bluuebunny/crossref_metadata_2025 huggingface dataset:
Suicidal Narrative
Authors: Galynker Igor
Published: November 2017

According to the narrative crisis model, as people with trait vulnerability to suicidal behavior experience stressful life events, they develop a perception of their life story as moving toward “the dead end,” which gives rise to the acute suicide crisis syndrome. This chapter details the suicidal narrative component of the narrative crisis theory, which organizes the common themes of suicidal narrative into seven phases that follow a coherent life story of progressive failure and alienation until the future becomes impossible: Setting up unrealistic life goals, entitlement to happiness, humiliating personal or social defeat, failure to redirect to more realistic goals, perceived burdensomeness, thwarted belongingness, and perception of no future. A person’s perception of his or her life in terms of coherent suicidal narrative is associated with imminent suicide risk. This chapter contains an interview algorithm to probe the suicidal narrative, three representative case examples, and a test case.
Conducting Short-Term Risk Assessment Interviews
Authors: Galynker Igor
Published: November 2017

This chapter describes several approaches to conducting imminent risk assessment interviews, which may be applicable to different clinical settings. The chapter has five sections. The first section uses the narrative crisis model of suicidal behavior to combine all the key components of the imminent risk assessment described in the preceding chapters into one comprehensive risk assessment outline. The second section addresses real-world challenges and limitations inherent to suicide risk assessments, limitations of self-reported suicidal ideation and intent, and strategies for minimizing interview bias. The third section is devoted to the potential advantages and disadvantages of using the short-term risk assessment instruments. The fourth section describes three different imminent risk assessment interview strategies and gives examples of each. The final section describes how to recognize a patient who has made a definitive plan to take his or her life behind the mask of “eerie calm.”
Conclusion
Authors: Galynker Igor
Published: November 2017

This chapter presents a brief summary of statistical trends in suicide rates and patterns, along with recent research, necessary healthcare responses, and the Zero Suicide approach.
Recovery Orientation as the Clinical Matrix
Authors: McQuistion Hunter L.
Published: November 2017

At the core of working with people who experience mental illnesses is a collaboration in pursuit of helping them actualize their goals in work and love. Their recovery is therefore a unique process of personal development, with psychiatrists and other human services professionals practicing with recovery orientation. Specific skills, techniques, and services are identified as recovery oriented. In this chapter, through relating one person’s story, the reader can understand how recovery orientation becomes operational in a clearly systematic manner, using such techniques as motivational interviewing, shared decision-making, rehabilitative focus, person-centered treatment planning, and the use of peer supports. In this way, it is illustrated how recovery orientation is not only richly humanitarian but also evidence-based.
School-Based Mental Health
Authors: Everett Mia
Published: November 2017

The majority of children and adolescents in need of mental health services do not receive adequate care. Barriers to quality care include limited financial resources, social stigma, and a paucity of appropriately trained clinicians. The deleterious effects of untreated childhood mental illness have been well documented. School-based child and adolescent psychiatrists are on the front line of managing this public health crisis. Approximately 75% of mental health services for children and adolescents are provided in educational settings. The success of school-based mental health programs is contingent upon effective collaboration between the practitioner, caregiver, child/adolescent, and educator. In this chapter, a case is used to illustrate salient features of school-based psychiatric practice, including assessment tools, interventions, educational advocacy, and logistical considerations. The practice of public psychiatry in school-based settings should optimally adhere to the principles of recovery, resilience, and cultural competence.
First Episode Psychosis
Authors: Manseau Marc W. , Crosby Jay
Published: November 2017

Engaging people experiencing a first episode of psychosis (FEP) in treatment is a priority. The duration of untreated psychosis (DUP) is the period of time between the onset of the FEP and the initiation of adequate treatment; longer DUP is associated with negative outcomes. Coordinated specialty care (CSC) is an evidence-based model that uses a team-based, multidisciplinary approach to engage people early in their psychotic illness in order to improve long-term psychosocial functioning and treatment outcomes. Best practices within CSC include assertive outreach, prescribing of low-dose antipsychotics, shared decision-making, family support, individual psychotherapy, and supported education and employment. Although people who have experienced an FEP may struggle to follow all treatment recommendations, they can still be engaged in their recovery by putting the focus on the individuals’ life goals.
Hippocrates’ Oath
Authors: Cavanaugh T.A.
Published: November 2017

Chapter 2 (Hippocrates’ Oath) begins by extensively examining the grounds for attributing the Oath to Hippocrates, finding them reasonable. It then contextualizes, articulates, and explains the Oath, line by line. It presents the Oath within the ancient Greek custom of oath-taking, beginning with the first aspect of the Oath, the gods and goddesses by whom the juror swears. It then explains the contract incorporated within the Oath (which concerns the novel teaching of the medical art to unrelated males), presenting the motivations for and implications of Hippocrates’ extending medical education beyond the traditional boundary of physician-father educating son. Chapter 2 then proceeds to the oath-proper (which deals with a physician’s interactions with patients). In particular, closely following and explicating the Greek text, it shows that the prohibition of giving a deadly drug certainly concerns the giving of such a drug to the doctor’s patient (in contrast to alternative interpretations).
Oath, Profession, and Autonomy
Authors: Cavanaugh T.A.
Published: November 2017

