OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Urology Third edition Published and upcoming Oxford Handbooks Oxford Handbook for the Oxford Handbook of Genitourinary Foundation Program 3e Oxford Handbook of Acute Medicine, HIV and AIDS 2e Oxford Handbook of Geriatric Medicine 3e Medicine Oxford Handbook of Anesthesia 3e Oxford Handbook of Applied Oxford Handbook of Infectious Diseases and Microbiology Oxford Handbook of Key Clinical Dental Sciences Oxford Handbook of Cardiology 2e Oxford Handbook of Clinical and Laboratory Investigation 3 e Oxford Handbook of Clinical Evidence Oxford Handbook of Medical Dermatology Oxford Handbook of Medical Dentistry 5e Imaging Oxford Handbook of Clinical Oxford Handbook of Medical Diagnosis 2e Sciences 2e Oxford Handbook of Clinical Oxford Handbook of Medical Examination and Practical Skills Statistics Oxford Handbook of Clinical Oxford Handbook of Nephrology Hematology 3e and Hypertension Oxford Handbook of Clinical Immunology and Allergy 3e Oxford Handbook of Clinical Medicine - Mini Edition 8e Oxford Handbook of Clinical Oxford Handbook of Neurology Oxford Handbook of Nutrition and Dietetics 2e Oxford Handbook of Obstetrics and Gynecology 2e Medicine 8e Oxford Handbook of Occupational Oxford Handbook of Clinical Health 2e Pathology Oxford Handbook of Oncology 3e Oxford Handbook of Ophthalmology 2e Oxford Handbook of Clinical Drugstore 2e Oxford Handbook of Clinical Oxford Handbook of Oral and Rehabilitation 2e Maxillofacial Surgery Oxford Handbook of Clinical Oxford Handbook of Pediatrics 2e Oxford Handbook of Pain Specialties 9e Oxford Handbook of Clinical Management Surgery 4e Oxford Handbook of Palliative Oxford Handbook of Care 2e Complementary Medicine Oxford Handbook of Practical Drug Oxford Handbook of Critical Care 3e Oxford Handbook of Dental Patient Therapy 2e Oxford Handbook of Pre-Hospital Care 2e Care Oxford Handbook of Dialysis 3e Oxford Handbook of Emergency Oxford Handbook of Psychiatry 3e Oxford Handbook of Public Health Medicine 4e Practice 2e Oxford Handbook of Endocrinology Oxford Handbook of Reproductive and Diabetes 2e Medicine & Family Planning Oxford Handbook of Respiratory Oxford Handbook of ENT and Head and Neck Surgery Medicine 2e Oxford Handbook of Epidemiology Oxford Handbook of Rheumatology 3e for Clinicians Oxford Handbook of Expedition and Oxford Handbook of Sport and Wilderness Medicine Exercise Medicine Oxford Handbook of Oxford Handbook of Tropical Gastroenterology & Hepatology 2e Medicine 3e Oxford Handbook of General Oxford Handbook of Urology 3e Practice 3e Oxford Handbook of Genetics Oxford Handbook of Urology Third edition John Reynard Consultant Urological Surgeon Nuf \201 eld Department of Surgical Sciences Ox ford University Hospitals Oxford, UK and Honorary Consultant Urologist to the National Spin al Injuries Center Stoke Mandeville Hospital Aylesbury, UK Simon Brewster Consultant Urological Surgeon Nuf \201 eld Department of Surgical Sciences Oxford University Hospitals Oxford, UK Suzanne Biers Consultant Urological Surgeon Addenbrooke \200\231s Hospital Cambridge Univer sity Hospitals Cambridge, UK 1 3 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the Univer sity \200\231s objective of excellence in research, scholarship, and education by publishin g worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Oxford University Press, 2013 The moral rights of the author have been asserted First edition published 2005 Second edition published 2009 Third edition published 2013 All rights reserved. No part of this publication may be reproduced, stored in a retrieval s ystem, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with t he appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, a t the address above You must not circulate this book in any other binding or cover and you must impose the same condition on any acquirer British Library Cataloging in Publication Data Data available ISBN 978 \200\2230 \200\22319 \200\223969613 \200\2230 ( \202 exicover: alk.paper) Printed in China by C&C Offset Printing Co. Ltd. Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and c linical procedures with the most up-to-date published product information and data sheets p rovided by the manufacturers and the most recent codes of conduct and safety regulations. T he authors and the publishers do not accept responsibility or legal liability for any error s in the text or for the misuse or misapplication of material in this work. Except where ot herwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding. v Acknowledgements The authors would like to express their gratitude to Dr Andrew Protheroe, medical oncologis t at the Churchill Hospital, Oxford, Professor Nick Watkin, urological surgeon, and Dr Huss ain Alnajjar, research fellow, both at St George \200\231s Hospital, London, for kindly rea ding and commenting on parts of the manuscript. They would also like to thank Mr Padraig Ma lone, Mr Marcus Drake, and Mr Rowland Rees, who gave freely of their time and expertise. This page intentionally left blank vii Contents Detailed contents viii Symbols and Abbreviations xix 1 General principles of management of patients 2 Signi \201 cance and preliminary investig ation 1 of urological symptoms and signs 7 3 Urological investigations 37 4 Bladder outlet obstruction 71 5 Incontinence and female urology 127 6 Infections and in \202 ammatory conditions 175 7 Urological neoplasia 235 8 Miscellaneous urological disease of the kidney 395 9 Stone disease 427 10 Upper tract obstr uction, loin pain, hydronephrosis 491 11 Trauma to the urinary tract and other urological emergencies 505 551 567 603 639 645 697 793 815 12 Infertility 13 Sexual health 14 Neuropathic bladder 15 Urological problems in pregnancy 16 Pediatric urology 17 Urological surgery and equipment 18 Basic science and renal transpl ant 19 Urological eponyms Index 820 viii Detailed contents Symbols and Abbreviations xix 1 General principles of management of patients 1 Communication skills 2 Documentation and note keeping 4 Patient safety in surgical practice 6 2 Signi \201 cance and preliminary investigation of urological symptoms and signs 7 Haematuria I: de \201 nition and types 8 Haematuria II: causes and investigation 10 Haemos permia 14 Lower urinary tract symptoms (LUTS) 16 Nocturia and nocturnal polyuria 18 Loin ( \202 ank) pain 20 Urinary incontinence 24 Genital symptoms 26 Abdominal examination in urological disease 28 Digital rectal examination (DRE) 30 Lumps in the groin 32 Lumps in the scrotum 34 3 Urological investigations 37 Assessing kidney function 38 Urine examination 40 Urine cytology 42 Prostatic-speci \201 c antigen (PSA) 43 Radiological imaging of the urinary tract 44 Uses of plain abdominal radiography (the \200\230KUB \200\231 X-ray \200\224kidneys, ureters, bladder) 46 Intravenous urography (IVU) 48 Other urological contrast studies 52 Computed tomography (CT) and magnetic resonance imaging (MRI) 54 DETAILED CONTENTS ix Radioisotope imaging 60 Uro \202 owmetry 62 Post-void residual urine volume measurement 66 Cystometry, pressure \202 ow studies, and videocystometry 68 4 Bladder outlet obstruction 71 Regulation of prostate growth and development of benign prostatic hyperplasia (BPH) 72 Pathophysiology and causes of bladder outlet obstruction (BOO) and BPH 73 Benign prostatic obstruction (BPO): symptoms and signs 74 Diagnostic tests in men with LUTS thought to be due to BPH 76 The management of LUTS in men: NICE 2010 Guidelines 78 Watchful waiting for uncomplicated B PH 84 Medical management of BPH: alpha blockers 86 Medical management of BPH: 5 -reductase inhibitors 88 Medical management of BPH: combination therapy 90 Medical management of BPH: alternative drug therapy 92 Minimally invasive management of BPH: surgical alternatives to TURP 94 Invasive surgical alternatives to TURP 96 TURP and open prostatectomy 100 Acute urinary retention: de \201 nition, pathophysiology, and causes 102 Acute urinary retention: initial and de \201 nitive management 106 Indications for and technique of urethral catheterization 