Clinical ATLAS OF. Urology

Transcription

1 Clinical ATLAS OF Urology

2 Clinical ATLAS OF Urology VOLUME I Impotence and lnferti I ity VOLUME EDITORS IMPOTENCE SECTION Tom F. Lue, MD University of California, San Francisco Chief of Urology Mt. Zion Hospital San Francisco, California INFERTILITY SECTION Marc Goldstein, MD joan and Sanford I. Weill Medical College and Director, Center for Male Reproductive Medicine and Microsurgery Staff Scientist Center for Biomedical Research, The Population Council SERIES EDITORS E. Darracott Vaughan, Jr., MD joan and Sanford I. Weill Medical College and james j. Colt and Chairman Aaron P. Perlmutter, MD, PhD Assistant Joan and Sanford I. Weill Medical College and Assistant Attending Urologist With 26 Contributors Developed by Springer Science+Business Media, LLC

3 Springer Science+Business Media, LLC CNI 10!_RRENTI \I EOJciNE Director of Product Development.. Lori j. Bainbridge Editorial Supervisor.... Susan L. Hunsberger Developmental Editor... jennifer Wood Editorial Assistant... Teresa Medaglia Associate Art Director... Jerilyn Bockorick Design and layout... jerilyn Bockorick lllustration Director... Ann Saydlowski lllustrators... Debra Wertz, Wiesia Langenfeld, Lisa Weischedel Cover Design... Jerilyn Bockorick Cover lllustration... Debra Wertz Production... Lori Holland, Amy Giuffi, Constance Copeland lndexing... Holly Lukens Impotence and infertility/volume editors, Tom F. Lue, Mare Goldstein; with 26 contributors. p. cm-(adas of clinica! urology v. 1) Indudes bibliographic references and index. 1. Impotence-Adases. 2. Infertility-Atlases. I. Lue, Tom F. IL Goldstein, Mare. III. Series. [DNLM: 1. lmpotence-physiopathology atlases. 2. Impotence-therapy atlases. 3. Infertility, Male-physiopathology atlases. 4. Infertility, Male-therapy atlases. WJ 17 A v.1) RC872.A vol. 1 [RC889] 616.6'92-dc21 DNLM/DLC for Library of Congress Library of Congress Cataloging-in-Publication Data CIP ISBN ISBN (ebook) DOI / by Springer Science+Business Media New York. Originally published by Current Medicine,!ne. in Softcover reprint of thc hardcover l st edition 1999 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means electronic, mechanical, photocopying, recording, or otherwise, without prior consent of the publisher. Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the author can be held responsible for errors or for any consequence arising from the use of the information contained therein. Any product mentioned in this publication should be used in accordance with the prescribing information prepared by the manufacturers. No daims or endorsements are made for any drug or compound at present under clinica! investigation

