Urology at a Glance E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: At a Glance
• Sprache: Englisch

Seitenzahl: 188

Veröffentlichungsjahr: 2016

Beschreibung

Following the undergraduate curriculum set by the British Association of Urological Surgeons, Urology at a Glance offers practical advice on diagnosis and management of one of the most rapidly developing medical specialties.

Building on basic science, the book provides an overview of clinical approaches to assist the medical student or junior doctor on rotation, as well as looking at practical procedures and specific details of the most commonly encountered urological disorders.

Vibrantly illustrated and containing common clinical scenarios, Urology at a Glance provides all the information and latest guidelines needed for a medical student or junior doctor to excel in this field.

Leseprobe

This title is also available as an e-book. For more details, please see www.wiley.com/buy/9781118923641or scan this QR code:

Urologyat a Glance

Edited by

Hashim Hashim

MBBS, MRCS(Eng), MD, FEBU, FRCS(Urol) Consultant Urological Surgeon in Female, Functional and Reconstructive Urology and Director of the Urodynamic Unit, Bristol Urological Institute, Southmead Hospital, Bristol, UK Honorary Senior Lecturer, University of Bristol, UK

Prokar Dasgupta

MSc(Urol), MD, DLS, FRCS, FRCS(Urol), FEBU Professor of Robotic Surgery and Urological Innovation Guy's Hospital, King's College London, UK

This edition first published 2017 © 2017 by John Wiley & Sons, Ltd

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Library of Congress Cataloging-in-Publication Data

Names: Hashim, Hashim, editor. | Dasgupta, Prokar, editor.

Title: Urology at a glance / edited by Hashim Hashim, Prokar Dasgupta.

Other titles: Urology at a glance (Hashim) | At a glance series (Oxford, England)

Description: Chichester, West Susex, UK ; Hoboken, NJ : John Wiley & Sons Inc., 2017. | Series: At a glance series | Includes bibliographical references and index.

Identifiers: LCCN 2016030552| ISBN 9781118923641 (pbk.) | ISBN 9781118923658 (epub)

Subjects: | MESH: Urologic Diseases | Genital Diseases, Male | Diagnostic Techniques, Urological

Classification: LCC RC871 | NLM WJ 140 | DDC 616.6-dc23 LC record available at https://lccn.loc.gov/2016030552

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: © SEBASTIAN KAULITZKI/GettyImages

CONTENTS

Contributors

Preface

About the companion website

Part 1: Urological history, examination and investigations

1: Taking a urological history

2: Male genital examination

The penis

The scrotum and contents

Scrotal swellings

The local lymphatics

The perineum and rectum

Further reading

3: Female genital examination

Examination of the external genitalia

Speculum examination

Bimanual examination (per vaginum or PV exam)

Rectal examination

Further reading

4: Urological investigations

Intravenous urogram/pyelogram

CT urogram

Transrectal ultrasound scan and biopsy of prostate

Flow rate test or uroflowmetry

Urodynamics

Dimercaptosuccinic acid (DMSA) renogram and mercaptoacetyltriglycine (MAG3) renogram

Further reading

5: Abdominal pain

Physical examination

Diagnostic tests

Further reading

Part 2: Kidney and ureter

6: Urolithiasis

Types of stones

Aetiology of stone types

Presentation of urolithiasis

Management of renal stones

Further reading

7: Renal failure

Classification

Clinical assessment

Investigations

Clinical management

Types of post-renal obstruction

Post-obstructive diuresis

Urological intervention in complex cases

Part 3: Bladder

8: Lower urinary tract symptoms

Lower urinary tract symptoms 
in male patients

Lower urinary tract symptoms in 
female patients

Urinary retention

Further reading

9: Urinary tract infections

Pathophysiology of urinary tract infection

Investigation and treatment of cystitis

Other infections

Further reading

10: Urinary incontinence

Definitions

Evaluation

Treatment

Further reading

11: Neuropathic bladder

The micturition cycle

Neurogenic detrusor overactivity

Classification of neuropathic bladder

Further reading

Part 4: Andrology

12: Scrotal swelling and pain

Understanding the causes of a scrotal swelling and scrotal pain

Category A: exclude an emergency

Category B: malignant causes of scrotal swelling

Category C: benign causes of scrotal swelling

Benign non-urological causes of scrotal swelling

Ultrasound of the scrotum

Further reading

13: Male infertility

Further reading

14: Erectile dysfunction

Physiology of penile erection (Figures 14.1, 14.2 and 14.3)

