Ebook Principles and practice of urology (2/E): Part 1

Principles and Practice
of

Urology



Principles and Practice
of

Urology
Second Edition

Volume 1
Editor

MA Salam MBBS FCPS FICS

Former Chairman and Professor of Uro-oncology
Department of Urology
Bangabandhu Sheikh Mujib Medical University
Dhaka, Bangladesh
and
Founder President and CEO
Urology and Transplant Foundation of Bangladesh
45/1, Green Road, Dhaka, Bangladesh

Foreword

Mahesh R Desai

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Principles and Practice of Urology (Volume 1)
First Edition: 2003
Second Edition: 2013
ISBN: 978-93-5025-260-4
Printed at


Dedicated to
All peoples suffering from urological diseases.
My lovely wife Jharna, my children Probal, Samudra,
Daughter-in-law Julee, my parents and all my other family members,
who missed me for many sweet moments.
My academic family members, the faculties, the postgraduate students,
trainees and residents of urology and staffs related to urology
and other subjects for their active assistance.



Contributors
Abdul Mannan Khan

Professor of Urology
Bangladesh Institute of Research and
Rehabilitation for Diabetes
Endocrine and Metabolic
Disorders Hospital
Dhaka, Bangladesh

ABM Golam Rabbani

AKM Zamanul Islam Bhuiyan

Director and Professor of Urology
National Institute of Kidney Diseases
and Urology
Sher-E-Bangla Nagar
Dhaka, Bangladesh

Ali Akbor

Assistant Professor of Urology
Rajshahi Medical College Hospital
Rajshahi, Bangladesh

Professor of Urology
Retired Major General
Holy Family Medical College Hospital
Easkaton, Dhaka, Bangladesh

Afiquor Rahman

ATM Aman Ullah

Head and Professor of Urology
Ad-din Medical College Hospital
Maghbazar, Dhaka, Bangladesh

AFM Kamal Uddin

Consultant Radiation Oncologist
United Hospital Ltd
Dhaka, Bangladesh

Agrawal Madhu Sudan
Department of Urology
SN Medical College
Agra, Uttar Pradesh, India

Ahsan Kabir

Senior Consultant of Urology
Monowara Hospital
Dhaka, Bangladesh

Ajit Vaje

Consultant, Female Urologist
Jaslok Hospital, Mumbai
Maharashtra, India

AKM Anwarul Islam

Chairman and Professor of Urology
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

AKM Khurshidul Alam

Professor
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Associate Professor of Neurourology
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

BK Dastur

Urological Surgeon
Medical Research Centre
Bombay Hospital Trust
Mumbai, Maharashtra, India

Christopher Cheng

Professor and Chairman
Department of Urology
Singapore General Hospital
Outram Road, Singapore

Deen Sharma

Consultant Urologist
10 Bel Air Springs, Greater Georgetown
Guyana, South America

Dev Narayan Dutta

Consultant Oncologist
Apollo Hospital
Chennai, Tamil Nadu, India

Emdadul Haque

Assistant Professor of Pediatric Urology
National Institute of Kidney Diseases
and Urology
Sher-E-Bangla Nagar
Dhaka, Bangladesh
Presently Urology Fellow
Central Coast Health Service
NSW, Australia

Farakh Khan

Former Professor of Urology
Medical College, Lahore, Pakistan

Fazal Naser

Assistant Professor of Urology

SS Medical College Hospital
Sher-E-Bangla Nagar, Dhaka, Bangladesh

Ganesh Gopalakrishnan

Senior Consultant of Urology
Coimbatore, Tamil Nadu, India
Former Head and Professor
Department of Urology
Christian Medical College
Vellore, Tamil Nadu, India

Golam Mowla Chowdhury
Associate Professor of Urology
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Harun-ur-Rashid

Former Chairman and Professor
of Nephrology
Bangabandhu Sheikh Mujib Medical
University, Dhaka, Bangladesh
Chairman of Kidney Foundation
Mirpur, Dhaka, Bangladesh

Hemant B Tongaonkar

Head and Professor
Department of Urologic Oncology
Tata Memorial Hospital, Parel
Mumbai, Maharashtra, India

Ishtiak Al Mamoon

Doctoral Researcher
Department of Electronic System Engineering
Malaysia Japan International Institute of
Technology (MJIIT)
University Technology Malaysia
Kuala Lumpur, Malaysia

Isteaq Ahmed Shameem

Associate Professor of Pediatric Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh


viii

Principles and Practice of Urology
Jagdeesh N Kulkarni

Honorable Professor
Division of Uro-oncology
Department of Urology

Bombay Hospital Institute of
Medical Sciences
Mumbai, Maharashtra, India

Jahangir Kabir

Chief Consultant Urologist
Department of Urology
Labaid Specialized Hospital
Dhanmondi, Dhaka, Bangladesh

