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Pediatric and Adult Reconstructive Urologic Surgery
BOOK REVIEWS
If voiding was successful urofluorometry was performed along with a determination of residual urine. In the experimental group 15 of 18 patients experienced the desire to void within 45 to 90 minutes after instillation of the drug. Although 83 per cent of the experimental group were able to void after instillation of prostaglandin F2a, 2 of these patients subsequently required insertion of an indwelling catheter. Over-all, 13 of 18 patients (72 per cent) were able to void satisfactorily without reinsertion of a catheter and they were deemed permanent cures. The mean residual urine volume in this group was 107 ± 79 ml., the mean maximum flow rate was 10.6 ± 5.5 ml. per second and the average length of hospitalization was 9.4 ± 1. 7 days. Although the maximum flow rate decreased or the residual urine increased in 11 of 15 patients, none required reinsertion of the catheter. These results contrast sharply with those of the control group in which the average onset of voiding occurred 7.1 ± 7.2 days postoperatively and the average length of hospitalization was 11.8 ± 3.3 days. No serious side effects were noted in the experimental group. Only 1 patient complained of mild abdominal pain associated with an urge to defecate. Two patients experienced mild dysmenorrhoea-like uterine cramps. In light of the documented efficacy and minimum morbidity, the authors conclude that prostaglandin F2a is an attractive treatment option in the management of urinary retention in this patient population. Moreover, since the drug was administered via an indwelling bladder catheter the theoretical impact of prostaglandin F2a upon an increase in urethral pressure apparently was obviated. Finally, the authors theorize that repeated instillations of this agent 2 or more days after the initial exposure might circumvent subsequent deterioration in bladder emptying. J. M. K. 1 figure, 1 table, 19 references
BOOK REVIEWS U reteroscopy
J. L. HUFFMAN, D. H. BAGLEY AND E. S. W. B. Saunders Co., 193 pages, 1988
LYON,
Philadelphia:
This book covers ureteroscopy in detail and it can be helpful for the urologist contemplating ureteroscopy. All of the various steps for ureteroscopy, including preparation, dilation of the ureter, passage of the ureteroscope, removal of calculi and postoperative care, are covered. In addition, a chapter describes diagnostic and therapeutic approaches to upper tract urothelial tumors. In experienced hands it may be feasible to remove small superficial papillary lesions in the upper urinary tract and to follow these patients in a similar manner as presently is done with lower tract transitional cell carcinoma, although this approach remains controversial. There is a chapter on flexible ureteroscopes but this technology is changing rapidly. In the past flexible ureteroscopes have been fragile, expensive and too large, so that they have not enjoyed great popularity. Increasingly, multiple companies are providing an array of smaller, better engineered, flexible ureteroscopes. There also is a good chapter on the care and sterilization of the instruments. It is increasingly important that the nursing and ancillary staff be aware of the delicate nature of these instruments as well as their expense. They can be broken easily. Lastly, there is a thoughtful appendix that
669
covers many of the hazards ofureteropyeloscopy. Many helpful hints are given. Problems addressed include inability to locate the ureteral orifice, pass guide wires or engage the calculus. In summary, this book provides helpful information to the urologist contemplating ureteroscopy. Increasingly, most stones in the urinary tract are treated with extracorporeal shock wave lithotripsy and ureteroscopy more often will be relegated to manipulation of distal ureteral stones. Manipulation of upper urinary calculi is fraught with greater hazard and it probably should not become an initial treatment choice, since there will be a significant complication rate and a poorer success rate compared to shock wave lithotripsy. Fray F. Marshall Department of Urology The Johns Hopkins Hospital Baltimore, Maryland
Pediatric and Adult Reconstructive Urologic Surgery, 2nd ed.
