bluuebunny/crossref_metadata_2025 huggingface dataset:
EEG-Based Anticipation and Control of Seizures
Authors: Kalitzin Stiliyan , Silva Fernando Lopes da
Published: November 2017

Early seizure-prediction paradigms were based on detecting electroencephalographic (EEG) features, but recent approaches are based on dynamic systems theory. Methods that attempted to detect predictive features during the preictal period proved difficult to validate in practice. Brain systems can display bistability (both normal and epileptic states can coexist), and the transitions between states may be initiated by external or internal dynamic factors. In the former case prediction is impossible, but in the latter case prediction is conceivable, leading to the hypothesis that as seizure onset approaches, the excitability of the underlying neuronal networks tends to increase. This assumption is being explored using not only the ongoing EEG but also active probes, applying appropriate stimuli to brain areas to estimate the excitability of the neuronal populations. Experimental results support this assumption, suggesting that it may be possible to develop paradigms to estimate the risk of an impending transition to an epileptic state.
Transcranial Electrical and Magnetic Stimulation
Authors: Rotenberg Alexander , Pascual-Leone Alvaro , Legatt Alan D.
Published: November 2017

Noninvasive magnetic and electrical stimulation of cerebral cortex is an evolving field. The most widely used variant, transcranial electrical stimulation (TES), is routinely used for intraoperative monitoring. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are emerging as clinical and experimental tools. TMS has gained wide acceptance in extraoperative functional cortical mapping. TES and TMS rely on pulsatile stimulation with electrical current intensities sufficient to trigger action potentials within the stimulated cortical volume. tDCS, in contrast, is based on neuromodulatory effects of very-low-amplitude direct current conducted through the scalp. tDCS and TMS, particularly when applied in repetitive trains, can modulate cortical excitability for prolonged periods and thus are either in active clinical use or in advanced stages of clinical trials for common neurological and psychiatric disorders such as major depression and epilepsy. This chapter summarizes physiologic principles of transcranial stimulation and clinical applications of these techniques.
The Neurophysiological Basis of Myoclonus
Authors: Thompson Phillip D. , Shibasaki Hiroshi , Hallett Mark
Published: November 2017

There are several types of myoclonus, with a variety of classification schemes, and the clinician must determine what type of myoclonus a patient has and what type of neurophysiological assessment can facilitate diagnosis. The electromyographic (EMG) correlate of the myoclonus should be examined, including the response to sensory stimuli (C-reflex). The electroencephalographic (EEG) correlate of the myoclonus should then be examined, possibly including back-averaging from the myoclonus or looking at corticomuscular (EEG–EMG) coherence. The somatosensory evoked response (SEP) should be obtained. Such studies will help determine the myoclonus origin, most commonly cortical or brainstem. One form of cortical myoclonus has the clinical appearance of a tremor (cortical tremor). Brainstem myoclonus includes exaggerated startle (hyperekplexia). Other forms of myoclonus include spinal myoclonus and functional myoclonus, which have their own distinct physiological signature. Several causes of myoclonus are reviewed, including rare types such as Creutzfeldt-Jakob disease and subacute sclerosing panencephalitis.
Visual Evoked Potentials and Electroretinograms
Authors: Celesia Gastone G. , Peachey Neal S.
Published: November 2017

Electrophysiological testing of vision permits the objective assessment of the function of the retina, visual pathways, and cortices. This chapter covers visual evoked potentials (VEPs) and electroretinography (ERG). Flash ERG is useful in evaluating the outer retinal function and specifically helping in the diagnosis of retinal degeneration, monitoring the progress of retinal diseases, monitoring the retinal toxicity of drugs, and understanding the pathophysiology of retinal disorders. VEPs to various stimuli are useful in evaluating macular disorders, diagnosing optic neuropathies, detecting silent pathologies in the absence of other clinical signs of visual impairment, and evaluating disturbances of visual processing in degenerative diseases of the central nervous system. Simultaneous recording of pattern ERG and pattern VEP permits the differentiation between maculopathies and optic neuropathy.
EEG Analysis
Authors: Wendling Fabrice , Congendo Marco , Lopes da Silva Fernando H.
Published: November 2017

This chapter addresses the analysis and quantification of electroencephalographic (EEG) and magnetoencephalographic (MEG) signals. Topics include characteristics of these signals and practical issues such as sampling, filtering, and artifact rejection. Basic concepts of analysis in time and frequency domains are presented, with attention to non-stationary signals focusing on time-frequency signal decomposition, analytic signal and Hilbert transform, wavelet transform, matching pursuit, blind source separation and independent component analysis, canonical correlation analysis, and empirical model decomposition. The behavior of these methods in denoising EEG signals is illustrated. Concepts of functional and effective connectivity are developed with emphasis on methods to estimate causality and phase and time delays using linear and nonlinear methods. Attention is given to Granger causality and methods inspired by this concept. A concrete example is provided to show how information processing methods can be combined in the detection and classification of transient events in EEG/MEG signals.
EEG-Based Brain–Computer Interfaces
Authors: Pfurtscheller Gert , Brunner Clemens , Neuper Christa
Published: November 2017

