for External Beam Radiation)
		Fractionation in Radiation Therapy
		Radiobiologic Basis for Hypofractionation
		Stereotactic Body Radiation Therapy
		Heavy Particle Beams/Proton Therapy
	Brachytherapy
		Low-Dose-Rate Brachytherapy Technique and Trends
		Assessment of Permanent Implant Quality
		High-Dose-Rate Brachytherapy
			High Dose Rate as a Boost With External Beam Radiation Therapy
			High-Dose-Rate Monotherapy
		Patient Selection for Brachytherapy
		Brachytherapy Combined With External Irradiation
	Androgen Suppression Combined With Radiation
		Background and Potential Mechanisms
		Androgen Suppression Therapy and Localized Disease
		Androgen Suppression Therapy and Locally Advanced Disease
		Benefit of Radiation in Addition to Androgen Suppression for Locally Advanced Disease
		Optimal Duration of Androgen Suppression
	Role of Prophylactic Pelvic Nodal Treatment
	Treatment Morbidity and Quality-of-Life Outcomes
		Rectal Toxicity and Management
		Rectal-Sparing Strategies
		Urinary Toxicity and Management
		Erectile Dysfunction and Management
	Evaluating the Response to Radiation Therapy
		Prostate-Specific Antigen Follow-up: Definition of Failure
		Significance of Time to Nadir
		Significance of Nadir Value and Doubling Time
		Brachytherapy and the Benign Bounce Phenomenon
		Biochemical Failure and Impact of Neoadjuvant Hormones
		Post–Radiation Therapy Imaging
		Post–Radiation Therapy Biopsy, Timing, and Interpretation
		Imaging and Sampling Error
	Treatment Efficacy
		Outcomes for External Beam Radiotherapy
		Role of Radiation Therapy in High-Risk or Locally Advanced Disease
		Outcomes for External Beam Hypofractionation
		Outcomes for Brachytherapy
		Comparative Efficacy of External Beam Radiation Therapy Versus Brachytherapy
		Brachytherapy Combined With External Irradiation
	Suggested Readings
	References
	References
158 Focal Therapy for Prostate Cancer
	Introduction
	Concepts and Historical Perspective
	Biologic Basis for Prostate Focal Therapy
		Using Cancer Grade as an Indication of Aggressiveness
		Multifocality of Prostate Cancer Versus the Index Lesion Hypothesis
	Clinical Applications of Focal Therapy
		Treating the Index Lesion
		The Complementary Roles of Focal Therapy and Active Surveillance
	Patient Selection
		Biopsy-Based Lesion Identification
	Advanced Imaging Techniques in Prostate Cancer
		Multiparametric Magnetic Resonance Imaging
		MRI-Targeted/Fusion Biopsy
	Promising Imaging Modalities
		Positron Emission Tomography (PET)
		Multiparametric Ultrasonography
		Contemporary Patient Selection Criteria
	Ablation Patterns and Current Technologies
		Types of Ablation
		Ablation Approach
		Cryotherapy
		High-Intensity Focused Ultrasonography
		Laser
		Irreversible Electroporation
		Vascular-Targeted Photodynamic Therapy
		Brachytherapy
		Other Modalities
		Adjuvants to Focal Therapy
		Post–Focal Therapy Follow-Up
	Conclusions and Areas for Future Research
	References
	References
159 Treatment of Locally Advanced Prostate Cancer
	Definition
		Contemporary Risk Assessment
		Imaging Modalities
		Novel Markers
	Trends in Incidence and Treatment
	Natural History
	Radical Prostatectomy
		Surgery for Clinical Stage T3 Prostate Cancer
		Outcomes of Prostatectomy for Pathologically Advanced Disease
		Outcomes of Prostatectomy for Node-Positive Disease
		Neoadjuvant Androgen Deprivation
		Neoadjuvant Chemotherapy and Chemotherapy–Hormonal Therapy
		Adjuvant Radiation Therapy
		Adjuvant Androgen Deprivation
	Radiation Therapy
		Neoadjuvant Androgen Deprivation and Radiation Therapy
		Adjuvant Androgen Deprivation and Radiation Therapy
		Radiation Therapy and Chemotherapy
	Focal Ablative Therapy
		Cryoablation
		High-Intensity Focused Ultrasonography
	Androgen Deprivation and Its Timing
		Intermittent Androgen Deprivation
		Quality of Life
	Management of Delayed Sequelae
	Clinical Trials
	Suggested Readings
	References
	References
160 Management Strategies for Biochemical Recurrence of Prostate Cancer
	Radical Prostatectomy
		Definition of Biochemical Recurrence After Radical Prostatectomy
		The Prediction of Biochemical Recurrence Postprostatectomy
		Natural History of Biochemical Recurrence Postprostatectomy
		Ultrasensitive Prostate-Specific Antigen
		Imaging in Patients With Biochemical Recurrence After Radical Prostatectomy
		Salvage Radiation Therapy
		Dose Response With Salvage Radiation Therapy
		Concurrent Androgen Deprivation Therapy With Salvage Radiation
		Whole Pelvis Versus Prostatic Bed Radiation Therapy
		Salvage Versus Adjuvant Radiation Therapy for Prostate Cancer
		Androgen Deprivation Therapy for Biochemical Failure After Radical Prostatectomy
	Radiation Therapy
		PSA Recurrence After Definitive Radiotherapy
		Postradiation PSA Bounce
		Natural History of PSA Recurrence After Definitive Radiation
		Biopsy After Radiotherapy
		Imaging After Biochemical Recurrence Following Radiotherapy
		Salvage Radical Prostatectomy
		Salvage Cryotherapy
		Salvage Brachytherapy
		Salvage High-Intensity Focused Ultrasonography
		Androgen Deprivation Therapy After Biochemical Recurrence Following Radiation Therapy to the Prostate
	Summary
	References
	References
161 Hormonal Therapy for Prostate Cancer
	Historical Overview
	Molecular Biology of the Androgen Axis
		Sources of Androgen
	Mechanisms of Androgen Blockade
		Orchiectomy
		Antiandrogens
			Steroidal First Generation
			Nonsteroidal First- and Second-Generation
				Flutamide.