J. A. LIBERTINO, Baltimore: The Williams & Wilkins Co., 664 pages, 1987 This edition, which succeeds the initial edition published 10 years ago, is a comprehensive volume written by a host of contributors. The list of urologists who are chapter authors reads like a Who's Who of American Urology and there are numerous distinguished foreign academicians. The book is divided into 4 sections. Section 1 is devoted to surgery of the kidney and covers subjects from proper renal incisions to the rare subject of renal intestinal fistulas. The chapters on ureteropelvic junction reconstruction and surgery for renovascular hypertension were particularly informative. However, I believe that more extensive coverage of the various technical aspects associated with infant and childhood pyeloplasty would have been helpful. The chapter on surgery for renovascular hypertension was especially informative, and it obviously reflects the authors' extensive interest and experience in this field. Section 2 discussed surgery of the ureter. The surgical management of the megaureter by Hendren was a concise summary of his extensive experience in this field. The next chapter on contraindications to remodeling and reimplantation of the ureters was a natural successor to Hendren's chapter and it will give the resident surgeon more of a perspective on approaching these most difficult problems. Inclusion of the chapters on continent urinary diversion under the section dealing with the ureter was somewhat cumbersome. Also, since these procedures for the most part are used to replace or supplement the bladder they rightfully should be included in the section dealing particularly with bladder operations. Section 3 discusses the majority of surgical conditions that involve the bladder. The chapter on bladder replacement in children and young adults shows the excellent results that can be obtained in children with severe congenital abnormalities when experience and surgical imagination are brought together. The subject of incontinence was covered well and the surgical procedures relating to incontinence were well described. Nonetheless, more attention should have been placed upon dealing with that most problematic patient with a neuropathic bladder and persistent urinary incontinence. Section 4 was concerned with surgical conditions of the penis and genitalia. The best part of this section was that it contained
670
BOOK REVIEWS
the 2 best chapters in the book. The chapter on reconstructive phallic surgery should be complimented on its completeness and artistry. Likewise, the chapter on muscle and myocutaneous grafts in urological surgery updated the practicing urologist in this new and evolving field. Not only is this chapter complete in its description of these procedures but it also is practical in describing the application of these grafts to difficult urological disorders. In summary, this book is of significant value to the urologist interested in reconstructive urological surgery. It offers sufficient depth to help the practicing urologist and resident decide
which of these techniques are applicable to their particular practice. I remember as a resident when the first copy of this book was published what a source of reference it was during the residency years. The current edition certainly magnifies the first edition and it shows how far the field of reconstructive urological surgery has evolved in the last 10 years.
John P. Gearhart Division of Pediatric Urology The Johns Hopkins Hospital Baltimore, Maryland
If voiding was successful urofluorometry was performed along with a determination of residual urine. In the experimental group 15 of 18 patients experienced the desire to void within 45 to 90 minutes after instillation of the drug. Although 83 per cent of the experimental group were able to void after instillation of prostaglandin F2a, 2 of these patients subsequently required insertion of an indwelling catheter. Over-all, 13 of 18 patients (72 per cent) were able to void satisfactorily without reinsertion of a catheter and they were deemed permanent cures. The mean residual urine volume in this group was 107 ± 79 ml., the mean maximum flow rate was 10.6 ± 5.5 ml. per second and the average length of hospitalization was 9.4 ± 1. 7 days. Although the maximum flow rate decreased or the residual urine increased in 11 of 15 patients, none required reinsertion of the catheter. These results contrast sharply with those of the control group in which the average onset of voiding occurred 7.1 ± 7.2 days postoperatively and the average length of hospitalization was 11.8 ± 3.3 days. No serious side effects were noted in the experimental group. Only 1 patient complained of mild abdominal pain associated with an urge to defecate. Two patients experienced mild dysmenorrhoea-like uterine cramps. In light of the documented efficacy and minimum morbidity, the authors conclude that prostaglandin F2a is an attractive treatment option in the management of urinary retention in this patient population. Moreover, since the drug was administered via an indwelling bladder catheter the theoretical impact of prostaglandin F2a upon an increase in urethral pressure apparently was obviated. Finally, the authors theorize that repeated instillations of this agent 2 or more days after the initial exposure might circumvent subsequent deterioration in bladder emptying. J. M. K. 1 figure, 1 table, 19 references
BOOK REVIEWS U reteroscopy
J. L. HUFFMAN, D. H. BAGLEY AND E. S. W. B. Saunders Co., 193 pages, 1988
LYON,
Philadelphia:
This book covers ureteroscopy in detail and it can be helpful for the urologist contemplating ureteroscopy. All of the various steps for ureteroscopy, including preparation, dilation of the ureter, passage of the ureteroscope, removal of calculi and postoperative care, are covered. In addition, a chapter describes diagnostic and therapeutic approaches to upper tract urothelial tumors. In experienced hands it may be feasible to remove small superficial papillary lesions in the upper urinary tract and to follow these patients in a similar manner as presently is done with lower tract transitional cell carcinoma, although this approach remains controversial. There is a chapter on flexible ureteroscopes but this technology is changing rapidly. In the past flexible ureteroscopes have been fragile, expensive and too large, so that they have not enjoyed great popularity. Increasingly, multiple companies are providing an array of smaller, better engineered, flexible ureteroscopes. There also is a good chapter on the care and sterilization of the instruments. It is increasingly important that the nursing and ancillary staff be aware of the delicate nature of these instruments as well as their expense. They can be broken easily. Lastly, there is a thoughtful appendix that
669
covers many of the hazards ofureteropyeloscopy. Many helpful hints are given. Problems addressed include inability to locate the ureteral orifice, pass guide wires or engage the calculus. In summary, this book provides helpful information to the urologist contemplating ureteroscopy. Increasingly, most stones in the urinary tract are treated with extracorporeal shock wave lithotripsy and ureteroscopy more often will be relegated to manipulation of distal ureteral stones. Manipulation of upper urinary calculi is fraught with greater hazard and it probably should not become an initial treatment choice, since there will be a significant complication rate and a poorer success rate compared to shock wave lithotripsy. Fray F. Marshall Department of Urology The Johns Hopkins Hospital Baltimore, Maryland
Pediatric and Adult Reconstructive Urologic Surgery, 2nd ed.
J. A. LIBERTINO, Baltimore: The Williams & Wilkins Co., 664 pages, 1987 This edition, which succeeds the initial edition published 10 years ago, is a comprehensive volume written by a host of contributors. The list of urologists who are chapter authors reads like a Who's Who of American Urology and there are numerous distinguished foreign academicians. The book is divided into 4 sections. Section 1 is devoted to surgery of the kidney and covers subjects from proper renal incisions to the rare subject of renal intestinal fistulas. The chapters on ureteropelvic junction reconstruction and surgery for renovascular hypertension were particularly informative. However, I believe that more extensive coverage of the various technical aspects associated with infant and childhood pyeloplasty would have been helpful. The chapter on surgery for renovascular hypertension was especially informative, and it obviously reflects the authors' extensive interest and experience in this field. Section 2 discussed surgery of the ureter. The surgical management of the megaureter by Hendren was a concise summary of his extensive experience in this field. The next chapter on contraindications to remodeling and reimplantation of the ureters was a natural successor to Hendren's chapter and it will give the resident surgeon more of a perspective on approaching these most difficult problems. Inclusion of the chapters on continent urinary diversion under the section dealing with the ureter was somewhat cumbersome. Also, since these procedures for the most part are used to replace or supplement the bladder they rightfully should be included in the section dealing particularly with bladder operations. Section 3 discusses the majority of surgical conditions that involve the bladder. The chapter on bladder replacement in children and young adults shows the excellent results that can be obtained in children with severe congenital abnormalities when experience and surgical imagination are brought together. The subject of incontinence was covered well and the surgical procedures relating to incontinence were well described. Nonetheless, more attention should have been placed upon dealing with that most problematic patient with a neuropathic bladder and persistent urinary incontinence. Section 4 was concerned with surgical conditions of the penis and genitalia. The best part of this section was that it contained
670
BOOK REVIEWS
the 2 best chapters in the book. The chapter on reconstructive phallic surgery should be complimented on its completeness and artistry. Likewise, the chapter on muscle and myocutaneous grafts in urological surgery updated the practicing urologist in this new and evolving field. Not only is this chapter complete in its description of these procedures but it also is practical in describing the application of these grafts to difficult urological disorders. In summary, this book is of significant value to the urologist interested in reconstructive urological surgery. It offers sufficient depth to help the practicing urologist and resident decide
which of these techniques are applicable to their particular practice. I remember as a resident when the first copy of this book was published what a source of reference it was during the residency years. The current edition certainly magnifies the first edition and it shows how far the field of reconstructive urological surgery has evolved in the last 10 years.
John P. Gearhart Division of Pediatric Urology The Johns Hopkins Hospital Baltimore, Maryland