Causes of male erectile dysfunction

Treatment

Further reading

Part 5: Urological cancers

15: Urological malignancies

Prostate cancer

Renal cancer

Bladder cancer

Penile cancer

Testicular cancer

Further reading

16: Haematuria

Significant episode of haematuria

Presentation

Examination

Initial investigations

Management

Further reading

Part 6: Paediatric urology

17: Common urological conditions in childhood

The foreskin

Hypospadias

Undescended testes

Incontinence and urinary tract infections

Further reading

Part 7: Urological trauma

18: Urinary tract trauma including spinal cord injury

Major trauma

Pelvic fracture

Spinal cord injury

Renal trauma

Testicular trauma

Penile trauma

Further reading

Part 8: Urological procedures and equipment

19: Urological procedures and equipment

Catheters

Urological equipment: Part 1

Urological equipment: Part 2

Common urological procedures

Further reading

Index

EULA

List of Tables

Chapter 3

Table 3.1

Chapter 4

Table 4.1

Chapter 16

Table 16.1

Guide

Cover

Table of Contents

Preface

Pages

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Contributors

Hashim U. Ahmed, Chapter 16

MRC Clinician Scientist and Reader in Urology

Division of Surgery and Interventional Sciences

University College London

London, UK

Waseem Akhter, Chapters 13 and 14

Specialty Registrar in Urology

North West London Trainee

Frimley Health NHS Foundation Trust

Frimley, UK

Salah Al Buheissi, Chapter 5

Consultant Urologist

North Bristol NHS Trust

Bristol, UK

Mo Belal, Chapter 11

Consultant Urological Surgeon

University Hospital Birmingham

Queen Elizabeth Hospital

Birmingham, UK

Michelle Christodoulidou, Chapter 12

Research Fellow in Urology

University College London Hospitals

London, UK

James F. Donaldson, Chapter 15

Speciality Registrar in Urological Surgery

Western General Hospital;

Tutor, MCh in Urology

University of Edinburgh and Royal College of Surgeons of Edinburgh

Edinburgh, UK

Hazel Ecclestone, Chapter 18

Urology Registrar

Charing Cross Hospital

London, UK

David S.J. Ellis, Chapter 9

Clinical Fellow in Urology

Imperial College Healthcare NHS Trust

London, UK

Michael S. Floyd (Jr), Chapter 7

Specialist Registrar in Urology

Whiston Hospital

St Helens and Knowsley Teaching Hospitals NHS Trust

Liverpool, UK

Rizwan Hamid, Chapter 18

Consultant Urological Surgeon

University College London Hospitals;

London Spinal Cord Injury Centre, Stanmore, UK

Hashim Hashim, Chapters 1-3

Consultant Urological Surgeon in Female, Functional and Reconstructive Urology;

Director of the Urodynamic Unit

Bristol Urological Institute

Southmead Hospital;

Honorary Senior Lecturer

University of Bristol

Bristol, UK

Talal Jabbar, Chapters 4 and 5

Fellow in Female, Functional and Reconstructive Urology

Bristol Urological Institute

Bristol, UK

Rozh Jalil, Chapters 13 and 14

Specialty Registrar in Urology

North West London Trainee

Frimley Health NHS Foundation Trust

Frimley, UK

Rahim Kaba, Chapter 8

Specialty Registrar in Urology (STR5)

Stepping Hill Hospital

University College London Hospitals;

London Spinal Injuries Unit, Stanmore, UK

Jas Kalsi, Chapters 12-14

Consultant Urological Surgeon and Andrologist

Imperial College Healthcare

Frimley Health Foundation Trust

Frimley, UK

Abi Kanthabalan, Chapter 16

Clinical Research Fellow

University College London Hospitals NHS Foundation Trust

London, UK

Sachin Malde, Chapter 10

Consultant Urological Surgeon

Guy's and St Thomas' NHS Foundation Trust

London, UK

Asif Muneer, Chapter 12

Consultant Urological Surgeon and Andrologist;

Honorary Senior Lecturer

University College London

London, UK

David Muthuveloe, Chapter 11

Urology Registrar

University Hospital Birmingham

Birmingham, UK

Arie Parnham, Chapter 19

Locum Consultant Urologist

Manchester Royal Infirmary

Manchester, UK;

Honorary Senior Associate Lecturer

Edge Hill University

Ormskirk, UK

Ian Pearce, Chapter 19

Consultant Urological Surgeon

Central Manchester University Hospitals NHS Trust

Manchester, UK

Tina G. Rashid, Chapter 9

Consultant Urological Surgeon

Imperial College Healthcare NHS Trust

London, UK

Mutie Raslan, Chapter 15

Speciality Registrar in Urology

Aberdeen Royal Infirmary

Aberdeen, UK

Justine Royle, Chapter 15

Consultant Urological Surgeon and Associate Postgraduate Dean

Aberdeen Royal Infirmary

Aberdeen, UK

Arun Sahai, Chapter 10

Consultant Urological Surgeon and Honorary Senior Lecturer

Department of Urology, Guy's Hospital;