Chapter 4 (Oath, Profession, and Autonomy) investigates the connections between medicine as incorporating an oath, being a profession, and possessing autonomy. It argues that professional medical practice cannot amount solely to a technique. Rather, it necessarily incorporates an internal medical ethic, to which practitioners swear. It argues that the most basic indisputable norm internal to medicine approximates the aphorism “as to diseases, practice two: help or do not harm”—primum, non nocere (or, “first, do no harm”). It details the implications of medical promising—including self-regulation, education of the public concerning the profession’s commitments, and societal respect for professional conscientious objection. Chapter 4 concludes by noting that the enduring legacy of the Oath—as seen in the renaissance of medical oath-taking in the White Coat Ceremony, for example,—consists in the conception and establishment of doctoring as a profession, a practice incorporating its own publicly avowed ethic.
The law in England and Wales on mental health treatment in the community
Authors: Beswick Jo , Gunn Michael
Published: November 2017

This chapter examines the legal framework for the treatment of the mentally disordered offender in the community in England and Wales. It examines both some of the ideological questions underlying the care of this group and the legal mechanisms within which treatment can be provided. The chapter begins by examining the principle, endorsed by the Mental Capacity Act 2005, that voluntary treatment will usually be the norm, regardless of setting. It then considers exceptions to these norm situations where legally mandated treatment in the community is permitted. In England and Wales, most of these exceptions are to be found in three pieces of legislation: the Mental Health Act 1983, as amended in 2007 to include community treatment orders; the Mental Capacity Act 2005, with its associated Deprivation of Liberty Safeguards (DOLS); and the Criminal Justice Act 2003.
Sex offender treatment
Authors: Bradford John M. W. , Levin Giovana V. de Amorim , Ahmed Adekunle G. , Gulati Sanjiv
Published: November 2017

There are many misconceptions about sexual-offender treatment, which are particularly magnified when it comes to understanding and managing the risk of sexual offending in the community. Many of the misconceptions are based on faulty information about the types of treatment, treatment outcomes, and sexual-offence recidivism. Additionally, public misconception of sexual-offending behaviour in sexually deviant individuals creates stigma and fear. This is despite the large number of studies on sexual-offender treatment, recidivism, and treatment outcome available in the scientific literature. In fact, various actuarial risk-assessment instruments can be used to estimate the probability that a sexual offender will recidivate. Risk can be managed through treatment. The aim of this chapter is to review the evidence-based studies on the efficacy of sexual-offender treatment, as well as how the risk management of sexual offenders is currently implemented in sexual-offender treatment programmes.
Community psychiatric treatment under legal mandates: The international experience
Authors: Buchanan Alec , Kisely Steve , Moseley Daniel D. , Rugkåsa Jorun , Swanson Jeffrey W. , Swartz Marvin S.
Published: November 2017

During the last 30 years, new ways of legally mandating psychiatric treatment for patients living in the community have emerged. Changes to law and practice have occurred in various jurisdictions and cultures. The simultaneous introduction in a range of settings of new approaches to mandating community treatment suggests that there may be shared causes for these changes. This chapter reviews the experience of mandated community treatment in the United States, Australia, and the United Kingdom. For each of these countries, we examine the measures and prevalence of their use, the evidence for their effectiveness, and the most likely explanation of any differences between the results in their jurisdiction and experience elsewhere.
Hospital-acquired urinary tract infection
Authors: Bayston Roger
Published: November 2017

Urinary tract infections (UTIs) account for the majority of hospital-acquired infections (HAI), and most of these occur in catheterized patients. However, for most the presence of bacteria in the urine (bacteriuria) is asymptomatic, yet in many institutional and national surveillance studies it is still attributed as ‘infection’. Although guidance is that only symptomatic UTI should be treated, except in pregnancy, bacteriuria in catheterized patients is frequently overinvestigated and antibiotics overused. Most infections are caused by enteric bacteria such as Escherichia coli, but other bacteria such as Proteus mirabilis and staphylococci are more prominent in HAI. Aseptic technique for catheter insertion and during subsequent catheter care together with minimizing catheter duration are very important to prevent catheter-associated UTI (CAUTI). Prophylactic antibiotics should be avoided. National and international action to adopt evidence-based consensus protocols for management of catheterized patients and judicial use of antimicrobial chemotherapy promise to be of greatest benefit.
Urinary tract infection
Authors: Grabe Magnus , Wullt Björn
Published: November 2017