A brain–computer interface (BCI) offers an alternative to natural communication and control by recording brain activity, processing it online, and producing control signals that reflect the user’s intent or the current user state. Therefore, a BCI provides a non-muscular communication channel that can be used to convey messages and commands without any muscle activity. This chapter presents information on the use of different electroencephalographic (EEG) features such as steady-state visual evoked potentials, P300 components, event-related desynchronization, or a combination of different EEG features and other physiological signals for EEG-based BCIs. This chapter also reviews motor imagery as a control strategy, discusses various training paradigms, and highlights the importance of feedback. It also discusses important clinical applications such as spelling systems, neuroprostheses, and rehabilitation after stroke. The chapter concludes with a discussion on different perspectives for the future of BCIs.
Trait Vulnerability Assessment
Authors: Gerlovina Zhanna
Published: November 2017

This chapter is devoted to the detailed assessment of the trait vulnerability component of imminent suicide risk. Demographic, clinical historic, biological, and cultural aspects of trait vulnerability are discussed in dedicated sections. The demographics section includes age, gender, ethnicity, and LGBT issues. The clinical history section addresses history of mental illness, history of suicide attempts, childhood trauma, parenting style, and attachment style. The biological traits section describes impulsivity, hopelessness and pessimism, perfectionism, fearlessness, and pain insensitivity. The cultural section includes cultural attitudes, immigration, moral philosophy and religious objections or lack thereof, regional affiliation within the United States, suicide in the family, suicide exposure, and suicide clusters. The chapter concludes with case examples and a test case.
Emotional Response
Authors: Galynker Igor
Published: November 2017

Clinicians’ emotional responses to suicidal patients are important factors in the assessment of imminent suicide risk and in treatment outcome. This chapter provides a comprehensive review of the role that emotional responses to suicidal patients play in clinical work and provides a framework for factoring them into the imminent risk assessment. The chapter discusses emotion differentiation and mindfulness, followed by a description of common psychological responses to suicidal individuals—“countertransference love” and “countertransference hate.” Common psychological defenses, including reaction formation, repression, turning against self, projection, denial, and rationalization, are described. This chapter also provides a framework for a self-assessment of one’s emotional response to a suicidal patient. The chapter concludes with case examples describing emotional responses and psychological defenses elicited when working with imminently suicidal individuals.
Interventions
Authors: Rose Raquel , Molina Nicolette
Published: November 2017

Despite the fact that suicide is one of the leading causes of death in the United States, there are currently no US Food and Drug Administration-approved treatments for suicidal behavior. However, interventions that provide potentially effective treatment are available. This chapter explores medications and biological interventions as well as psychosocial, alternative, and app/Internet-based interventions. The section on medications and biological interventions covers clozapine, lithium, and ketamine. The psychosocial intervention section covers dialectical behavior therapy, cognitive–behavioral therapy for suicidal patients (CBT-SP), Collaborative Assessment and Management of Suicidality (CAMS), attachment-based family therapy, and safety planning. The section on alternative and Internet-based interventions covers mindfulness meditation as well as online applications that can act as supplements to traditional treatments. The chapter concludes with a reminder of the importance of suicide risk assessment and clinician self-care in suicide prevention.
Trauma-Informed Care
Authors: Panzer Paula , Smit-Dillard Stephanie
Published: November 2017

Many people seeking psychiatric care have been exposed to interpersonal and/or community trauma; those experiences have direct bearing on their presenting concerns. Understanding that trauma can pervasively impact well-being, it is critical for psychiatric practitioners to routinely address trauma exposure, coping strategies, and related symptoms so that interventions are experienced as collaborative, safe, and effective. This chapter discusses practical approaches addressing the role of trauma in health and behavioral health symptoms, and it introduces evidence-based interventions for assessing and treating trauma-related disorders in public practice. Trauma-informed systems of care that limit undue harm while attending to the needs of practitioners are also discussed.
Integrated Health Care
Authors: Cheng Jason , Tse Jeanie
Published: November 2017

People with serious mental illness often receive inadequate care for physical health conditions. This chapter illustrates ways in which psychiatrists can play a key role in managing the physical health of an individual by communicating with primary care providers, educating behavioral health staff about disease management, and expanding the scope of practice to include screening for and managing metabolic conditions. This role is particularly important for the numerous individuals with mental illness who are not well engaged with primary care. For these people, therapeutic approaches such as motivational enhancement and trauma-informed care can support self-management of physical health conditions. Co-location and integration of primary care and behavioral health services can address barriers to accessing care. Although integration poses certain challenges, it has the potential to achieve the triple aim of improving the health care experience, improving population health, and reducing health care costs.
Cultural Humility
Authors: Cabán-Alemán Carissa
Published: November 2017