MRC Centre for Transplantation, King's College London

London, UK

Matthew Shaw, Chapter 6

Consultant Urological Surgeon

Freeman Hospital

Newcastle upon Tyne, UK

Iqball S. Shergill, Chapter 7

Consultant Urological Surgeon

Wrexham Maelor Hospital, Wrexham, UK;

Honorary Senior Lecturer

Manchester Medical School, University of Manchester, Manchester, UK;

Honorary Senior Lecturer

Division of Biological Sciences, University of Chester, Chester, UK;

Honorary Clinical Teacher

Cardiff University School of Medicine, Cardiff, UK;

Clinical Director

North Wales and North West Urological Research Centre (NW2URC)

University of Chester, Chester, UK

Andrew Sinclair, Chapter 8

Consultant Urologist

Stepping Hill Hospital

Stockport NHS Foundation Trust

Stockport, UK

Rajan Veeratterapillay, Chapter 6

Specialist Registrar in Urology

Freeman Hospital

Newcastle upon Tyne, UK

Christian I. Villeda Sandoval, Chapter 5

Consultant Urologist and Robotic Surgery Coordinator

Hospital General Naval y de Alta Especialidad

(General and Specialties Naval Hospital)

Mexico City, Mexico

Dan Wood, Chapter 17

Consultant in Adolescent and Reconstructive Urology

University College London Hospitals

London, UK

Mussab S. Yassin, Chapters 1-3

Specialist Registrar in Urology

Urology Department

Churchill Hospital, Oxford University Hospitals NHS Trust

Oxford, UK

Preface

Urology is an exciting specialty incorporating medicine, surgery, paediatrics and the very latest in science and technology. It also continues to evolve rapidly, more perhaps than any other surgical field. We often hear from colleagues, both senior and junior, that it is difficult to keep up with this fast moving pace.

In parallel, the formal teaching of urology itself is facing gentle extinction from many university curricula, particularly in the UK. Many of our medical students are lucky to spend a week on a urology firm, with only the truly interested and the die-hard opting for a urological topic during a Special Study Module or an intercalated BSc. Nevertheless after graduation, most of our students will look after urological patients and therefore need the fundamentals of the specialty on their fingertips.

It is with this mind that we have put together Urology at a Glance for your reading pleasure. The majority of authors are UK-based. There is, however, an international flavour as a number are prominent for their important contributions to the growing body of modern literature in high quality journals. The text is deliberately arranged in eight parts to focus the readers minds on their topics of interest.

The book is meant to be an easy reference for medics at all levels of experience. We hope that our readers will find it useful especially when they do not have the time to go through the many encyclopaedic volumes that are out there. Or perhaps when they cannot be entirely certain that Dr Google is giving them the correct information that they need!

We hope you enjoy reading it and welcome your feedback.

Hashim Hashim, Bristol Prokar Dasgupta, London

About the companion website

Part 1Urological history, examination and investigations

Chapters

1 Taking a urological history

2 Male genital examination

3 Female genital examination

4 Urological investigations

5 Abdominal pain

1Taking a urological history

2Male genital examination

The penis

Inspection

Note particularly size, shape, presence or absence of a foreskin, colour of the skin, the position and calibre of the urethral meatus, any discharge, abnormal curvature and other superficial abnormality such as erythema or ulceration, particularly at the glans (Figure 2.1).

Palpation

Note any abnormalities of the underlying tissues (e.g. firm areas). This can indicate the plaques of Peyronie’s disease. Retract the foreskin to expose the glans penis and urethral meatus. The foreskin should pull back with a smooth and painless retraction. Look especially for any secretion or discharge and collect a specimen if possible. Replace the foreskin to its normal position at the end of the examination.

Key points

Explain to the patient that you would like to examine the penis and testes and reassure them that the procedure will be quick and gentle.

You should have a chaperone present.

Ensure that the examination room is warm and that you are unlikely to be disturbed. With the patient on a bed or couch, raised to a comfortable height, ask them to pull their clothing down. You should be able to see the genitalia and lower part of the patient’s abdomen at the very least.

The scrotum and contents

Inspection

This can be carried out with the patient lying down or standing up. Examine the scrotal skin. The left testis usually hangs lower than the right. Remember to lift the scrotum, inspecting the inferior and posterior aspects. Look especially for oedema, sebaceous cysts, ulcers, scabies and scars (Figure 2.1).

Palpation

The scrotal contents should be gently supported with your left hand and palpated with the fingers and thumb of your right hand. It may help to ask the patient to hold their penis to one side. Examine the normal testis first if the patient is complaining of an abnormality in one of them.

Check that the scrotum contains

two

testes. Absence of one or both testes can be because of previous surgery, failure of the testis to descend or a retractile testis. If there appears to be a single testis, carefully examine the inguinal canal for evidence of a discrete swelling that could be an undescended testis.

Make careful note of any discrete lumps or swellings in the body of the testis. Any swelling in the body of the testis must be considered to be suggestive of a malignancy.