Infections of the urinary tract are among the most frequent infections encountered in the community and hospital environments. They range from harmless self-curing cystitis to severe pyelonephritis with life-threatening sepsis. Urinary tract infections are often recurrent. Host defence is crucial to control the infection but can also be deleterious in terms of scar formation. Early diagnosis, determination of severity, evaluation of possible risk factors, and assumption of possible pathogen are essential aspects to initiate efficient treatment. Urine culture with antibiotic sensitivity testing is the most important tool to confirm a suspected clinical diagnosis and direct treatment. Patients with urological disease are particularly susceptible to urinary tract infections, and healthcare-associated urinary infections are observed in approximately 10% of hospitalized urological patients. In view of the worsening resistance pattern of common urinary pathogens against available antimicrobial agents, it is important to comply with recommended treatment regimens.
Inflammation
Authors: Garthwaite Mary
Published: November 2017

This section provides key knowledge on the pathogenesis and natural history of epididymitis and scrotal abscess, as well as providing a framework for the assessment, investigation, and management of patients presenting with these conditions. The information provided links to the knowledge and clinical skills requirement of Intermediate stage topics ‘Urinary Tract Infection’ and ‘Emergency Urology’, within the syllabus of the United Kingdom (UK) Intercollegiate Surgical Curriculum Project (ISCP) Urology Curriculum (https://www.iscp.ac.uk/). There is a lack of data concerning the incidence and prevalence of these conditions. Previous estimates from UK general practice suggested incidence rates of epididymo-orchitis of 38/10,000 male person-years. A recent study of first presentations of epididymo-orchitis in UK general practice has reported a lower incidence of 21/10,000 male person-years in 2007. However, the true figure is likely to be higher, given that many patients will present directly to urgent care facilities.
Epidemiology of stone disease
Authors: Turney Ben , Reynard John
Published: November 2017

In developed countries, the lifetime prevalence of kidney stones is around 10% and most commonly affects people in the working age-group. The incidence is increasing internationally. After passage of a first stone, the risk of recurrence is high. Direct and indirect costs involved in treating stones are considerable. Intrinsic risk factors include age, gender, genetics, and metabolic syndromes. The incidence of stone disease peaks between the ages of 20 and 60 years. While historically the male to female ratio was around 3:1, the gender gap is closing. The reasons for increased incidence are due in part to increased detection through better imaging but also due to environmental factors (e.g. diet, obesity, diabetes, dehydration) which put more people with an underlying genetic predisposition at risk. Despite the increasing prevalence of kidney stones, the majority are categorized as idiopathic.
Prevention of other non-calcium stones
Authors: Iqbal Muhammad Waqas , Lipkin Michael E. , Preminger Glenn M.
Published: November 2017

Urolithiasis is a worldwide problem with an increase in incidence and prevalence affecting the quality of life of millions of people. While there have been significant advances in minimally invasive and endourological techniques to treat urinary stones, stone recurrence remains a substantial medical problem posing considerable social and financial burdens. Although debate continues on optimal metabolic workup in stone formers, identification of metabolic risk factors and medical preventive therapy is known to decrease stone recurrence. Specific treatment measures include targeted medical therapy tailored to individual stone types. In this chapter we discuss the current specific as well as non-specific measures to prevent non-calcium-based stones.
Stone fragmentation techniques
Authors: Neisius Andreas , Lipkin Micheal E. , Preminger Glenn M. , Glenn James F.
Published: November 2017

After its implementation in 1980, shock wave lithotripsy (SWL) became the first-line treatment for more than 80% of patients with urolithiasis. During the last three decades, SWL technology has advanced rapidly in terms of shock wave generation, focusing, patient coupling, and stone localization. Indications for SWL have evolved as well. Although endoscopic treatment techniques continue to improve, SWL continues to be considered first-line therapy for the treatment of many urinary stones. This chapter reviews the fundamental principles of SWL and presents advances in lithotripsy technology such as shock wave generation and focusing, advances in stone localization (imaging), different energy source concepts, and coupling modalities. Our understanding of the pathophysiology and the physics of shock waves can enhance extracorporeal SWL efficacy while limiting complications. Finally, current indications for and contraindications to SWL depending on stone location and in context of the updated AUA/EAU Guidelines are discussed.
Medical therapy (dissolution therapy)
Authors: Turney Ben , Reynard John
Published: November 2017

Medical therapy of stone disease aims to prevent stones or dissolve existing stones. Dissolution therapy aims to dissolve stones through administration of oral agents to by direct chemolysis through renal irrigation. Since dissolution therapy may take weeks to achieve an effect, it is usually used as an adjunct to endourological treatment. Urate stones are most amenable to dissolution therapy. Stones containing any calcium have a lower chance of successful dissolution. Providing stone composition is known, irrigating chemolysis is an option for patients with large stone burdens who are unsuitable for percutaneous nephrolithotomy (PCNL). Both uric acid and cystine stones can be treated with irrigating solutions of trihydroxymethyl-aminomethan with pH 8.5–9.0, though it takes a long time to dissolve stones and oral treatment is preferred.
Ureteric stones
Authors: Scales Charles D.
Published: November 2017