Kazi Rafiqul Abedin

Assistant Professor of Urology
National Institute of Kidney Diseases
and Urology, Dhaka, Bangladesh

Khoorsheed Jahan Maula

Makarand V Khochikar

Consultant Uro-oncologist
Siddhi Vinayak Ganapati Hospital
Miraj, Sangli, Maharashtra, India

MA Salam

Former Chairman and Professor of
Uro-oncology
Department of Urology

Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh
and
Founder President and CEO
Urology and Transplant Foundation of
Bangladesh, 45/1, Green Road
Dhaka, Bangladesh

Matiur Rahman

Former Head and Associate Professor
of Gyne-oncology
Senior Consultant of Gyne-oncology
Comfort Nursing Home
Dhaka, Bangladesh

Founder Professor and
Senior Consultant of Nephrology
Comfort Nursing Home
Dhaka, Bangladesh

KM Monwarul Karim

Matiur Rahman

Assistant Professor of Urology
Chittagong Medical College Hospital
Chittagong, Bangladesh

K Sasidharan

Professor of Urology
Kasturba Medical College
Manipal Academy of Higher Education
Manipal, Karnataka, India

KT Foo

Professor
Department of Urology
Singapore General Hospital
Outram Road, Singapore

Laila Anjuman Banu

Professor of Molecular Biology and
Genetics
Department of Anatomy
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Mahesh R Desai

President, Endourological Society
Past President, Societe Internationale
d’urologie
Medical Director
Muljibhai Patel Urological Hospital

Nadiad, Kheda, Gujarat, India

Professor
Department of Pediatric Surgery
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

MA Wahab

Former Chairman and Professor of Urology
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Md Abdul Awal

Associate Professor of Urology
Dhaka Medical College Hospital
Dhaka, Bangladesh

Md Faisal Islam

Md Saiful Islam

Female and Reproductive Urologist
Department of Urology
Bangabandhu Sheikh Mujib
Medical University

Dhaka, Bangladesh

Md Sayedul Islam

Associate Professor of Urology
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Md Waliul Islam Maruf

Associate Professor of Urology
National Institute of Kidney Diseases
and Urology
Dhaka, Bangladesh

M Hasan Akther

Consultant Urologist
Sylhet Women’s Medical College
Sylhet, Bangladesh

Mir Ehteshamul Haque

Assistant Professor of Uro-oncology
National Institute of Cancer Research and
Hospital, Mohakhali, Dhaka, Bangladesh

Mirza M Hasan

Head and Professor of Urology
Department of Urology
Bangladesh Institute of Research and
Rehabilitation for Diabetes Endocrine and
Metabolic Disorders
Dhaka, Bangladesh

Mohammad Shafiqur Rahman

Associate Professor of Uro-oncology
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Assistant Professor of Urology
National Institute of Kidney Diseases
and Urology
Sher-E-Bangla Nagar
Dhaka, Bangladesh

Mohsin Uddin

Md Fakhrul Islam

Head
Department of Surgery
Dinapur Medical College
Dinapur, Bangladesh

Chairman and Professor of Urology
Bangladesh Medical College Hospital
Dhanmondi, Dhaka, Bangladesh

Associate Professor of Urology
Khwaja Yunus Ali Medical College and
Hospital, Sirajganj, Bangladesh

Moudud Hossain Alamgir


ix

Contributors
Mozzam Hossain

Paddy Dewan

Ravindra Bhalchandra Sabnis

Professor of Pediatric Nephrology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Professor of Pediatric Urology
Chairman
Kind Cut for Kids Foundation
St Albans, Australia

Chairman
Department of Urology
Muljibhai Patel Urological Hospital
Nadiad, Kheda, Gujarat, India

Muhammad Choudhury

Prabhjot Singh

Rupin Shah

Chairman and Professor of Uro-oncology
Department of Urology
New York Medical College
New York, USA

Muhammad Hossain

Senior Research Associate
Department of Urology
All India Institute of Medical Sciences
New Delhi, India

Consultant Reproductive Urology
Department of Urology
Lilavati Hospital and Research Center
Bandra Reclamation, Mumbai
Maharashtra, India

Pranashish Saha

Sajid Hasan

Associate Professor
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Assistant Professor of Urology
National Institute of Kidney Diseases and
Urology (NIKDU), Sher-E-Bangla Nagar
Dhaka, Bangladesh

Muhammad Rafiqul Alam

Pranjal R Modi

Chairman and Professor of Nephrology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

NI Bhuiyan

Assistant Professor of Urology
Bangladesh Medical College
Dhanmondi, Dhaka, Bangladesh

Nitin S Kekre

Professor of Urology
Department of Urology
Christian Medical College and Hospital
Vellore, Tamil Nadu, India