4 SERIES PREFACE As urology enters the 21st century, it is appropriate that the Atlas of Clinical Urology series captures and explains the major areas of modern urologic practice using a unique combination of images, schematics, tables, and algorithms. It does so in a compelling fashion, by combining a multilevel approach that includes the individual volumes and the internet. Urology is a specialty of great breadth, and visual images provide much of the backbone of urologic diagnosis and endoscopy and are key to surgical technique. The increasingly complex diagnostic and treatment paths are best depicted and understood as visual algorithms. The editors of this five-volume series have not only contributed their world-renowned expertise to the chapters but have also assembled an outstanding group of individual chapter authors. Together, they provide each volume with completeness, depth, and-most important in this age of rapidly expanding science and technology-current urologic thinking. In Volume I, Tom Lue and his contributors cover the expanding area of impotence from anatomic considerations through many of the new treatment modalities. As our population ages, urologists are evaluating and treating an expanding number of impotent patients. This section provides an excellent understanding and practical approach. In the second half of Volume I, Marc Goldstein and his expert colleagues provide a beautiful series of images that depict the important aspects of reproductive anatomy and endocrinology, as well as detailed surgical schematics demonstrating the ever-evolving "standard" surgery for infertility in addition to new assisted-reproduction techniques. It would be fair to say that the 1990s are the decade of the prostate, and Volume II captures the paradigm changes that occurred in the management of both prostate cancer and benign disease. Management of prostate cancer is challenging, and the section by Peter Scardino provides a clear, concise, factual background for understanding prostate cancer and the myriad of treatment options. John McConnell's section on noncancerous diseases provides the background for understanding the new treatment modalities available for benign prostatic hyperplasia (BPH). The choices of pharmacologic management and device therapies continue to challenge even the most seasoned urologist, and the diagnostic and treatment schematics provided in the section have been constructed by leaders in the field. Renal carcinoma is covered in Volume Ill by section editor Andrew Novick. Radiologic images play an increasing role in our diagnosis and management of renal cancer, and the visual image format of the Atlas is ideal. The challenges of nephron sparing and vena caval surgery are clearly illustrated and are combined with an understanding of the appropriate patient populations for these procedures. This section also includes the management of benign and malignant adrenal disorders. Michael Marberger has assembled an extremely diverse and important set of noncancerous diseases of the kidney. Nephrolithiasis management is covered from medical therapy to endoscopy to incisional surgery. The important role that laparoscopy has established in both excisional and reconstructive renal surgery is visually depicted and explained. The evolution of the techniques illustrated in this section will likely provide the basis for renal intervention in the 21 st century. Bladder diseases cause many patients to seek urologic care. In Voume IV, Donald Skinner and John Stein have assembled state-ofthe-art contributions in the management of bladder and urethral cancer. The combination of a better understanding of bladder cancer and new options in surgical urinary diversions is changing the management of bladder cancer. The role of surgery and surgical approaches to bladder cancer are illustrated in this volume by the innovative surgeons who contributed chapters to the section. Voiding dysfunction and incontinence as well as inflammatory and infectious conditions of the bladder are covered by Alan Wein's section. The excellent contributions to this section provide an illustrated understanding of the neuromuscular function of the lower urinary tract, and the images reproduced in this volume allow an easy understanding of the diagnosis and management of incontinence, inflammatory conditions, and fistulae. Volume V covers the diversity of pediatric urology under the editorship of Dix Poppas and Alan Retik. This volume provides images illustrating the most important diseases that confront the pediatric urologist. In addition, the changes in management and thinking in classic conditions such as vesicoureteral reflux and neurogenic vesical dysfunction are illustrated. This volume will not only be of great value to the practicing pediatric urologist, but also to general urologists as well as pediatricians and pediatric nephrologists. These section editors and authors deserve tremendous credit for this Atlas of Clinical Urology, which was initiated by Abe Krieger, President of Current Medicine. We thank Abe, the developmental editors, and the excellent illustrators of Current Medicine for their outstanding efforts. E. Darracott Vaughan, Jr. Aaron P. Perlmutter v

5 CONTRIBUTORS Richard E. Berger, MD University of Washington Seattle, Washington Ahmed I. EI-Sakko, MD Assistant Suez Canal University lsmalia, Egypt Sarah K. Girardi, MD Assistant Joan and Sanford I. Weill Medical College and Assistant Attending Urologist Irwin Goldstein, MD of Urology Boston University School of Medicine Boston, Massachusetts Aizid I. Hoshmot, MD, MBBS State University of New York Health Sciences Center at Brooklyn Chairman The Brooklyn Hospital Center Brooklyn, New York Jeremy Heaton, MD, FRCSC, FACS Queen's University Kingston General Hospital Kingston, Ontario, Canada Jonathan P. Jarow, MD Associate Johns Hopkins University School of Medicine Baltimore, Maryland Edward D. Kim, MD Assistant Scott Baylor College of Medicine Houston, Texas Milton M. Lakin, MD, FACP Head, Section of Medical Urology Cleveland Clinic Foundation Cleveland, Ohio Philip Shihua Li, MD Lecturer in Urology Joan and Sanford I. Weill Medical College and Director of Microsurgical Training and Research Center for Male Reproductive Medicine and Microsurgery Lorry I. Lipshultz, MD Chief, Division of Male Reproductive Medicine and Surgery of Urology Scott Baylor College of Medicine Houston, Texas Gerold J. Matthews, MD Assistant New York Medical College Urological Faculty Associates Valhalla, NewYork Stewart W. McCallum, MD, FRCSC Assistant Stanford University Stanford, California Arnold Melman, MD Chairman and Albert Einstein College of Medicine Chairman and Montefiore Medical Center Drogo K. Montague, MD of Surgery (Urology) Cleveland Clinic Foundation Health Sciences Center of Ohio State University Director Center for Sexual Function Cleveland Clinic Foundation Cleveland, Ohio VII