Symptomatic ureteral calculi are common. While in many cases, spontaneous passage or medical expulsive therapy (MET) can avoid the need for surgical intervention, in others intervention is required to relieve ureteral obstruction and/or remove the stone. Important indications exist for immediate or urgent intervention to assure urinary drainage or to remove obstructing ureteral calculi. In the case of infection, the consequences of failure to relieve the obstructed ureter can include severe sepsis and death. For both emergent and urgent indications for urinary drainage, a ureteral stent or percutaneous nephrostomy tube may be considered first-line options. For those patients that require intervention to fragment and remove a ureteral stone, ureteroscopy, and shock wave lithotripsy are acceptable options. This chapter will review indications and techniques for relieving ureteral obstruction and removing the ureteral stone.
Management of ureteric stones in pregnancy
Authors: Turney Ben , Reynard John
Published: November 2017

Renal colic is the most common non-obstetric cause for abdominal pain and hospitalization during pregnancy. Ureteric stones occur in about 1 in 2,000 pregnancies, most (>80%) in the second and third trimesters. Primary management concerns are diagnostic foetal radiation exposure and the potential for adverse perinatal events arising either from the stone or from intervention. Indications for intervention are the same as for the non-pregnant patient, but are influenced by obstetric circumstances. Active treatment options may be temporizing (stent or nephrostomy) or definitive (ureteroscopic stone extraction). Historically, temporizing measures were the only recommended treatment option. However, potential problems associated with temporary drainage mechanisms include recurrent obstruction, infection, nephrostomy displacement, encrustation, infection, and pain. These factors may impact on pregnancy. In recent years, advances in surgical technology and technique have permitted definitive ureteroscopic management of stones during pregnancy.
Principles of laparoscopic and robotic urological surgery
Authors: Sullivan Mark , Patel Nilay , Gill Inderbir
Published: November 2017

The development of laparoscopic and consequently robotic urological surgery have improved the visual field for the urological surgeon and led to reductions in postoperative pain, reduced convalescence, and improved cosmesis for the patient. Laparoscopy and robotics require video systems and telescopes to produce high-resolution images. Trocars have been developed to access the surgical field together with devices to deliver the insufflating gases. Instruments have been developed to allow for tissue dissection and incision together with haemostatic devices and sealants for control of small diameter vessel bleeding. Clips and staplers are used to control larger diameter vessels. Methods of access and skills training are discussed. Robotic surgery provides three-dimensional vision, greater range of movement, and the lack of tremor. Whether these are real benefits in terms of patient outcome is not yet clear, but the learning curve for robotic surgery does appear to be shorter than for pure laparoscopy.
Urgency incontinence and overactive bladder
Authors: Chapple Christopher R. , Mangera Altaf
Published: November 2017

Overactive bladder (OAB) is very prevalent and may be very bothersome. In this chapter, we describe the various definitions associated with this condition, its assessment and management. The definitions for lower urinary tract symptoms have been standardized by the International Continence Society. OAB is a symptomatic diagnosis after all other pathology has been excluded. Important assessments include a frequency volume chart and in some cases urodynamic studies. Here we describe the important parameters which should be sought from a frequency volume chart. In addition, the relationship to the urodynamic diagnosis provided by a cystometry study is explained. Thereafter we discuss the therapeutic options for OAB which include conservative measures, antimuscarinics, beta-3 agonists, intravesical botulinum toxin, neuromodulation, and surgery. The various management options including lifestyle changes, alpha antagonists, 5-alpha reductase inhibitors, antimuscarinics, desmopressin and surgery are also described.
Urinary fistula
Authors: Osman Nadir I. , Chapple Christopher R.
Published: November 2017

Genitourinary fistulae (GuF) are one of the oldest described causes of incontinence. They are associated with significant social and psychological debilitation. In developed countries, they most commonly occur after iatrogenic injury to the urinary tract during gynaecological surgery for benign conditions, whereas in developing countries the most common cause remains prolonged obstetric labour. The most frequent type of GuF occurs between the bladder and vagina. GuF require careful evaluation to confirm the diagnosis and assess the number, location, and anatomy of defects, as well as any associated injuries before operative management is undertaken. The surgical approach to each fistula is individualized and relies upon the use of healthy vascularized tissue to repair defects, preferably with interposition of a tissue flap to augment repairs.
Faecal incontinence
Authors: Chapple Keith
Published: November 2017

Faecal incontinence, the uncontrolled loss of faecal material, is a surprisingly common condition with many epidemiological and aetiological similarities to that of urinary incontinence. The condition carries many challenges for the clinician, from obtaining a history from patients often too embarrassed to fully recount their symptoms, through to the difficulty in ascertaining whether a treatment has been a success or not. A wide range of pathological conditions cause the symptoms of faecal incontinence, yet in clinical practice the condition is generally seen in women following childbirth. Assessing the individual patient for a successful outcome includes ascertaining not only a reduction in incontinent episodes, but also patient satisfaction and an improved quality of life.
Non-traumatic neurourology
Authors: Panicker Jalesh N. , Fowler Clare J.
Published: November 2017