The importance of culture in mental health is widely recognized. It plays a key role in defining the predisposing, precipitating, perpetuating, and protective factors that mediate the development of an illness. It is the lens that colors provider–patient interactions, as well as the social, political, economic, and climatological systems that sustain these interactions. This chapter uses a case example to illustrate the principles of cultural humility and how this concept provides a general framework to address health disparities and recognize the systemic imbalances that influence illnesses. The chapter discusses how health care systems and providers can develop respectful partnerships with their patients and communities using critical self-reflection, implement institutional accountability, and address power dynamics related to health in order to improve treatment practices and sustain efforts to address the structural inequities that predispose and potentiate illnesses.
Navigating Systems
Authors: Le Melle Stephanie
Published: November 2017

People who have complex behavioral health needs must navigate many different systems of care. To do this, they may require the support of providers who are knowledgeable about these systems of care and understand their roles from a systems perspective. The four factor model of systems-based practice gives providers a recovery-oriented conceptual framework for providing optimal care. The model is conceptualized as four roles—patient care advocate, team member, information integrator, and resource manager—that are performed by providers/psychiatrists to meet the comprehensive needs of the individual patient within and beyond the health care system and the traditional provider role. This model can also be used as a tool for helping providers think through complex clinical problems that are not easily addressed using the standard medical model of care.
Early Childhood Mental Health
Authors: Weis J. Rebecca
Published: November 2017

Compelling research indicates that the mental health trajectory of an individual begins before birth. Engaging with parents and young children based on risk factors for future mental health problems allows an opportunity to guide the trajectory in a positive direction. When behavioral and emotional problems do emerge, intervening early has a much better chance of helping the child get back on track with social–emotional development before issues become entrenched. Using a case example, this chapter highlights the importance of developing systems within health care and other settings for early identification and treatment of both parental and early childhood mental health problems. Specific strategies for implementation of screening, assessment, and intervention are explored in depth for parents and young children.
Adults with Serious Mental Illness
Authors: Volpp Serena Yuan , Runnels Patrick
Published: November 2017

The clinician’s goal for every adult with serious mental illness should be recovery, moving beyond symptom control toward the promotion of an individual’s functioning, autonomy, and sense of purpose. This chapter highlights some of the nonpharmacological, evidence-based practices that have been shown to further recovery for adults with serious mental illness. The case-based discussion highlights illness management, supported employment, supported housing, assertive community treatment, mobile crisis teams, cognitive–behavioral therapy for psychosis, peer support, and clubhouses as best practice models of care. Strategies to enhance medication adherence are discussed. The use of court-ordered assisted outpatient treatment as a strategy to prevent hospitalizations is also explored.
Forensic Psychiatry
Authors: Magona Sheku , Straka Tara
Published: November 2017

Law enforcement, lawmakers, and the public are increasingly concerned about how people with mental illness are treated within the criminal justice system. This chapter focuses on the role of public psychiatrists in the provision of timely evaluation, expertise, and care for individuals in custody—particularly for individuals with serious mental illnesses. A case-based discussion illuminates important aspects of the legal and health care challenges facing individuals at the time of arrest, arraignment, incarceration, trial, and community re-entry. The chapter discusses mental hygiene law, criminal procedure law, advocacy, and the formation of policy with an emphasis on fitness to stand trial. Appropriate diversion of individuals with mental illness from incarceration, and its role in helping these individuals to achieve recovery, is explored in detail.
HIV Psychiatry
Authors: Spicer Shane S.
Published: November 2017

Years after effective medications have been available for HIV infection, the stigma of this illness persists and presents a barrier to prevention, testing, and treatment. The treatment of HIV among people with mental illnesses is additionally challenging due to neuropsychiatric manifestations of HIV and drug interactions that may occur between antiretroviral and psychotropic medications. This chapter uses a case example to illustrate the range of psychosocial and clinical issues experienced by people living with HIV/AIDS and those at high risk of HIV infection. The chapter also provides an overview of HIV post-exposure prophylaxis and pre-exposure prophylaxis. In addition, the chapter suggests approaches for improving individual clinical care and provides recommendations for organizational and public health strategies to improve treatment and outcomes in this population.
Rural Communities
Authors: Peirson Ryan P. , Gillig Paulette Marie
Published: November 2017

Rural environments provide many challenges and opportunities to psychiatrists and their patients. Although telemedicine is a growing option in some communities, access to mental health care remains difficult, compounded by transportation and other resource limitations. Although many technical aspects of community psychiatry are universal, particular attention must be paid to the special characteristics of rural settings, including boundary issues in close-knit communities, each of which may have a unique culture that a psychiatrist may need to learn to understand. Managing risks associated with substance use, particularly opioid dependence, and suicide risk can be more challenging in rural practice. Poverty and homelessness are also common problems. This chapter provides expertise on best practices to address these challenges, encouraging psychiatrists to consider the potential rewards of rural practice.
Lesbian, Gay, Bisexual, Transgender, and Queer People
Authors: Erickson-Schroth Laura , Barba Antonia
Published: November 2017