NP Gupta

Former Chairman and Professor
Department of Urology
All India Institute of Medical Sciences
New Delhi, India
Consultant Urologist
Medanta: The Medicity
Gurgaon, Haryana, India

Nurjahan Begum

Professor of Physiology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Nurul Hooda

Assistant Professor of Urology
National Institute of Kidney Diseases
and Urology
Dhaka, Bangladesh

Professor and Head
Department of Urology and
Transplantation Surgery
Institute of Kidney Diseases and
Research Center
Institute of Transplantation Sciences
Civil Hospital Campus, Asarwa
Ahmedabad, Gujarat, India

Prem Nath Dogra
Chairman and Professor
Department of Urology
All India Institute of Medical Sciences
New Delhi, India

Prem Raj Gyawali
Associate Professor and Chairman
Department of Urology and Transplant
Grande International Hospital
Dhapasi, Kathmandu
Nepal and Tribhuvan University
Teaching Hospital
Maharajganj, Nepal

Promode Ranjan Singh
Head and Associate Professor of Urology
MAG Osmani Medical College and Hospital
Sylhet, Bangladesh

Rajeev Kumar
Professor
Department of Urology
All India Institute of Medical Sciences
New Delhi, India

Professor of Uro-oncology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

SA Khan

Professor of Urology
Popular Medical College Hospital
Dhanmondi, Dhaka, Bangladesh

SAM Golam Kibria

Professor and Former Chairman
Department of Urology
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Sanjay Kulkarni

Honorable Associate Professor of Urology
KEM Hospital, Pune, Maharashtra, India
Chief Urologist

Kulkarni Endosurgery Institute
Pune, Maharashtra, India

Shadrul Alam

Associate Professor
Rangpur Medical College Hospital
Rangpur, Bangladesh

Shafiqul Haque

Professor of Pediatric Surgery and
Former Chairman
Department of Pediatric Surgery
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh

Shahadat Hossain

Associate Professor
Department of Pediatric Surgery
Bangabandhu Sheikh Mujib
Medical University
Dhaka, Bangladesh


x

Principles and Practice of Urology

Shahidul Islam Sugom

Assistant Professor of Urology
Rangpur Medical College Hospital
Rangpur, Bangladesh

Shailesh Puntambekar

Consultant Cancer Surgeon and
Head of Galaxy Care Laparoscopy Institute
Center for Advanced Laparoscopy and
Robotic Surgery, Pune, Maharashtra, India

Shailesh Raina

Consultant Urologist
Lilavati Hospital and Research Center
Bandra Reclamation
Mumbai, Maharashtra, India

Shankar Kumar Biswas

SM Mahbub Alam

Associate Professor
Center for Nuclear Medicine and Ultrasound
Dhaka Medical College Hospital
Dhaka, Bangladesh

Head and Professor of Urology

Dhaka Medical College Hospital
Dhaka, Bangladesh

Shivaji Basu

Professor of Urology
Bangladesh Medical College Hospital
Dhanmondi, Dhaka, Bangladesh

Chief Urologist
Kidney Institute
Rashbehari Avenue and Fortis Hospitals
Kolkata, West Bengal, India

Shohrab Hossain

Assistant Professor of Urology
MAG Osmani Medical College Hospital
Sylhet, Bangladesh

Zahid Hossain Bhuiyan

Zahirul Islam Miah

Senior Consultant of Urology
Faridpur Diabetic Hospital
Faridpur, Bangladesh


Foreword

Urology has made many advances and progress in the past few decades primarily as a result of significant progress in
understanding the pathophysiology of urological diseases and introduction of truly minimally invasive surgery.
Principles and Practice of Urology mainly addresses young trainees in urology and is written by experts in this field who
are also experienced teachers. It is hoped that the book will be helpful to prevent the younger surgeons and trainees from
the mistakes and common complications.
There are many good books on urology in the world market, but Principles and Practice of Urology has been developed
to address the urological issues that are commonly met in the developing part of the world and the management has been
tailored to obtain the best success with the limited resources. I sincerely hope that the specialists, trainees and students of
Asian, African and Latin American developing countries will find the book more useful than others.
For the beginners, four big ‘Cs’ is strongly recommended: Climb, Communicate, Confess, and Comply. These are the basic
actions for any pilot in distress and they may just be as applicable for any medical professional facing a difficult situation
that may help to overcome.
Traditionally, as before, the book is emphasizing the principle of art of urologic surgery from the standpoint of open,
laparoscopic, endourologic, microsurgical, prosthetic, tissue engineering, genetic engineering and robotic approaches. An
internationally reputed set of contributions has graced us with their wisdom.

