Urological eponyms

This chapter explores eponymous terms and conditions in urology and a brief background of the people they are named after.

Basic science and renal transplant

This chapter covers the basic physiological functions of the kidney, bladder, and urethra. Renal anatomy is detailed, including the anatomical relations of the kidney. Renal physiology is covered in detail, including the regulation of renal blood flow and regulation of water, acid–base, sodium, and potassium balance. It includes the principles of renal replacement therapy and the principles of renal transplantation, including assessment of both the recipient and the donor. Transplant surgery is outlined, including commonly used drugs and complications and their management and common complications of renal transplant surgery. The different types of organ rejection are discussed, including their treatments.

Infertility

Male factor infertility is outlined in an easily digestible format to provide clear information on this sometimes less familiar topic, starting with the basics of male reproductive physiology, the hypothalamic–pituitary–testicular axis, and spermatogenesis. This chapter includes a review of the aetiologies of abnormal sperm counts (with particular emphasis on azoospermia and oligospermia), relevant clinical assessment, and key male factor infertility investigations such as semen analysis, hormone measurement, karyotying, imaging, and testicular biopsy. The chapter explains the management options for the infertile male and couple, including information on the different assisted reproductive techniques. The chapter covers additional important clinical and exam topics, including varicoceles, indications for repair in males of different ages, red flag signs that should trigger further investigation, and the treatment options of embolization and surgical repair. The fourth edition also includes the addition of new material exploring the pros and cons of vasectomy and vasectomy reversal.

Trauma to the urinary tract and other urological emergencies

Management of urological trauma remains much as it was at the time of the third edition of this handbook, though selective renal artery embolization is increasingly used when compared with surgical exploration for renal trauma with persistent bleeding.

General principles of management of patients

This chapter details basic principles that underpin management of the surgical, including urological, patient, namely safe communication techniques, correct note-keeping practice, and a brief introduction to concepts of patient safety such as cross-checking.

Urological surgery and equipment

This chapter covers the principles of urological surgery and the equipment commonly used in urological procedures. This includes preoperative preparation, including the management of patients on anticoagulants, and the fourth edition includes novel oral anticoagulants. Technology such as catheters, lasers, stents, telescopes, and diathermy are all discussed in detail and at a level suitable for the FRCS(Urol) examinations. The principles of consent and the recent Montgomery ruling are included in the fourth edition. The surgical principles of a range of urological operations are outlined, ranging from inguinoscrotal procedures to pelvic oncology procedures, including reconstruction.

Paediatric urology

This chapter covers paediatric urology, and the fourth edition includes the latest guidelines and recommendations (National Institute for Health and Care Excellence 2013, British Association of Paediatric Urologists 2015). The embryology of the urinary and genital tracts is detailed. The presentation of undescended testes, vesicoureteric reflux, and urinary tract infection and their current management recommendations are included. New sections in the fourth edition include paediatric trauma, nephrolithiasis, uro-physiology, and the foreskin. Megaureter, ectopic ureter, and ureterocele are also covered in detail. Hypospadias and epispadias are covered. This chapter also includes the assessment and management of children with urinary incontinence and nocturnal enuresis.

Sexual health

This andrology chapter covers the physiology of erection and ejaculation and expands on the evaluation and treatment of erectile dysfunction (ED), including the use of drugs (phosphodiesterase type-5 inhibitors or PDE-5I), intracavernosal injections, and insertion of penile prosthesis. The evaluation and treatment of Peyronie’s disease with Nesbitt or Lue procedure are explained. Ejaculatory dysfunction is covered, including the topics of retrograde, premature, delayed and absent ejaculation, and anorgasmia. The topical subjects of late-onset hypogonadism (LOH) and general male hypogonadism are examined in detail, with a clear description of testosterone replacement therapy. Gonococcal and non-gonococcal urethritis evaluation is laid out with current treatment guidelines.

Upper tract obstruction, loin pain, hydronephrosis

This chapter covers upper tract obstruction, loin pain, and hydronephrosis. A comprehensive discussion of causes and management of unilateral and bilateral hydronephrosis is included. The pathophysiology of renal obstruction is detailed, including the physiology of urine flow from the kidney to the bladder. An overview of the management of non-pelviureteric junction obstruction (PUJO) ureteric strictures is included, including minimally invasive treatment options. The causes of retroperitoneal fibrosis are outlined, and this fourth edition includes the newer diagnosis of IgG4-related disease (causative in up to half of previously considered idiopathic cases). Common presentations, investigation, and management options are detailed, including both emergency management and longer-term treatments.

Miscellaneous urological diseases of the kidney

This chapter covers miscellaneous diseases of the kidney and outlines their presentation, investigations, and management. This includes renal cysts, calyceal diverticulum, medullary sponge kidney, and cystic disease (acquired renal cystic disease and autosomal dominant polycystic kidney disease, including the aetiology and associated disorders). Adult vesicoureteric reflux and pelviureteric junction obstruction are discussed alongside informative and representative images, together with their management. Embryological abnormalities are covered in detail, including horseshoe kidney, ectopic kidney, renal agenesis, malrotation, and duplication. The investigation and management of each anomaly are included.