This chapter reviews bladder disturbances in non-traumatic neurological conditions and provides an approach to its evaluation and management. The pattern of bladder dysfunction depends upon the level of neurological localisation and accordingly, lesions can be suprapontine, infrapontine/suprasacral (spinal), or infrasacral. The importance of the frontal lobes for bladder control has been confirmed and vascular disease or tumour can result in incontinence. There is better understanding about the very different urological profile of the two sometimes confused conditions, multiple system atrophy and Parkinson’s disease. Guidelines for the management of lower urinary tract dysfunction in multiple sclerosis are reviewed. Lower urinary tract (LUT) dysfunction is common in neurological disease and its importance to patient health and quality of life is now widely recognized.
Urethral strictures
Authors: Mundy Anthony R. , Andrich Daniela E.
Published: November 2017

Urethral strictures are common and almost all urologists will deal with them on a regular if not daily basis. They have always been common and the history of the subject stretches back to 3,000 BC. Urethral dilators have been found in the tombs of the pharaohs so that they might be able to catheterize themselves or dilate their own strictures in the afterlife. Urethrotomy and dilatation are two of the most frequently performed procedures in urology. But these are usually only palliative, and curative treatment by urethroplasty is performed by very few urologists. In part this is because most strictures are bulbar strictures and most non-bulbar strictures are seen only by reconstructive urologists; but in part this represents a somewhat ambivalent attitude of most urologists to urethral stricture disease. In this chapter, we will attempt to clarify the current approach to this problem.
Upper urinary tract trauma
Authors: Mundy Anthony R. , Andrich Daniela E.
Published: November 2017

Of all the major urological injuries, injury to the kidney is the most common. Indeed it is the most commonly injured intra-abdominal organ. Blunt or penetrating external injury is almost always the cause. The diagnosis and treatment of renal trauma has changed dramatically in the last 30 years or so reflecting the development of CT scanning for diagnosis and of endovascular interventional radiological techniques for treatment, at the expense of intravenous urography and surgery, respectively. Complications can be divided into early and late. The commonest early complications are bleeding and extravasation of urine, which may in turn lead to a urinoma, infection, and abscess formation. The best way of handling bleeding is by selective microembolization or surgery if necessary, which is usually only when embolization fails. A urinoma can usually be drained percutaneously through the flank, but may require surgery occasionally.
Lower urinary tract trauma
Authors: Mundy Anthony R. , Andrich Daniela E.
Published: November 2017

Lower urinary tract trauma is common. Indeed, iatrogenic lower urinary tract trauma is the commonest type of urological injury. External trauma is much less common but potentially life-threatening, if only because of the force needed to cause it. This chapter describes the incidence, aetiology, pathology, clinical features, and management of both types of injury and draws attention to the controversies in management of the most serious of these injuries which remain controversial after nearly 100 years of debate. Despite the controversies, the three fundamental principles of treatment remain unchallenged: to provide urinary drainage to prevent or relieve urinary retention; to prevent or treat urinary extravasation; and to provide the best possible conditions for recovery of the injury.
Bladder outflow obstruction
Authors: Chapple Christopher R. , Mangera Altaf
Published: November 2017

Bladder outflow obstruction (BOO) may occur due to several underlying causes in both men and women. It is not possible to diagnose bladder outlet obstruction on a history alone. It can be suspected based on the use of a flow rate but can only be diagnosed using pressure flow urodynamics. In this chapter, we discuss the aetiology, pathophysiology, and investigation of BOO. We emphasize the importance of a complete history, examination, and investigations with investigations such as flow rate and voiding cystometry, in addition to standard tests including urinalysis and a bladder diary. The management of the underlying disorder responsible for the BOO symptoms is discussed in the relevant chapters separately.
Urinary retention in men
Authors: Speakman Mark
Published: November 2017

Urinary retention continues to be a significant burden for both the patient and healthcare services in the United Kingdom and around the world. It is associated with a significant reduction in patients’ quality of life. In the past (20–30 years ago) urinary retention was regarded as an immediate indication for surgery and in older reports, 25% to 30% of men who underwent transurethral prostatectomy (TURP) had acute urinary retention (AUR) as their main indication. With the introduction of medical treatments and changes in practice for the management of retention, these rates have changed significantly. Key topics discussed in this chapter include the aetiology, pathogenesis, presentation, initial assessment, investigation, management, and prevention of urinary retention in men.
Benign prostatic hyperplasia
Authors: Thiruchelvam Nikesh
Published: November 2017