6 Alvaro Morales, MD, FRCSC, FACS Queen's University Kingston General Hospital Kingston, Ontario, Canada John J. Mulcahy, MD, PhD, FACS Indiana University of Urology Indiana University Medical Center Indianapolis, Indiana John P. Mulhall, MD Assistant Loyola University Maywood, Illinois Harin Padma-Nathan, MD Clinical University of Southern California Beverly Hills, California Jon L. Pryor, MD Associate Departments of Urologic Surgery, Cell Biology and Neuroanatomy, and Obstetrics and Gynecology University of Minnesota Minneapolis, Minnesota Jamil Rehman, MD Resident Albert Einstein College of Medicine Montefiore Medical Center Kenneth P. Roberts, PhD Assistant Department of Urologic Surgery University of Minnesota Minneapolis, Minnesota Peter N. SchlegeL MD Associate joan and Sanford I. Weill Medical College and Associate Attending Urologist Ronald J. Zagoria, MD Department of Radiology Wake Forest University Director Division of Uroradiology Wake Forest University Baptist Medical Center Winston-Salem, North Carolina VIII

7 CONTENTS IMPOTENCE SECTION Introduction: Tom F. Lue CHAPTER 1 Pathophysiology of Erectile Dysfunction }ami/ Rehman and Arnold Melman Central Nervous System Pathway Involved in Penile Erection and Flaccidity Mechanism of Penile Erection and Flaccidity Psychogenic Erectile Dysfunction Arteriogenic Erectile Dysfunction Venogenic Erectile Dysfunction CHAPTER 2 Office Diagnostic Testing Drago K. Montague and Milton M. Lakin Rationale for Diagnostic Evaluation Classification of Male Sexual Dysfunctions History Physical Examination Laboratory (Blood and Urine) Tests Specialized Testing for Erectile Dysfunction Nocturnal Penile Tumescence Testing Suggested Protocol for Erectile Dysfunction Work-up Overview oftreatment Options Following Diagnosis CHAPTER 3 Vascular (Arterial and Venous) Assessment of Erectile Dysfunction Harin Padma-Nathan CHAPTER 4 Nonsurgical Treatments for Erectile Dysfunction: OraL Topical, lntracavernous, and Vacuum Devices Alvaro Morales and jeremy P. W Heaton Mechanisms of Penile Erection Ideal Pharmacologic Treatment CHAPTER 5 Penile Prostheses john}. Mulcahy Types of Implants Patient Selection and Expectations Advantages and Disadvantages Preoperative Preparation lncisional Approaches Administration of Anesthesia Surgical Technique Intraoperative Complications Postoperative Care Postoperative Com pi ications Repair Rate of Implants Patient Satisfaction ix

8 CHAPTER 6 Penile Revascularization john P. Mulhall and Irwin Goldstein Indications Patient Evaluation CHAPTER 7 Priapism Aizid I. Hashmat Treatment of Priapism CHAPTER 8 Peyronie's Disease Tom F. Lue and Ahmed I. EI-Sakka Evaluation of the Patient with Peyronie's Disease Indications for Medical and Surgical Treatment Surgical Procedures Incision and Venous Grafting INFERTILITY SECTION Introduction: Marc Goldstein CHAPTER 9 Evaluation of the Infertile Male Edward D. Kim and Larry I. Lipshultz Male Subfertility History Physical Examination Laboratory Testing Ultrasound Evaluation Testis Biopsy CHAPTER 10 Imaging of the Male Reproductive Tract jonathan P. jarow and Ronald}. Zagoria Imaging Modalities Varicocele CHAPTER 11 Varicocele Stewart W McCallum, Sarah Girardi, and Marc Goldstein CHAPTER 12 Microsurgical Vasovasostomy Gerald j. Matthews, Philip Shihua Li, and Marc Goldstein Patient Evaluation Preoperative Preparation Surgical Technique Postsurgical Care and Results X

9 CHAPTER 13 Vasoepididymostomy Stewart W McCallum, Richard E. Berger, and Marc Goldstein CHAPTER 14 Sperm Retrieval for Assisted Reproduction Peter N. Schlegel Assisted Reproduction Sperm Retrieval CHAPTER 15 Genetics of Male Infertility: Essentials for the Clinician jon L. Pryor and Kenneth P. Roberts General Overview of Genetics Pretesticular Causes of Male Infertility Testicular Causes of Male Infertility Posttesticular Causes of Male Infertility Index Color Plates XI