Mahesh R Desai
MS FRCS (Lond) FRCS (Edin)

President, Endourological Society
Past President, Societe Internationale d’urologie
Medical Director
Muljibhai Patel Urological Hospital
Nadiad, Kheda, Gujarat, India



Preface to the Second Edition
The second edition of Principles and Practice of Urology has been extensively revised, reviewed and improved, including the
format and presentation. The book is aimed mainly at urologists, general surgeons, nephrologists, gynecologists, residents

and postgraduate medical students of different disciplines, senior medical students and trainee medical professionals of
relevant specialties.
The first edition was reasonably limited and published in USA by Brown Walker, Florida, USA and in Bangladesh. It was
so instantly well received that further reprints were required within the first year of its appearance. There was a pressing
request for further emphasis on graphic and pictorial representations of the various surgical techniques.
I hope that you will find the second edition of the book as an informative and a good reference to refresh your knowledge
in the field of urology. Specialists of all fields will also find the book is a quick review of the current developments in this
field and a reminder of important features of different conditions in their field of interest.
The main objective of the book is to enable the reader to have a quick review of the subject and can update him with
current relevant information. I believe that the readers will find the value and enjoyment when reading the textbook, either
as a ‘cover-to-cover’ read or a particular section that applies to their area of interest. I hope very much that you will enjoy
reading the book.
I keep six honest serving men
(They taught me all I knew);
Their names are What and Why and When
and How and Where and Who.

—Rudyard Kipling (The Elephant’s Child, in the Just-So Stories, 1902)
Clinical knowledge is based on the three components: meticulous observation, detailed recording, and an understanding
and analyzing the clinical data relevant to the clinical situation to overcome the clinical problem. The first two come with
apprenticeship and the last one with personal inquisitive reading. It is the last component that is the basis for the book.
Perfect practice of urology will develop ‘Urological Artists’ in urological community and their output will result a stateof-the-art outcome. Some of these artistic urologists will emerge as philosopher urologists. This ‘Philosopher Urologists’
will be able to make change over the existing method of treatment or they may set a new horizon for the others. Some of
the talented urologists of the past is introduced in the book. There are many ‘Urologist Philosophers’ among us now and
we hope that there will be many in future. The objective of the book is to build more and more ‘Urological Artists’ if not
‘Philosopher Urologists’. This is true for all branches of medical sciences.
The text is didactic and should provide the basis for further reading from journals or more detailed review papers. The
book is aimed at residents and urological specialists at all levels of training in urology.
I am indebted to the outstanding panel of national and international contributors for their efforts and outstanding work
toward the production of the book. I am most grateful to all the contributors who covered their topics expertly and clearly.

I am fortunate to have so many eminent colleagues contributing to the book.
I remain grateful to all my friends and colleagues for their enthusiasm and active help for the preparation, processing the
manuscripts and proofreading. Dr Mohsin Uddin, Dr Ibrahim Kaiser and my secretary Mr Roney worked very hard for the
book and deserve special thanks.
I remain very much grateful to the superb job done by all the outstanding staffs at M/s Jaypee Brothers Medical Publishers
(P) Ltd, New Delhi, India, and their close cooperation, for the task of the difficult publication.

MA Salam



Preface to the First Edition
Why another textbook on urology? There is always a universal demand of appropriate good book in any subject. Despite
the existence of numerous monographs on urology, there remains a desperate need for a book emphasizing the scientific
background and principles of patient care for the student trainees and reinforcing such concepts for the practicing
urologists in the developing world.
Urology today is a subject of growing importance and the need for a comprehensive text on the basic principle of
general urology was deeply felt by the author, by the trainees and students. All medical writings are practically rewritings
plus the recent advances, but they are presented in a different format suitable for the specific class of readers or users.
Despite many good books available, an appropriate book is needed in between the users and the advanced texts.
Principles and Practice of Urology is neither intended to replace the existing textbook nor it can provide the minute
details contained in scientific journals. Instead, the author expects that the book will serve as a rapid review of clinically
important informations for the postgraduate students, residents, trainees, practicing surgeons and urologists. It is also
expected to provide much of the updated information in an identifiable and understandable format.
The purpose of composing this text is to guide and assist the students, residents, trainee doctors of urology and this
book may be used as a text or reference book by the senior students in medical colleges. A space is kept on the left side of
the page for the reader to record his personal note. This book is expected to be helpful for the consultant general surgeons
who are working in a hospital where there are no urologists.
I do solicit additional modifications, corrections and criticism which may be addressed to me.