Although discussion of sexual orientation and gender identity is more prevalent in the media now than ever before, the lesbian, gay, bisexual, transgender, and queer (LGBTQ) population continues to encounter stigma, disproportionately high rates of trauma, and a resulting increased risk for developing mental illness. These factors, together with a conflicted history with the field of psychiatry, can create barriers to treatment that require practitioners to be active in their approach to providing LGBTQ-inclusive care. This chapter uses case examples to illustrate the range of psychosocial and clinical issues experienced by this population and suggests approaches for improving clinical care. It also discusses strategies for creating safe and LGBTQ-affirming environments.
Society, madness, and control
Authors: Rose Nikolas
Published: November 2017

What role does psychiatry play in contemporary strategies of control? How do psychiatrists and their institutions operate within all those ways of thinking and acting that aim to eliminate, minimize, or manage conduct that authorities consider undesirable? Since the middle of the nineteenth century, two great assemblages for the control of pathological conduct have taken shape in Western societies—the criminal justice system and the psychiatric system. This chapter will explore how these assemblages interact and how those who some now term forensic psychiatrists have claimed, or been given, the task of managing a multiplicity of points of tension, friction, and conflict within this dual logic of control. In doing so, the chapter considers the rise of risk thinking in psychiatry and some social, political, and ethical consequences.
UK health policy in relation to mentally disordered offenders in the community
Authors: Senior Jane , Hayes Adrian , Shaw Jenny
Published: November 2017

The majority of mentally disordered offenders are never treated within forensic mental health services. Instead, they remain within the criminal justice system, where care and treatment for complex and co-morbid mental health, substance-misuse, and personality disorder issues remain secondary to justice and punishment. In this chapter, we explore the policy, practice, and legislative drivers influencing healthcare delivery throughout the criminal justice pathway. Firstly, we consider the current liaison and diversion programme in England, which aims to identify people with mental health issues at the point of entry into the criminal justice system. Secondly, we review the state of mental healthcare in prisons, a quarter of a century after the clinical improvement partnership between the National Health Service and HM Prison Service. Thirdly, we discuss issues around court mandated mental health treatment in the community. Finally, we consider initiatives designed to meet the discrete needs of offenders with personality disorders.
Achieving positive outcomes for justice-involved people with behavioural health disorders
Authors: D’Amora David A. , Tran Mai P. , Osher Fred C.
Published: November 2017

Across the United States, a disproportionate number of individuals with behavioural health disorders (mental, substance-use, or co-occurring disorders) are under correctional supervision. This creates challenges for corrections systems that must juggle the multiple responsibilities of confinement, rehabilitation, treatment, and supervision. Correctional administrators and behavioural health administrators who work with the same populations have different goals that may lead to conflicting priorities and decisions: correctional administrators’ primary goal is to ensure public safety, whereas behavioural health administrators’ primary goals are treatment and recovery. While some efforts have been made to collaborate and coordinate between the two groups, little consensus exists between the two communities on how to serve their shared population. This chapter presents a shared framework for both groups for reducing recidivism and the prevalence of behavioural health disorders among individuals under correctional control or supervision, while also optimizing the best use of their limited resources.
Lowering legal barriers to transitioning mentally disordered offenders into general mental health care
Authors: Dawson John , Burns Tom
Published: November 2017

This chapter considers legal mechanisms for directing that the treatment of a mentally disordered offender should take place under the civil commitment scheme. Mentally disordered offenders should be dealt with in the least restrictive manner and receive timely transfer of their care to general mental health teams. We discuss factors likely to influence the responsible authorities when deciding whether to direct offenders to treatment under the civil scheme. The scope of the powers that would continue to be available over the person’s treatment is a key factor. With insufficient powers, authorities might be reluctant to direct an offender to the civil scheme. Yet, if strong powers were available, that would pose a threat to the rights of ordinary civil patients under that scheme. Some way must therefore be found to finesse the differing interests of offenders and ordinary civil patients in the design of the civil scheme. .
Multiple agencies with diverse goals
Authors: McGuire James , Wootton Lisa
Published: November 2017

This chapter charts the relationships between three large areas of background knowledge and professional practice, at the intersection of which everyday work in forensic mental health takes place. We describe the three underpinning models (biomedical, psychological, and sociological) the differences between them in training and in outlook, and the relationship of each to the legal context in which all must operate. Representing different models of human problems and distress, we recognize that sometimes there is friction between them. Their diverse perspectives notwithstanding, these models can be integrated, and they all have an indispensable part to play in how we understand and respond to the difficulties of working with people with mental health problems who also break the law. We illustrate this with reference to how services are delivered, and conclude by discussing the role played by Multi- Agency Public Protection Arrangements (MAPPA) in England and Wales.
The Community Mental Health Team and the mentally disordered offender
Authors: Holloway Frank , Davies Tony
Published: November 2017