Male lower urinary tract symptoms (LUTS) has a multifactorial aetiology and is not simply solely due to bladder outflow obstruction (BOO) from benign prostatic hyperplasia (BPH). Other causes of LUTS include bladder dysfunction, malignant prostatic disease, urethral disease, and medical conditions such as polyuria and sleep disorders. In an ageing population, LUTS and BPH will become more common. BOO can only be diagnosed by urodynamic evaluation, although treatment can be started before requiring this invasive investigation. Once considered the only treatment option for BOO, open prostatectomy has been surpassed by TURP and over the past few decades by medical therapy for BPH. α‎-blockers and 5-α‎ reductase inhibitors improve LUTS and in combination, can reduce the progression of BPH. There are now many competing surgical options for TURP including a variety of laser ablating and enucleating techniques. To date, no one endourological option shows superiority on outcome and complication rates.
High-risk prostate cancer
Authors: Joniau Steve , Van Bruwaene S. , Karnes J , De Meerleer G , Gontero P , Spahn M , Briganti A
Published: November 2017

In this chapter, patients with adverse tumour characteristics and a high risk of tumour progression are discussed. In the current era of PSA testing, the proportion of patients presenting with high-risk prostate cancer (PCa) is estimated between 10% and 20% with a 10-year cancer specific survival approaching 40% for those not receiving active local treatment. The prevalence of high-risk disease varies with community PSA use, and is higher in countries (e.g. 30% in the United Kingdom) with little PSA testing. Adequate staging with magnetic resonance imaging for tumour extension, computer tomography for visceral metastases, and bone scan for skeletal metastasis is advocated in this group. The treatment of locally advanced or high-risk prostate cancer is a contemporary challenge.
Novel therapies and emerging strategies for the treatment of patients with castration-resistant prostate cancer
Authors: Mukherji Deborah , Omlin Aurelius , Pezaro Carmel , Bono Johann De
Published: November 2017

Castration-resistant prostate cancer (CRPC) represents a final stage of this malignancy for many men and is defined as the progression of prostate cancer despite castrate levels of testosterone. CRPC may present as a rising PSA, the development of new metastases, or worsening of known metastases. Recent advances have resulted in five new treatments for CRPC: the immunotherapy sipuleucel-T; the cytotoxic cabazitaxel; the androgen biosynthesis inhibitor abiraterone acetate; the radioisotope radium-223; and the antiandrogen enzalutamide. These have all improved overall survival in randomized phase III studies for patients with metastatic CRPC. Furthermore, multiple agents and combinations are currently in late-stage clinical testing. Men with advanced prostate cancer represent an important population for clinical and translational research and clinical trial participation should be considered as part of standard care.
Bladder and upper urinary tract cancer
Authors: Goossens Maria E. , Buntinx Frank , Zeegers Maurice P.
Published: November 2017

Urinary bladder cancer (UBC) ranks ninth in worldwide cancer incidence. The most common histological type in Western countries is transitional cell carcinoma (TCC), while in Africa, a substantial proportion of squamous cell carcinomas (SCC) are observed related to the prevalence of infection with Schistosoma haematobium (bilharziasis). UBC has the highest per-patient lifetime cost for cancer in terms of healthcare expenditure compared to all other types of cancer. It is more frequent in men than in women and age is now widely accepted as the greatest single risk factor for developing UBC. The median age at diagnosis is 70 years. Cigarette smoking and specific occupational exposures, such as carcinogenic dyes for painters, are the main known causes of UBC.
General overview of bladder cancer
Authors: Bryant Richard J , Catto James W.F
Published: November 2017

Bladder cancer (BC) is a common malignancy and is one of the most expensive to manage. This tumour typically affects middle-aged and elderly patients and is more common in men. These demographics reflect the aetiological links between BC and tobacco smoking and occupational exposure to carcinogens. While the presenting symptom of BC is usually painless visible haematuria, around one-quarter of tumours present with irritative voiding symptoms, recurrent or antibiotic-refractory urinary tract infections, non-visible haematuria, or are found by chance during the investigation of unrelated symptoms. As such, these urological symptoms require urgent investigation in patients at risk of BC. The diagnosis of BC is confirmed by endoscopic transurethral resection. This procedure requires meticulous tumour excision, sampling of the underlying detrusor muscle and the flat urothelium or prostatic urethra in patients with high-grade cancers. The prognosis of BC depends upon tumour grade, stage, and other features.
Kidney cancer
Authors: O’Brien Tim , Patel Amit
Published: November 2017

Despite advances in imaging techniques, many patients with renal cancer still present with locally advanced or metastatic disease. Surgical resection remains the main stay of treatment for locally advanced disease, but is technically challenging and survival remains limited. Progression free and overall survival following nephrectomy are dependent on many factors including pathological T-stage, lymph node status, and Fuhrman grade. Patients presenting with metastatic disease still have a poor prognosis and the use of multimodal therapy has yet to deliver dramatic improvements in outcomes, with just 15% of patients surviving in the long term. Understanding the potential but also the limitations of surgery is very important when the overall prognosis may be so limited in this challenging group of patients.
Testicular cancer
Authors: Winter Christian , Albers Peter
Published: November 2017