				Bicalutamide.
				Nilutamide.
			Nonsteroidal Second Generation
				Enzalutamide.
				Apalutamide.
			Antiandrogen Withdrawal Syndrome
		Inhibition of Luteinizing Hormone–Releasing Hormone
			Luteinizing Hormone–Releasing Hormone Agonists
			Luteinizing Hormone–Releasing Hormone Antagonists
		Inhibition of Androgen Synthesis
			Aminoglutethimide
			Ketoconazole
			Abiraterone
	Clinical Follow-Up on Hormonal Therapy
		Response to Androgen Blockade
			Prognostic Model
			Prostate-Specific Antigen Metrics
			Other Clinical Predictors
			Bone Scan Index
			Genomic Predictors
		General Complications of Androgen Ablation
			Osteoporosis
			Hot Flashes
			Sexual Dysfunction (Erectile Dysfunction and Loss of Libido)
			Cognitive Function
			Changes in Body Habitus
			Diabetes and Metabolic Syndrome
			Cardiovascular Morbidity and Mortality
			Gynecomastia
			Anemia
	Combination Therapy
		With Radical Prostatectomy
		With Radiation Therapy
		Combination Hormonal Therapy
		With Chemotherapy
	Timing of Therapy
		Continuous Androgen Deprivation Therapy: Immediate Versus Delayed
			Results in Clinically Localized Disease
			Results in Lymph Node Metastatic Prostate Cancer as Adjuvant Therapy
			Results in Locally Advanced or Asymptomatic Metastatic Disease or Disease Not Suitable to Local Treatment
			Results in Biochemically Recurrent Prostate Cancer
			Immediate Versus Delayed Androgen Deprivation Therapy: Integrating the Data
		Intermittent Versus Continuous Androgen Deprivation Therapy
		Emerging Androgen Receptor–Associated Biomarkers
			Androgen Receptor Splice Variants
			Androgen Receptor Gene Amplification and Mutation
	References
	References
162 Treatment of Castration-Resistant Prostate Cancer
	Clinical Considerations
		Disease Assessment and Prognostic Considerations
		Nonmetastatic Castration-Resistant Prostate Cancer
		Metastatic Castration-Resistant Prostate Cancer
	Cytotoxic Chemotherapy
		Evaluation of Treatment Efficacy
		Chemotherapeutic Agents
			Mitoxantrone
			Docetaxel
			Cabazitaxel
		Platinum Agents
	Next-Generation Hormonal Therapies
		CYP17 Inhibition: Abiraterone and Other Agents
		Androgen Receptor Modulation: Enzalutamide, Apalutamide, and Other Agents
		AR-V7: A Potential Treatment-Selection Marker
	Immunotherapy
		Sipuleucel-T
		ProstVac-VF
		Immune Checkpoint Blockade
		Pembrolizumab for Microsatellite Instability-High Cancers
	Targeted Treatments
		Rational Target Overview
		PI3K/Akt/mTOR Pathway
		Angiogenesis
		c-Met Signaling
		Apoptosis Pathway
		Targeting DNA Repair
	Palliative Management
		Pain and Spinal Cord Compression
		Bone-Targeted Approaches
			Bisphosphonates
			RANK Ligand Inhibitors
			Radium-223 and Other Radiopharmaceuticals
	Neuroendocrine Prostate Cancer
	Conclusion
	Suggested Readings
	References
	References