There is a long-standing policy of diversion of mentally disordered offenders (MDOs) from the criminal justice system to care by mental health services. Care of the MDO presents specific challenges to the non-forensic practitioner. These include the need to understand the workings of the criminal justice system and the specific legal issues presented by an offender, the salience of risk, and its management in the mind of the courts and novel additional ethical dilemmas that arise. The importance of substance misuse as a factor in offending behaviour is emphasized, and its implications are explored. In addition, the MDO may present with clinical problems that are unfamiliar. Key principles of management are set out. These include developing a clear understanding of the patient and their world, excellent communication between all those involved, and rapid intervention when there is cause for concern. Staff working with an MDO require adequate supervision and support.
The interface of general psychiatric and forensic psychiatric services
Authors: Wootton Lisa , Fahy Tom , Wilson Simon
Published: November 2017

This chapter examines community psychiatric service provision for mentally disordered offenders, focussing on the United Kingdom and United States. In doing so, it acknowledges that mentally disordered offenders are at risk of rejection and of falling between services. They are doubly stigmatized by having a mental illness and being offenders. It explores the context, commissioning, components of a service, and models of care (including the evidence base for them). Also considered are the pros and cons of specialist services, as well as how they might differentiate their task from that of the CMHT. The chapter concludes by considering how services can work together to meet the needs of this complex and challenging group of patients.
Pathogenesis of urinary tract infection
Authors: Ali Ased
Published: November 2017

The realization of the harms resulting from indiscriminate use of antibiotics for minor infection has added impetus to the need to understand better the interaction between urogenital tract epithelium and invading bacteria during the initial stages of urinary tract infection (UTI). It is thought that uropathogenic Escherichia coli clones develop in the gut and migrate across the perineum to the urethra and up into the bladder. The response of the epithelium to bacterial adherence and the evolution of the invading bacteria will then govern the clinical consequences. These can vary between rapid invasion and further migration to produce systemic sepsis to tolerance of the bacteria in a planktonic state in asymptomatic bacteriuria. The key to these differences is the activation of epithelial pathogen-associated molecular pattern receptors by expressed proteins on the bacterial cell wall. Increased understanding of these interactions will lead to non-antibiotic-based strategies for clinical management of urinary infection.
Antimicrobial agents
Authors: Walton Katherine E. , Ager Sally
Published: November 2017

Antimicrobial resistance is a growing problem, which can be exacerbated by inappropriate use of antimicrobial agents. An understanding of the judicious use of antimicrobial agents, also known as antimicrobial stewardship, is therefore of fundamental importance to safe clinical practice. Patient factors should also be considered, including age, clinical status, special factors such as pregnancy or immunosuppression, co-morbidities, allergies, medication which may result in potential drug interactions, previous microbiology results, and antimicrobial treatment history. Important antimicrobial characteristics include the drug’s spectrum of activity, routes of administration, potential side effects, and cost. This chapter provides an overview of the ways in which antibacterial agents work and how bacteria develop resistance. It also outlines the principles of safe antimicrobial prescribing for prophylaxis and therapy, and highlights the key features, clinical indications, and potential adverse effects of antibacterial and antifungal agents commonly used in urology.
Tuberculosis and parasitic infestations involving the urogenital system
Authors: Heyns Chris
Published: November 2017

Urogenital tuberculosis is caused by Mycobacterium tuberculosis, which evokes a granulomatous tissue reaction leading to caseous necrosis, fibrosis, and eventual calcification. It most commonly presents as cystitis with sterile pyuria but can show many other symptoms and signs requiring a high index of suspicion to make the diagnosis. Schistosomiasis (Bilharzia) affecting the urinary tract is caused by the flatworm Schistosoma haematobium. Humans are infested by contact with fresh water harbouring the intermediate snail host. Echinococcosis (hydatid disease), is caused by the tapeworm Echinococcus granulosis or multilocularis. Human infection results from close contact with the parasite host (usually dogs and sheep). Filariasis, caused by the roundworm Wuchereria bancrofti, is transmitted by mosquito bite
Inflammation
Authors: Wagenlehner Florian M.E. , Pilatz Adrian , Bschleipfer Thomas , Diemer Thorsten , Weidner Wolfgang
Published: November 2017