MA Salam



Acknowledgments
I would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja
(Director-Publishing) and Mr KK Raman (Production Manager) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi,
India, for their continued support and encouragement to complete this incredible work. I wish to thank Ms Samina Khan
(PA to Director-Publishing), who provides continuous communication about the corrections, placements, editing, etc. She
helped immeasurably to stay on time, on the job, and on focus. The final result has been inestimably improved by her
efforts. I wish to extend my sincere thanks to Mr Nitin Huria and Mr Amitoj Singh, who were intimately connected to the
preparation of the book. The medical artists deserve a special thanks for their excellent works. I am very much concerned
about the background staffs of the publisher who escapes the notice of everyone my special thanks to them. Finally and
most importantly, I would like to thank my family, who missed me long time during the period of many years. Without their
support and sacrifice, I would have never been able to dedicate the time and effort required for the publication of this
innovative venture.



Contents
Volume 1
Section 1:  Milestone of Urology





1. History of Urology

MA Salam

Prehistoric Urology in Different Parts of World  4; Middle Ages to the Eighteenth Century  6;
Nineteenth Century  7; Great Mind and Philosophers in Urology  22

3

Section 2:  Presentation of Urological Disease





2. Presentation of Urological Disease

MA Salam, Mohammad Shafiqur Rahman
Art of History Taking (Careful Listening to the Patient is an Art)  33; Smoking and Urological Disease  41;
Drug Allergies  41; Physical Examination of Urological Patients  42

33

Section 3: Investigations of Urological Disease


3. Laboratory Test for Urological Work-up

47



4. Application of X-ray in Urology

57



5. Intravenous Urography and Contrast Study of Lower Urinary Tract

64



6. Principles of the Ultrasound and its Applications in Urology

68



7. Computed Tomography

85




MA Salam, MA Wahab
Urinalysis  47; Laboratory Tests  51; Hormonal Studies in Urine  55


AKM Zamanul Islam Bhuiyan

Radiology Techniques  57; Radiation Exposure Hazard  57; Contrast Media  58; Anaphylactic Reactions  59;

Nephrotoxicity  59; Cardiovascular Toxicity  59; Radiological Investigations for Urological Patients  59



















AKM Anwarul Islam, Zahirul Islam Miah
Procedure  64; Basic Techniques and Principle of Intravenous Urography  64;
Contraindications of Intravenous Urography  65; Indications of Intravenous Urography  65;
Advantages of Intravenous Urography  65; Limitations of Intravenous Urography  65;
The Future of the Intravenous Urography  65; Antegrade Urography and Retrograde Urography  66;
Voiding Cystourethrogram or Micturating Cystourethrogram  66; Cavernosography and Cavernosometry  67
MA Salam
Physics of Medical Ultrasound  68; Ultrasound Imaging Methods  68; Intraoperative Use of Ultrasound  72;
Renal Ultrasound  72; Bladder Ultrasound  76; Ultrasound Imaging of Prostate Prelude  78;
Determination of Prostate Volume with Ultrasound  78; Benign Prostatic Hypertrophy  78; Prostate Cancer  78;

Prostatic Infection  79; Techniques of Ultrasound Study of Prostate  79; Perineal Approach  79;
Biopsy of Prostate  80; Seminal Vesicle Cyst  80; Ultrasound Scan of Urethra  80;
Scrotal Ultrasonography  81; Doppler Principles  82
Jahangir Kabir
History of CT Scan  85; Principle of Techniques of CT Scan  85; Principles of Three-dimensional Image Reconstruction  87;
Recent Advances in CT  87; Common Problems in Interpreting CT Scan  87; Limitations of CT Scan  87;
Criteria for CT  87; CT Renal Arteriography  89; Digital Subtraction Angiography  89; CT Urography  89


xx

Principles and Practice of Urology


8. Magnetic Resonance Imaging



9. Nuclear Medicine in Genitourinary Tract









Abdul Mannan Khan
Physics of MRI  92; Recent Advances of Mri  92; Basic Principles of Mri  93; Clinical Applications of Mri 94;

Advantages of Mri  97; Contraindications of Mri  97; Magnetic Resonance Urography  97;
Advantages and Disadvantages of Mri 98
SA Khan, Shankar Kumar Biswas
Radioisotope Measurement of Glomerular Filtration Rate  101;
Radionuclide Techniques Available for Studying the Function of the Renal Tract  102

10. Abdominal Positron Emission Tomography or Computed Tomography




Ali Akbor
Radioisotopes  108; Cyclotron Centers  109; Indications of Pet/CT  110; Transitional Cell Carcinoma  110;
Renal Cell Carcinoma  110; Testicular Malignancies  110