Testicular germ cell tumours (GCTs) represent the most common solid malignancy of young men aged 15–40 years. The disease is rising in incidence. Germ cell tumours are best divided into those with pure seminoma and non-seminoma (NSGCT) histology. While cryptorchidism is clearly established as a risk factor, the pathogenesis of testicular cancer remains unknown. Familial studies and molecular analyses suggest an association to genetic alterations. Most testicular cancer patients present a primary tumour in the testis. Diagnostic examinations include testis palpation and ultrasound, and measurement of serum tumour markers (AFP, ß-HCG, and LDH). Surgical exploration is obligatory for suspected tumours and radical orchidectomy should be performed if a tumour is found. Prognosis and subsequent treatment depends upon the clinical stage and the IGCCCG classification (in case of advanced GCT disease).
Testis cancer
Authors: Heidenreich Axel
Published: November 2017

Testicular germ cell tumours represent the most common solid neoplasms in the age group of 20 to 40 years. These cancers have an excellent prognosis, with a 90% long-term survival rate due to well-established, interdisciplinary guidelines for diagnosis and treatment. Independent on the clinical stage at time of diagnosis, treatment after orchidectomy is performed on an individual risk adapted approach. In clinical stage I seminoma, active surveillance is the recommended therapy and adjuvant chemotherapy with carboplatin remains an option in men not suitable for surveillance. Clinical stage IIA/B and IIC are treated by radiation therapy and by systemic chemotherapy following orchidectomy. Clinical stage I non-seminomas are either treated by active surveillance or by one cycle of adjuvant PEB chemotherapy. Clinical stages IIA-C and advanced stages of GCT are treated by 3-4 cycles of PEB chemotherapy depending on IGCCC risk profile. Relapsing cases should be treated at tertiary referral centres only.
Adrenocortical cancer
Authors: Ball Steve , Kalathil Sajid
Published: November 2017

Adrenocortical cancer (ACC) is rare and associated with poor prognosis. The incidence is estimated at 0.7–2 cases per one million. Overall survival rate at five years for ACC is 37–47%. While the pathogenesis of ACC is incompletely understood, inherited predisposition syndromes are common in childhood ACC. Clinical presentation can be with symptoms and signs of hormone excess (functional tumours), mass effects, or as an incidental radiological finding. A multidisciplinary approach combining radiology, biochemistry, and tissue-based pathology is needed to establish a diagnosis to guide a surgical approach aimed at complete resection of the tumour where possible. At present, recommended first-line therapies for advanced disease are mitotane monotherapy or etopiside, doxorubicin, and cisplatin plus mitotane. Metronomic capecitabine and gemcitabine have been used as alternatives. Adjuvant radiotherapy to the tumour bed should be considered for patients considered to be at high risk of recurrence.
Surgical treatment of male infertility
Authors: Dohle Gert R
Published: November 2017

Surgical treatment of male infertility is indicated in men with obstructive azoospermia due to epididymal and vassal blockage, in infertile men with a varicocele and oligozoospermia, and to harvest spermatozoa for future intracytoplasmic sperm injection (ICSI). Testis biopsy may be performed in men with normal testis volume and normal gonadotrophins to confirm the diagnosis of obstructive azoospermia. Furthermore, testis biopsies are indicated in men with risk factors for testis cancer, such as infertility and ultrasonograhic abnormalities.Varicocele repair seems effective in case of an infertility duration of at least 2 years, oligozoospermia, and otherwise unexplained infertility in a couple. The advantages of surgery in these couples are a fair chance of spontaneous pregnancies at relative low cost and with less obstetric problems and birth defect compared to pregnancies from IVF procedures.
Erectile dysfunction
Authors: Saccà Antonino , Salonia Andrea
Published: November 2017

Erectile dysfunction (ED) has progressively emerged as an important sentinel marker of cardiovascular and overall health among men. A timely and accurate diagnosis of ED may thus represent a significant opportunity not only to diagnose the dysfunction per se, but also to comprehensively identify co-morbid and potentially life-threatening conditions. Basic work-up for a man seeking help for ED should start considering that ED may share several modifiable and unmodifiable common risk factors with cardiovascular disorders and other potential life-threatening conditions. Overall, most patients with ED can be adequately managed with a basic diagnostic work-up; this includes a comprehensive medical and sexual history, along with a physical examination and some laboratory tests. Conversely, only some selected patients may also need specific diagnostic tests.
Priapism
Authors: Muneer Asif , Ralph David
Published: November 2017

Priapism is rare and is a medical emergency. Ischaemic priapism is the commonest subtype with haematological abnormalities, psychotropic or recreational drug use and malignancy being the other common aetiologies. Emergency decompression of this compartment syndrome is required to preserve cavernosal smooth muscle function and this should ideally be performed as soon as possible. The degree of resultant erectile dysfunction is related to the duration of the priapism. Non-ischaemic priapism is an unregulated inflow of arterial blood, often as a result of perineal trauma and a lacerated cavernosal vessel. Selective arterial embolization should be performed and results are usually excellent. The final subtype is stuttering priapism, the cause of which is often unknown and a variety of methods will be discussed for its treatment.
Peyronie’s disease, congenital curvature, and chordee
Authors: Levine Laurence A. , Brant William , Larsen Stephen M.
Published: November 2017