There is a consensus on the diagnostic and therapeutic manage¬ment of bacterial prostatitis (acute and chronic). However, increas¬ing antimicrobial resistance rates for quinolones pose problems for the future, especially for therapy of chronic bac¬terial prostatitis. In chronic prostatitis/chronic pelvic pain syndrome, the diag¬nostic approach currently points more and more to an individu¬alized phenotypic assessment, in an effort to direct multimodal management towards improvement of specific symptom domains. Most therapy trials for single agents in CP/CPPS have been nega¬tive, therefore stratification by phenotype followed by individu¬alized multimodal treatment seems to be a promising strategy, although good evidence-based data are not available currently to substantiate this. Consensus regarding the need and option for treatment of asymptomatic prostatitis is far from being achieved. Therefore, taking the high prevalence of infections and inflammations in different asymptomatic conditions into consideration, further research is urgently needed to address this important field.
Inflammation
Authors: Greco Francesco , Fornara Paolo
Published: November 2017

Fournier’s gangrene (FG) defines a life-threatening necrotizing fasciitis of the external genitalia and perineum with a peak incidence at 50 years of age. It is associated with a mixed bacterial infection with Escherichia coli and Bacteroides spp. predominating. The diagnosis is made clinically with symptoms of skin necrosis, swelling, pain, crepitus, and feculent odour, and local and systemic signs of severe sepsis. Initial resuscitation with fluid replacement, oxygen therapy, and broad-spectrum empirical antibiotics should be rapidly followed by complete and aggressive surgical debridement with postoperative placement of an occlusive dressing. Urinary and faecal diversions are often required. Debridement should be repeated until all necrotic tissue has been excised, allowing later reconstruction. Early diagnosis and immediate therapy is crucial to improve survival in patients with FG.
Sexually transmitted infection
Authors: McCarty Emma J. , Dinsmore Wallace
Published: November 2017

The rising incidence of sexually transmitted infections (STIs) provides a challenge to clinicians in all fields to whom patients may present. This chapter aims to provide an overview of the common infections, particularly those aspects which may be relevant to urologists. There have been many recent changes in diagnostic testing (including use of polymerase chain reaction DNA identification) and treatment for STIs, especially with regard to the increasing resistance of gonorrhoea to many antibiotics. The presence of sexual infection is often overlooked in clinical practice or diagnosed late in the course of investigation of symptoms, resulting in difficulty in treatment and in some cases permanent sequelae. This overview should enable urologists to consider STI when formulating a list of differential diagnoses and aid appropriate testing or prompt referral to specialist genitourinary medicine clinics.
Bladder pain syndrome
Authors: Fall Magnus
Published: November 2017

Bladder pain syndrome has a profound impact on the patients’ physical, professional, and personal life. Generally, recognition of this clinical syndrome is hampered by insufficient expertise in the medical community. The correct diagnosis is often delayed by several years and may be preceded by multiple medical consultations and treatment attempts. Still, this is one of the most painful, non-malignant conditions to be encountered in urology and it is probably more common than generally believed. Problems as to diagnosis, phenotyping, terminology, and management persist, but during the last few years there has been increasing activity to resolve those issues. In this chapter, symptoms, findings, and treatment options are outlined.
Prevention of idiopathic calcium stones
Authors: Turney Ben , Reynard John
Published: November 2017

The main principles of idiopathic calcium oxalate stone prevention are to maintain dilute urine through increasing fluid intake and to reduce calcium and oxalate excretion. The influence of various urinary factors on the risk of stone formation has been quantified mathematically. Urine volume and urinary oxalate concentration are most influential on the risk of stone formation, while magnesium concentration contributes a small amount to risk. It is estimated that around 50% of stone formers will form another stone within five years. Some stone formers have frequent recurrences. Most stone formers ask how they can prevent future episodes. Advice can be generic or personalized, and treatment may include changes to diet, fluid intake, and addition of drugs to alter urine biochemistry.
Intracorporeal techniques of stone fragmentation
Authors: Astroza Gastón M. , Lipkin Michael E. , Preminger Glenn M.
Published: November 2017

The use of intracorporeal lithotripsy for the management of larger ureteral and intrarenal calculi has dramatically improved. Although the choice of intracorporeal fragmentation is frequently based on the location and composition of the stone to be treated, the experience of the clinician and availability of equipment often dictates this decision. Several different modalities of intracorporeal lithotripsy are currently available. Ultrasonic lithotripsy is mainly used for the fragmentation of large renal calculi during percutaneous nephrolithotripsy procedures. Ultrasound is used rarely via an ureteroscopic approach. Significant advances in laser fibres and power generation systems have propelled laser lithotripsy to the treatment of choice for fragmentation of most ureteral stones. Pneumatic lithotripsy consists of a pneumatically driven piston which will fragment stones by direct contact.
Kidney stones
Authors: Reynard John , Turney Ben
Published: November 2017