92

101

108

Section 4: Emergency Urology
11. Acute Ureteric Colic

115

12. Acute Urinary Retention

126

13. Renal Trauma

130

14. Ureteral Injury

137

15. Lower Genitourinary Tract Trauma

142

16. Urinary Bladder Injury

145

MA Wahab, MA Salam
Presentation  115; Diagnosis  115; Differential Diagnoses of Flank Pain  118; Management  121
SAM Golam Kibria, AKM Anwarul Islam
Etiology  126; History  127; Physical Examination  127; Management  127; Complications of Relieving Obstruction  128
Shivaji Basu
Principle of Treatment of Acute Upper Genitourinary Tract Injury  130;
Upper Tract Trauma (Renal Injuries and Ureteral Injuries)  130
MA Salam, AKM Khurshidul Alam
Etiology of Ureteric Trauma  137; Clinical Diagnosis  137; Radiological Diagnosis  137;
Classification of Ureteric Injury  138; Management of Ureteric Injury  138
MA Salam, Md Sayedul Islam
Causes of Lower Genitourinary Tract Trauma  142; Pathophysiology of Lower Genitourinary Tract Trauma  142;
History  142; Physical Examination  143; Prehospital Care  144;
Principle of Management of Lower Urinary Tract Trauma  144
K Sasidharan
Diagnosis of Bladder Injury  145; Cause and Pathophysiology of Bladder Injury  145;
Classification of Bladder Injury  146; Computed Tomography Scan  148;
Cystography  148; Excretory Urography  148; Management of Bladder Rupture  148;
Penetrating Bladder Injury  148; Postoperative Care  148; Follow-up  149

17. Urethral Injury

150

18. Penile Injuries

156









Sanjay Kulkarni, MA Salam
Applied Anatomy and Pathophysiology  150; Etiology  151; Mechanism of Injury  151; Clinical Assessment  152;
Classification of Urethral Injury  152; Presentation  152; Work-up  152; Anterior Urethral Injuries  153;
Posterior Urethral Injuries  153; Female Urethral Injuries  154; Complications of Urethral Injury  154;
Outcome and Prognosis  154
MA Salam, SM Mahbub Alam
Common Injuries of Penis  156; Strangulation of Penis by Metallic or Nonmetallic Ring  160


xxi

Contents
19.Scrotal and Testicular Injury

MA Salam, Mirza M Hasan

Mechanism of Injury  162; Etiology  162; Presentation  162; Physical Examination  162; Imaging of Scrotal Injury  163;

General Management of Scrotal Injury  163; Complications of Scrotal Injury  164; Indications for Scrotal Exploration  164;

Follow-up  164; Complications of Testicular Injury  164

162

Section 5: Genitourinary Infection
20. Urinary Tract Infections

169

21. Urinary Tract Infection in Children

179

22.Urosepsis

187

23. Prostatitis or Chronic Pelvic Pain Syndrome

193

24. Epididymitis and Orchitis

197

25. Perioperative Antibacterial Prophylaxis in Urology

200

26. Recurrent Urinary Tract Infection

204

27. Sexually Transmitted Diseases

212

28. Genitourinary Tuberculosis

217

29. Interstitial Cystitis

221

Jahangir Kabir
Pathogenesis of Urinary Tract Infection  169; Bacteriological Evidence of Infection  169; Pathophysiology  170;
Prevalence of Urinary Tract Infection  171; Risk, Mortality and Morbidity  171;
The Natural History of Urinary Tract Infection  171; Physical Examination  172; Differential Diagnoses  172;
Work-up of Urinary Tract Infection  172; Treatment  174; Prevention of Urinary Tract Infection  177; Complications  177
Isteaq Ahmed Shameem
Etiology  179; Pathogenesis and Risk Factors  179; Signs and Symptoms  179; Classification  179;

Diagnosis  180; Schedule of Investigation  183; Treatment  183; Management  184
Rajeev Kumar
Definition  187; Pathophysiology of Sepsis  188; Clinical Manifestation of Urosepsis  188; Treatment  189;
Focus on the Management of the Septic Patient  190; Focus on Outcome from Sepsis  191
AKM Khurshidul Alam
Diagnosis  193; Classification Systems  194; Treatment  195
Golam Mowla Chowdhury
Incidence and Prevalence  197; Pathogenesis and Pathology  197; Diagnosis  197; Treatment  198
AKM Khurshidul Alam, MA Salam
Aims and Objectives  200; Risk Factors  201; Principles of Antibiotic Prophylaxis  201;
Regimens for Prophylaxis for Different Procedures 202
Mohammad Shafiqur Rahman
Definitions  204; Risk Factors  204; Diagnosis  205;
Antimicrobial Strategy for the Treatment of Urinary Tract Infection  205; Management of Specific Urological Infection  206;
Recommendations on Recurrent Urinary Tract Infection  210; Conclusion and Future  210
Pranashish Saha, Kazi Rafiqul Abedin
Factors Responsible for the Sexually Transmitted Diseases  212; Nongonococcal Urethritis  212; Gonorrhea  213;
Syphilis  213; Chancroid  214; Lymphogranuloma Venereum  214; Granuloma Inguinale  214;
Condyloma Acuminata or Venereal Warts  214; Genital Herpes Simplex  215;
Acquired Immunodeficiency Syndrome   215; Prevention of Sexually Transmitted Diseases  215
NP Gupta, Md Sayedul Islam
Incidence   217; Etiopathogenesis   217; Pathogenesis  218; Presentation  218; Diagnosis  218; Treatment  218;
Follow-up of Genitourinary Tuberculosis  219; Management of Drug Resistant Tuberculosis  219