Compare the left and right testes, noting the size and consistency. The testes are normally equal in size, smooth, with a firm, rubbery consistency. If there is a significant discrepancy, ask the patient if he has ever noticed this.

Feel for the epididymis which lies at the posterolateral aspect of each testis.

Scrotal swellings

If a lump is palpable:

Decide if the lump is confined to the scrotum. Are you able to feel above it? Does it have a cough impulse? Is it fluctuant? (You will be unable to get above swellings that descend from the inguinal canal.)

Define the lump and any other mass.

Transillumination is often important here. Darken the room and shine a small torch through the posterior part of the swelling. A solid mass remains dark while a cystic mass or fluid will transilluminate. If it transilluminates, it would suggest there is a hydrocele.

Feel for any varicoceles (feels like worms in a bag): the patient should be examined in the lying and standing positions for this to see if it disappears. Varicoceles on the left side warrant a renal scan as well as a scrotal scan.

The local lymphatics

This is best performed with the patient lying comfortably on a bed or couch.

Lymph from the skin of the penis and scrotum drains to the inguinal lymph nodes.

Lymph from the covering of the testes and spermatic cord drains initially to the internal, then common, iliac nodes.

Lymph from the body of the testes drains to the para-aortic lymph nodes. These are impalpable.

The perineum and rectum

Key points in digital rectal examination (DRE)

Usually performed in the left lateral position – with the patient lying on their left side, and with the hips and knees flexed to 90° or more (if you are right handed).

Examine the anal region for fistulae and fissures.

Apply plenty of lubricating gel to the gloved finger.

Palpate the surface of the prostate. Note its consistency (normal or firm), its surface (smooth or irregular) and estimate its size.

Normal bi-lobed prostate has a groove (the median sulcus) between the two lobes. In the patient with prostate cancer, this groove can be obscured.

The prostate will be very tender if it is involved by an acute, inflammatory condition such as acute, infective prostatitis or a prostatic abscess.

Practical tips

A normal prostate is the size of a walnut, a moderately enlarged prostate that of a tangerine and a large prostate the size of an apple or orange (Figure 2.2).

DRE should be avoided in the profoundly neutropenic patient (risk of septicaemia) and in patients with an anal fissure where DRE would be very painful.

The integrity of the sacral nerves that innervate the bladder and the sacral spinal cord can be established by eliciting the bulbocavernosus reflex (BCR) during a DRE. The sensory side of the reflex is elicited by squeezing the glans of the penis. The motor side of the reflex is tested by feeling for contraction of the anus during this sensory stimulus.

Further reading

Gleadle J.

History and Clinical Examination at a Glance

, 3rd edn. Oxford: Wiley-Blackwell; 2012.

Resnick MI, Novick AC.

Urology Secrets

, 3rd edn. Philadelphia, PA: Hanley & Belfus; 2002.

Thomas J, Monaghan T.

Oxford Handbook of Clinical Examination and Practical Skills (Oxford Medical Handbooks)

. Oxford: Oxford University Press; 2007.

3Female genital examination

Examination of the external genitalia

Inspection

Uncover the mons to expose the external genitalia making note of the pattern of hair distribution.

Apply a lubricating gel to the examining finger. Separate the labia from above with the forefinger and thumb of your left hand.

Inspect the clitoris, urethral meatus for stenosis (rare) or urethral caruncles, and vaginal opening. Look especially for any discharge, redness, ulceration, atrophy or old scars.

Ask the patient to cough or strain down and look at the vaginal walls for any prolapse and assess for any leakage of urine. Also look at the mobility of the urethra. Ask the patient to squeeze as if she is trying to stop passing urine to look for pelvic floor lift.

Palpation

Palpate the length of labia majora between the index finger and thumb. The tissue should feel pliant and fleshy. Palpate for Bartholin’s gland with the index finger of the right hand just inside the introitus and the thumb on the outer aspect of the labium majora (Figure 3.1).

Bartholin’s glands are only palpable if the duct becomes obstructed resulting in a painless cystic mass or an acute Bartholin’s abscess. The latter is seen as a hot, red, tender swelling in the posterolateral labia majora.

Speculum examination

There are different types of vaginal specula but the most common is the Cusco’s speculum which allows inspection of the cervix and vaginal walls (Figure 3.2) and the Sims’ speculum which allows better inspection of the vaginal walls and is used in particular if prolapse is suspected (Figure 3.3). Examination with the Sims’ speculum is undertaken with the patient in the left lateral position with legs curled up, while for an examination with Cusco’s speculum the patient lies as for the digital examination.

Key points

Explain to the patient that you would like to examine them and reassure them that the procedure will be quick and gentle.

Ensure the abdomen is covered. Ensure good lighting and remember to wear disposable gloves.

You should have a chaperone present.