Impotence and Infertility (Atlas of Clinical Urology, V.1

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9781573401197: Impotence and Infertility (Atlas of Clinical Urology, V.1
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As urology enters the 21st century, it is appropriate that the Atlas of vena caval surgery are clearly illustrated and are combined with Clinical Urology series captures and explains the major areas of an understanding of the appropriate patient populations for these modern urologic practice using a unique combination of images, procedures. This section also includes the management of benign schematics, tables, and algorithms. It does so in a compelling and malignant adrenal disorders. Michael Marberger has assem­ fashion, by combining a multilevel approach that includes the indi­ bled an extremely diverse and important set of noncancerous vidual volumes and the internet. Urology is a specialty of great diseases of the kidney. Nephrolithiasis management is covered breadth, and visual images provide much of the backbone of from medical therapy to endoscopy to incisional surgery. The urologic diagnosis and endoscopy and are key to surgical tech­ important role that laparoscopy has established in both excisional and reconstructive renal surgery is visually depicted and nique. The increasingly complex diagnostic and treatment paths are best depicted and understood as visual algorithms. explained. The evolution of the techniques illustrated in this The editors of this five-volume series have not only contributed section will likely provide the basis for renal intervention in the their world-renowned expertise to the chapters but have also 21 st century. assembled an outstanding group of individual chapter authors. Bladder diseases cause many patients to seek urologic care.

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From the Author:

Section I - Impotence Tom F. Lue Innovative research in the past two decades has greatly improved our understanding of penile physiology and erectile dysfunction (ED). We have seen revolutionary changes in the diagnosis and treatment of ED, and millions of men and their partners have benefited as a result. The phenomenal success of a recently introduced oral phosphodiesterase inhibitor and the media blitz surrounding it have also changed the attitudes of physicians, patients, partners, insurance companies, and government agencies toward this condition. On the other hand, these rapid changes have caught many physicians off guard, and there is continuing debate in the medical community regarding the most appropriate and cost-effective approach to the management of ED. In this section, I have invited experts to present state-of-the-art information on the treatment of ED. Drs. Rehman and Melman elegantly discuss and illustrate the basic anatomy, mechanism, pharmacology, and neurophysiology of penile erection and various causes of ED. The chapter by Drs. Montague and Lakin thoroughly addresses the questions asked most frequently by physicians: How much evaluation is necessary? Which test, if any, should be performed? How valid are the current tests? The discussion of and indications for vascular testing by Dr. Padma-Nathan are well delineated. Drs. Morales and Heaton, with their strong background in pharmacology, present a comprehensive review of the philosophy and rationale behind the various classes of pharmacologic treatment for ED, including the new oral phosphodiesterase inhibitor. Penile prosthesis, although the most invasive treatment, is still the most successful for ED, especially with the newly improved prosthetic devices now available. Dr. Mulcahy shares his vast experience with implanting prostheses and taking care of complications. His results in salvage operations for penile prosthesis infections are so far the most impressive in the field. Penile revascularization is one of the rare cause-specific curative treatments for ED, and is quite successful in young men whose arterial insufficiency is a result of injury. Drs. Mulhall and Goldstein have perfected the diagnostic and surgical approach to this condition and their suggestions should be followed closely to achieve the best result. The treatment of both ischemic and nonischemic priapisms has also been revolutionized thanks to the better understanding of their pathogenesis. Dr. Hashmat has treated more than 100 priapisms and his extensive experience provides the reader with a simple and practical guide to the management of this condition. Peyronie's disease is another common cause of ED and Dr. El-Sakka and I discuss various medical and surgical treatments for this condition. We also illustrate our simplified surgical techniques for the correction of deformed penis secondary to Peyronie's disease. Overall, I believe this is an excellent reference book skillfully presented by authorities in the fields of ED, priapism, and Peyronie's disease. The reader will not only appreciate the incredible advances in ED research and management but will also learn of rational and cost-effective approaches to these conditions.

Section II - Infertility Marc Goldstein Dramatic advances have been made in reproductive biology that were unthinkable just a few years ago. The widespread use and success of in vitro fertilization (IVF) with intracytoplasmic injection of a single sperm (ICSI) into a mature oocyte has expanded our ability to treat all but the most severe cases of testicular failure. These techniques, although initially feared by urologists as a replacement for male infertility treatment, have instead expanded the applications of male infertility surgery. Pregnancy rates with epididymal and testicular sperm aspiration in men with unreconstructable obstructions now exceed 50%. For nonobstructive azoospermia, testicular sperm can be retrieved in almost half of such men, even those with small testes and elevated follicle-stimulating hormone (FSH) levels. Testicular biopsy, previously performed only in men with normal testis volumes and normal FSH levels, is now indicated in all azoospermic men. Furthermore, testis biopsy is frequently both a diagnostic and therapeutic procedure. Any sperm retrieved at the time of diagnostic biopsy can either immediately be used for IVF with ICSI or cryopreserved for future use. Microsurgical varicocelectomy has resulted in return of sperm to the ejaculate in 50% of azoospermic men with testicular failure in previously hopeless cases. The discovery of Y chromosome microdeletions in men with nonobstructive azoospermia and cystic fibrosis gene mutations in men with congenital absence of the vas deferens has made genetic evaluation an essential part of the male infertility evaluation. Varicocele, long known to be associated with male infertility, has now clearly been shown to result in progressive, duration-dependent testicular injury. Surgical repair of varicocele previously was reserved for men already infertile. However, early repair of varicocele in adolescents using safer, more effective surgical techniques is helping urologists prevent future infertility. Many of the procedures described in this Atlas are among the most technically demanding in all of urology. This section provides a detailed, cutting-edge manual of diagnostic and therapeutic techniques in male infertility surgery.

About the Author:

E. Darracott Vaughan, Jr., MD
Professor Department of Urology
Joan and Sanford I. Weill Medical College
Graduate School of Medical Sciences of Cornell University
James J. Colt Professor and Chairman Department of Urology
New York Presbyterian Hospital New York, New York
Aaron P. Perlmutter, MD, PhD
Assistant Professorm Department of Urology
Joan and Sanford I. Weill Medical College
Graduate School of Medical Sciences of Cornell University
Assistant Attending Urologist New York Presbyterian Hospital New York, New York

Tom F. Lue, MD
Professor Department of Urology
University of California, San Francisco
Chief of Urology Mt. Zion Hospital San Francisco, California

Marc Goldstein, MD
Professor Department of Urology
Joan and Sanford I. Weill Medical College
Assistant Professorm Department of Urology
Graduate School of Medical Sciences of Cornell University
Director, Center for Male Reproductive Medicine and Microsurgery
Department of Urology New York Presbyterian Hospital
Staff Scientist Center for Biomedical Research, The Population Council New York, New York

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