Penile curvature is usually secondary to Peyronie’s disease, which is a fibrotic wound healing disorder of the tunica albuginea. Other causes include congenital penile curvature and chordee. Penile deformity, if severe, results in significant difficulties with sexual intercourse and may make sexual intercourse impossible. The mainstay of treatment, if the deformity is stable and interfering with intercourse is surgery, while a variety of surgical treatments exist. Side effects of treatment include penile shortening, erectile dysfunction, and recurrent deformity. Medical treatments are usually ineffective, although recently, injections of intralesional collagenase have been licensed in the United States for Peyronie’s disease.
Penile reconstruction
Authors: Garaffa Giulio , Ralph David John
Published: November 2017

Although the last decades have been characterized by the continuous evolution of reconstructive surgery and in particular of free tissue transfer techniques, the repair and reconstruction of the penis remains anatomically, functionally, and aesthetically a great challenge. This is due to the unique architecture of the penis and to the absence in the whole human body of an alternative tissue that could adequately replace the corpora cavernosa in terms of colour, texture, structure, and ultimately, function. The aim of this chapter is to describe the state of the art in penile reconstructive surgery with an emphasis on the cosmetic and functional outcome.
Penile augmentation
Authors: Sansalone Salvatore , Garaffa Giulio , Eardley Ian , Ralph David
Published: November 2017

Most patients who seek penile enhancement have a normally sized and functioning penis. Any man seeking penile augmentation benefits from a careful clinical assessment, together with counselling regarding the treatments options available and the results and complications of surgery. Indeed, for those with a normal penile size, careful psychological assessment is essential before any physical treatment should be considered. If a man perceives his penis to be too small, when actually it is of normal size, the condition is termed penile dysmorphophobia. However, demand for penile enhancement in men with a normally sized penis is increasing. Surgical outcomes are often disappointing, and there may be severe complications that can involve permanent disfigurement and impaired urinary and sexual function. Penile enhancement should therefore be offered only to patients with a true micropenis. We describe current surgical augmentation techniques with an emphasis on their cosmetic and functional outcomes.
Disorders of the kidney and upper urinary tract in children
Authors: Hutton Kim
Published: November 2017

The majority of clinically significant congenital disorders of the upper urinary tract are now detected prenatally. Commonly identified abnormalities include pelviureteric junction obstruction (PUJO), vesicoureteric junction obstruction (VUJO), duplication anomalies, multicystic dysplastic kidney (MCDK), high grade vesicoureteric reflux (VUR) and anomalies of renal migration and/or fusion. Most affected infants are asymptomatic at birth and further investigation can usually be undertaken on a non-urgent basis in the first few weeks or months of life. Long-term natural history studies have shown that many of these conditions can be managed non-operatively. In most cases, standardized procedures such as pyeloplasty and ureteric reimplantation give predictably satisfactory results. Long-term outcome data for surgical and conservative management of upper tract disorders in children is sparse and research in this area is still required.
Chronic kidney disease and dialysis
Authors: Haynes Richard J , Gilbert James A
Published: November 2017

Chronic kidney disease (CKD) is a common disorder as currently defined. Patients with CKD face two major hazards: cardiovascular disease and—in a minority—progression to end-stage renal disease (ESRD). Advanced CKD also causes numerous metabolic and other complications. The management of CKD involves excluding acute kidney injury, diagnosing the cause of CKD, slowing progression, and detecting and treating complications. If patients do reach ESRD, then renal replacement therapy (RRT) options must be considered. These include haemodialysis, peritoneal dialysis, or transplantation. Haemodialysis requires creation of an arteriovenous fistula or insertion of a prosthetic graft while peritoneal dialysis necessitates the insertion of a catheter into the abdominal cavity. All forms of dialysis access are associated with complications both in the short and long term. However, they remain vital and central to the life and the well-being of the end-stage renal patient on dialysis.
Ionizing radiation and radiation protection
Authors: Kraft Jeannette Kathrin , Howells Peter
Published: November 2017

Ionizing radiation has been revolutionizing the diagnostic process in medicine. However, its use is not without risk, necessitating protection of patients and staff from potential harm. The amount of radiation patients receive continues to rise, mainly due to the use of high-dose examination techniques such as computed tomography and image-guided interventional procedures. In some countries, the amount of radiation a population receives from medical use is already larger than that from natural background radiation. Therefore, a basic knowledge of radiation effects on the human body, radiation protection principles, and relevant legislation is of great importance to all clinicians. This will enable doctors to assess potential risks associated with ionizing radiation in medical imaging and to make an informed choice when different investigations are available to assess a patient.