This chapter summarizes the variety of ways in which kidney stones can present, clinical findings in patients with renal stones, and the diagnostic tests used to identify them. Plain radiography remains a good way of identifying renal stones if calcified, will identify cysteine stones which are relatively radiolucent, but cannot ‘see’ non-calcium-containing stones (e.g. uric acid, triamterene, indinavir). The sensitivity of ultrasound for detecting renal calculi is variably reported at between 50–95%. Unenhanced computed tomography (CT) is nowadays regarded as the diagnostic gold standard for identifying renal calculi, for measuring their size and number and, to a lesser degree, determining their location. Where doubt exists over stone location, precise determination requires either CT urography or retrograde ureterorenography. The ‘limitation’ of CT is its radiation dose, but as a single ‘upfront’ diagnostic test, there is no substitute.
Kidney stone treatment
Authors: Neisius Andreas , Lipkin Michael E. , Preminger Glenn M.
Published: November 2017

Following the first large cohort of percutaneous nephrolithotomy (PCNL) reported by Alken in 1981, PCNL has subsequently become the preferred treatment method for large and/or complex renal and large proximal ureteral calculi. Current guidelines recommend PCNL as first-line therapy for all renal calculi ≥20 mm and for lower pole stones ≥15 mm. In this chapter we review the current indications, techniques, and outcomes of PCNL. Nowadays stone-free rates of approximately 70% overall can be achieved with PCNL, while at experienced high-volume centres, stone-free rates can approach 100%. While generally percutaneous nephrolithotomy has low morbidity, nonetheless significant complications can occur and the diagnosis, treatment, and preventative measures of these complications are presented in this chapter.
Bladder stones
Authors: Reynard John , Turney Ben
Published: November 2017

The majority of bladder stones in Western practice are secondary to underlying pathology—bladder outlet obstruction due to benign prostatic enlargement in men and urethral obstruction from pelvic prolapse or cystocele in women, chronic infection in the neuropathic or augmented bladder, or in the neobladder. While the pathology of endemic bladder stones remains as it always was, the advent of augmentation cystoplasty and rising use of the neobladder after cystectomy has, through a different pathological mechanism, led to a rise in frequency of bladder stones. The mode of presentation of bladder stones and diagnostic technique are reviewed in this chapter. Treatment options are determined, to a significant degree, by the clinical context in which the stone arise, the major determinant of the approach to such stones being the calibre of the conduit (urethra or Mitrofanoff) through which access to the bladder is achieved.
Upper urinary tract obstruction
Authors: Sullivan Mark , Henderson John , Gill Inderbir , Patel Nilay
Published: November 2017

Obstructive uropathy refers to the clinical sequelae of impairment of free urinary flow in the urological tract. The clinical manifestation of obstructive uropathy depends on the level and duration of obstruction, whether it is partial or complete, and whether infection has supervened. Obstruction may be clinically silent—and incidental radiological, biochemical, or examination findings may suggest the diagnosis. The radiological techniques used to demonstrate obstruction can be divided into anatomical and functional studies. These include ultrasound, urography, cross-sectional imaging, micturating cystourethrography, the Whitaker test, nuclear renography, and urodynamic techniques. Presence of infection with obstruction constitutes a urological emergency and urgent decompression is warranted. The pathophysiological effects of unilateral or bilateral upper tract obstruction differ and have important implications for clinical management of patients. The management of numerous upper urinary tract obstructive conditions is discussed.
The principles of endourology
Authors: Keoghane Stephen , Sullivan Mark
Published: November 2017

The chapter discusses the principles of endourology outlining the principles behind the sub-specialty. Topics disused include endoscopes, cystoscopes, rigid and semi-rigid ureteroscopes, flexible ureterorenoscopes, rigid and flexible nephroscopes, disposable equipment, integrated operating theatres, narrow band imaging (NBI), theatre ergonomics, and antibiotics. Urologic endoscopes are generally of two optical designs: the rigid, rod lens system described by Hopkins, while fibre-optic imaging bundles are used in both rigid and flexible endoscopes. The rod lens system consists of a series of glass rods with polished ends with the key feature of air gaps that act as a lens. Light is carried efficiently along the rod, resulting in a clear and bright image.
Urodynamics
Authors: Jones Julie Ellis , Hashim Hashim
Published: November 2017

Urodynamic studies encompass several tests to investigate the hydrodynamics of the lower urinary tract during bladder storage/filling and voiding. These tests include bladder diaries, free uroflowmetry, and post-void residuals, filling cystometry, voiding pressure/flow studies, urethral pressure profiles, leak point pressures, videourodynamics, ambulatory urodynamics, and electromyography. The tests are performed after formulating a urodynamics question to objectively observe lower urinary tract function and dysfunction with the idea of choosing an appropriate treatment for the pathology. Invasive urodynamic tests require appropriate training, as per the joint statement on minimum standards for urodynamic practice in the United Kingdom, and should be performed according to the International Continence Society good urodynamics practice guidelines. It is also important to be able to interpret the traces appropriately and troubleshoot any problems occurring during the test.
Urinary incontinence principles
Authors: Chapple Christopher R. , Osman Nadir I.
Published: November 2017