Shahidul Islam Sugom
New Concepts  221; Interstitial Cystitis Symptoms  221; Diagnosis  221;
Potassium Test (Persons Test)   222; Management  222


xxii

Principles and Practice of Urology

Section 6: General Urology
30.Advances of Radiation Oncology and its Applications to Urology

227

31. CyberKnife in Urology

236

32. Application of Gene Therapy in Urology

239

33. Lasers in Urology

243

34. Image-guided Percutaneous Treatment of Genitourinary Cancer

259

AFM Kamal Uddin, Afiquor Rahman
Kidney Tumors  227; Role of Radiotherapy in Renal Cell Carcinoma  227;
Carcinoma of Bladder  229; Carcinoma Prostate  231
Dev Narayan Dutta
Important Features  236; Imaging Techniques of CyberKnife  236;
Other Stereotactic Systems  238; Clinical Uses  238
AFM Kamal Uddin, MA Salam
Gene Therapeutic Strategies  239; The Future of Gene Therapy  241

Prem Nath Dogra, Prabhjot Singh
History  243; Basic Principle of Laser  243; Components of Laser System  244; Laser Tissue Interaction  245;
Types of Lasers  246; Laser Applications in Urology  249; Lasers in Laparoscopy  255
MA Salam, Md Faisal Islam
Indications  259; Patient Preparation/Anesthesia  260; Image Guidance  260;
Image-guided Tumor Ablation Modalities  261;
Complications of Percutaneous Ablation  263; Follow-up  264

35. Stem Cells Research and its Practical Applications

266

36. Telemedicine in Urology

270

37. Tissue Engineering in Urology

273











Laila Anjuman Banu, Mohsin Uddin
Embryonic Stem Cell Lines  266; Adult Stem Cells  266; Amniotic Stem Cells  267;
Induced Pluripotent Stem Cells  267; Practical Applications of Stem Cell Research  269
Ishtiak Al Mamoon, MA Salam
History of Telemedicine  270; Types of Telemedicine  270
Mohsin Uddin, MA Salam
Principles of Tissue Engineering  273; Application of Stem Cells  274;
Urological Applications of Tissue Engineering  274;
Generation of Histocompatible Tissues Using Nuclear Transplantation  275

38. Ideal Operating Theater Complex

277

39. High Frequency Electrosurgical Apparatus (Diathermy Equipment)

284

40. Ultrasonic Surgical Shears (Harmonic Scalpel)

292













MA Salam, Nitin S Kekre
Statutory Regulations for Operating Theater Complex  277; Different Zones of Operation Theater Complex  277;
Sub Areas  278; Types of Operating Theater Complex  279;
Principles to be Taken into Consideration While Planning an Operating Theater (Physical/Architecture)  279;
Usual Disadvantages of Existing OT in Old Hospitals  282; Operating Theater for the Urologist  283
Prem Raj Gyawali

Technical Concept  284; Tissue Effect  284; Unipolar Diathermy  285; Bipolar Diathermy  286;
Urological Applications  286; Mode of Action  287; Quality of High-frequency Current (Modulation)  288;
Factors Influencing the Therapeutic Effect  288; Safety Considerations  288
Jahangir Kabir, MA Salam
Mechanism of Tissue Coagulation  292;
Use of the Ultrasonic Surgical Shears or Harmonic Scalpel  292


xxiii

Contents
41.Tissue Fusion System (LigaSure) and Evident Microwave Ablation System

294

42. Principles of Intravesical Chemotherapy and Immunotherapy

297








Pranjal R Modi
The Evident™ Microwave Ablation System  295

Hemant B Tongaonkar

Intravesical Chemotherapy  297; Intravesical Immunotherapy  297; Indications of Intravesical Chemotherapy  297;
Contraindications  297; Prerequisite for Intravesical Therapy  297

Section 7:  Pediatric Urology
43. Applied Anatomy of Genitourinary Tract

301

44. Developmental Anomalies of the Upper Urinary Tract

306

45. Polycystic Kidney Disease

309

46. Wilms’ Tumor

311

47. Congenital Ureteral Obstruction (Congenital Pelviureteric Junction and Vesicoureteral
Junction Obstruction)

317

48. Abdominal Masses in Children

324

49. Bladder Exstrophy Complex

326

50. Diseases of Urachus

330

51. Prune Belly Syndrome

332

52. Vesicoureteric Reflux

334

53. Neuropathic Bladder in Children

342

Laila Anjuman Banu
Development of Kidney  301; Kidney  302; Ureter and Renal Pelvis  304
Zahid Hossain Bhuiyan
Clinical Embryology of the Upper Urinary Tract  306; Renal Agenesis  306; Multicystic Dysplastic Kidney  306
Mozzam Hossain
Autosomal Recessive Polycystic Kidney Disease  309; Autosomal Dominant Polycystic Kidney Disease  309;
Multilocular Renal Cyst  310; Solitary Renal Cyst  310