Urinary incontinence (UI) is a highly prevalent and bothersome problem that affects men and women of all ages. The aetiological spectrum of UI is wide, encompassing dysfunctions of the lower urinary tract, its neural control, the pelvic floor as well as other factors such as the side effects of pharmacotherapy. Although not life-threatening, UI frequently impacts upon the quality of life, psychological and emotional well-being of affected individuals. Additionally, UI imposes a tremendous economic burden on both the individual and the wider society in costs of nursing care, treatments, and lost productivity. The purpose of this chapter is to provide a broad overview of the epidemiology, aetiopathophysiology of UI, and to discuss the approach to the assessment, investigation, and initial management of the patient presenting with UI.
Pelvic organ prolapse
Authors: Cortes Eduardo , Belal Mohammed , Sahai Arun , Morley Roland
Published: November 2017

Pelvic organ prolapse (POP) is a common condition in women. It is defined as a downward descent of pelvic organs through or at the introitus. Symptoms relate to the prolapse itself and its potential effects on the bowel and urinary systems. Careful assessment is required and all compartments of the vagina need to be examined to assess for multicompartment POP. Several classification systems exist but the Baden Walker and POP-Q systems are commonly employed today. Several patient and surgical factors will influence the management. Conservative management involves pelvic floor exercises and the use of pessaries. Goals of surgery are to reconstruct and restore the pelvic anatomy, maintain, or restore normal bowel and bladder function, and maintain vaginal capacity for sexual intercourse, if desired. Surgery can be transvaginal or abdominal. This chapter will outline the anatomy, aetiology, presentation, and management of anterior, posterior, and apical compartment prolapse.
Urethral diverticula
Authors: Osman Nadir I. , Chapple Christopher R.
Published: November 2017

Urethral diverticula (UD) are not uncommon, affecting up to 6% of the female population, but are in the majority of cases asymptomatic and of no clinical significance. They are thought to arise as a consequence of infection, obstruction, and subsequent rupture of a periurethral gland. UD often pose a significant diagnostic challenge, as symptoms are largely non-specific and easily confused with other conditions such as bladder pain syndrome and recurrent urinary tract infection. As such, both misdiagnosis and delayed diagnosis are common, to the frustration of both patients and surgeons. Traditional methods of diagnosis, such as voiding cystourethrogram, relied upon urethral catheterization and contrast instillation, and were associated with poor anatomical detail. Recent advances in imaging, particularly magnetic resonance imaging, have improved the diagnosis and staging of UD, and have allowed for more accurate preoperative planning.
Spinal cord injury
Authors: Harrison Simon C.W.
Published: November 2017

Injury to the spinal cord carries a high risk of lower urinary tract dysfunction, which will either be due to damage to the sacral segments of the cord (conus injuries) or partial or complete disconnection of the sacral parasympathetic and somatic centres from the brain centres that coordinate lower urinary tract function (supraconal injuries). As a result, spinal cord injury (SCI) causes urinary symptoms such as urinary retention or incontinence, but can also lead to renal deterioration unless managed appropriately. Long-term urinary tract management has to take into account the nature of the patient’s neurological dysfunction, their personal preferences, and the result of urodynamic evaluation of the lower urinary tract.
Principles of reconstructive urology
Authors: Mundy Anthony , Andrich Daniela
Published: November 2017

Here we give a brief overview of the development of reconstructive urology and of the types of clinical conditions for which it is appropriate. We introduce the fundamental surgical approaches to the repair or replacement of the ureter, bladder, and urethra and describe the anatomical and pathophysiological principles of the use of grafts and flaps of various types to achieve these goals – concentrating particularly on oral mucosal grafts and skin flaps for the urethra, intestinal flaps for the bladder and ‘bridging’ techniques for the ureter. The general principles of reconstructing the ureter or urethra are similar. One either finds a way of bridging a gap between the two ends of healthy ureter or urethra on either side of the area of pathology, or finds a way of replacing the affected segment, or of augmenting its calibre if part of the circumference is healthy enough for it to be worth preserving.
General principles of trauma
Authors: Sleat Graham , Noyes David
Published: November 2017

Trauma is a major public health problem worldwide, responsible for a substantial morbidity and mortality burden. All surgeons need to be familiar with the key steps in managing traumatized patients not only for injuries that are relevant to their specialty, but also in the wider management of trauma as part of the multidisciplinary team. These include recent advances in care such as the use of tranexamic acid, major transfusion protocols, and changes to the organization and management of trauma care after the implementation of regional trauma networks for major trauma in England. Appropriate and timely care during the initial stages after significant trauma improves long-term survival, but if patients are to return to a socially and economically productive life then tailored input from rehabilitation and re-enablement services is required. In many respects, after surviving their traumatic insult, this is the most important phase of their treatment.