Shafiqul Haque, Matiur Rahman
Etiology  311; Causes  311; Pathology  311; Work-up  312; Presentation  313; Staging of Wilms’ Tumor  313;
Management Principles  313; Treatment by Type and Stage of Wilms’ Tumor  314; Prognostic Factors  316

Jahangir Kabir, MA Salam
Ureteropelvic Junction Obstruction  317; Bilateral Ureteropelvic Junction Obstruction  321; Complications  322;
Outcome and Prognosis  322; Future and Controversies  322; Follow-up  322
Isteaq Ahmed Shameem
Imaging Techniques  324

Paddy Dewan
Cloacal Exstrophy (10%)  326; Classical Bladder Exstrophy (60%)  326; Epispadias (30%)  326;
Diagnosis of Bladder Exstrophy  328; Management of Bladder Exstrophy  328; Prognosis and Natural History  328
Ishteaq Ahmed Shameem
Patent Urachus  330; Urachal Cyst  330
Matiur Rahman
Major Characteristics  332; Associated Anomalies  332; Management  332; Work-up  333; Treatment  333
Paddy Dewan
Incidence  334; Pathophysiology  334; Causes  335; Consequences  335; Incidence  335; Grading System  335;
Diagnosis  336; Work-up  336; Management  337; Surgical Techniques  340; Follow-up  340
Paddy Dewan
Definition  342; Classification  342; Urodynamic Studies  342;
Management  343; Follow-up of Neurogenic Bladder Patients  344


xxiv

Principles and Practice of Urology
54. Nocturnal Enuresis

346

55.Rhabdomyosarcoma

348







Pranashish Saha
Definition 346; Diagnosis 346; Treatment 346
Shahadat Hossain
Presentation of Rhabdomyosarcoma  348; Pathology  348; Pathologic Classification  348;
Clinical Groups of Rhabdomyosarcoma  349; Management  349

56. Acute Scrotum in Children




57. Empty Scrotum or Undescended Testis

381

Emdadul Haque
Diagnosis 381; Treatment 381

65. Repair of Hypospadias: Current Trend








375

Shafiqul Haque
Mechanisms of Sexual Differentiation  375; Disorders of Sexual Differentiation  376;
Work-up of Ambiguous Genitalia  376; Gender Assignment  378;
Timing of Genital Reconstruction  378; Management  378

64.Micropenis



373

Ishteaq Ahmed Shameem
Presentation of Paraphimosis  373; Manual Reduction  373; Follow-up  374; Complications  374

63. Ambiguous Genitalia



368

MA Salam, Shahidul Islam Sugom
Diagnosis  368; Treatment  368; Methods of Circumcision  369

62.Paraphimosis



364

Paddy Dewan
Classification of Posterior Urethral Valves  364; Presentation of Posterior Urethral Valve or Membrane  364;
Work-up of Posterior Urethral Valves  365; Management of Posterior Urethral Valves  365;
Antenatal Treatment  365; Postnatal Treatment  366; Vesicostomy  366; Follow-up  366

61.Phimosis



361

K Sasidharan
Diagnosis  361; Treatment of Varicocele  362

60. Posterior Urethral Valves or Membrane

359

MA Salam, Md Saiful Islam
Diagnosis 359; Treatment 359

59. Varicocele in Children and Adolescents



355

Paddy Dewan
Significance 355; Classification 355; Diagnosis 356; Investigations 356;
Treatment  357; Advantages of Early Orchidopexy  357; Prognosis  358

58.Hydrocele



350

Shafiqul Haque
Diagnosis  350; Treatment of Testicular Torsion  352; Prognosis  352;
Perinatal Torsion  353; Epididymitis  353; Testicular Cancer  353

Paddy Dewan
History  382; Pathophysiology of Hypospadias  382; Classification System of Hypospadias  383;
Risk Factors for Hypospadias  383; Differential Diagnosis of Hypospadias  384;
Objectives of Repair of Hypospadias  384; Diagnosis  384; Treatment of Hypospadias  384;
Techniques for Posterior Hypospadias  387; Two-stage Hypospadias Repair  389;
Bladder/Buccal Mucosa Technique  390; Operative Technical Points  392; Complications of Hypospadias Repairs  393;
Hypospadias Patients with Multiple Failures  394; Long Term Follow-up  394

382