108 Technique of suprapubic catheterization 110 Management of nocturia and nocturnal polyuria 116 Chronic retention 118 High-pressure chronic retention (HPCR) 120 Bladder outlet obstruction and retention in women 122 Urethral strictures and stenoses 124 5 Incontinence and female urology 127 Incontinence: classi \201 cation 128 Incontinence: causes and pathophysiology 130 DETAILED CONTENTS x Incontinence: evaluation 132 Stress and mixed urinary incontinence 136 Surgery for stress i ncontinence: injection therapy 138 Surgery for stress incontinence: retropubic suspension 1 40 Surgery for stress incontinence: suburethral tapes and slings 142 Surgery for stress incontinence: arti \201 cial urinary sphincter 146 Overactive bladder: conservative and medical treatments 148 Overactive bladder: options for failed conventional therapy 150 Overactive bladder: intravesical botulinum toxin-A therapy 152 Post-prostatect omy incontinence 154 Vesicovaginal \201 stula (VVF) 156 Incontinence in elderly patients 158 Management pathways for urinary incontinence 160 Initial management of urinary incontin ence in women 161 Specialized management of urinary incontinence in women 162 Initial manag ement of urinary incontinence in men 163 Specialized management of urinary incontinence in men 163 Management of urinary incontinence in frail older persons 164 Female urethral diverticulum (UD) 166 Pelvic organ prolapse (POP) 170 6 Infections and in \202 ammatory conditions 175 Urinary tract infection: de \201 nitions and epidemiology 176 Urinary tract infection: microbiology 178 Lower urinary tract infection: cystitis and investigation of UTI 182 Urinary tract infection: general treatment guidelines 184 Recurrent urinary tract infection 186 Upper urinary tract infection: acute pyelonephritis 190 Pyonephrosis and perinephric abscess 192 Other forms of pyelonephritis 194 Chronic pyelonephritis 196 Septicaemia 198 Fournier \200\231s gangrene 202 Peri-urethral abscess 204 DETAILED CONTENTS xi Epididymitis and orchitis 206 Prostatitis: classi \201 cation and pathophysiology 208 Bact erial prostatitis 210 Chronic pelvic pain syndrome 212 Bladder pain syndrome (BPS) 214 Urological problems from ketamine misuse 218 Genitourinary tuberculosis 220 Parasitic infections 222 HIV in urological surgery 226 Phimosis 228 In \202 ammatory disorders of the penis 230 7 Urological neoplasia 235 Basic pathology and molecular biology 236 Wilms \200\231 tumor and neuroblastoma 238 Radiol ogical assessment of renal masses 242 Benign renal masses 244 Renal cell carcinoma: patholo gy, staging, and prognosis 246 Renal cell carcinoma: epidemiology and etiology 250 Renal cell carcinoma: presentation and investigation 252 Renal cell carcinoma (localized): surgical treatment I 254 Renal cell carcinoma: surgical treatment II and non-surgical alternatives for localized disease 256 Renal cell carcinoma: management of metastatic disease 258 Upper urinary tract transitional cell carcinoma (UUT-TCC) 260 Bladder cancer: epidemiology and etiology 264 Bladder cancer: pathology, grading, and staging 266 Bladder cancer: clinical presentation 270 Bladder cancer: haematuria, diagnosis, and transurethral resection of bladder tumor (TURBT) 272 Bladder cancer (non-muscle invasive TCC): surgery and recurrence 276 Bladder cancer (non-mu scle invasive TCC): adjuvant treatment 280 Bladder cancer (muscle-invasive): staging and surgical management of localized (pT2/3a) disease 282 Bladder cancer (muscle-invasive): radical radiotherapy and palliative treatment 286 DETAILED CONTENTS xii Bladder cancer: management of locally advanced and metastatic disease 288 Bladder cancer: urinary diversion after cystectomy 290 Prostate cancer: epidemiology and et iology 294 Prostate cancer: incidence, prevalence, mortality, and survival 296 Prostate cancer: preven tion 298 Prostate cancer: pathology of adenocarcinoma 302 Prostate cancer: grading 304 Pros tate cancer: staging and imaging 306 Prostate cancer: clinical presentation 315 Prostate ca ncer: screening 316 Prostate cancer: prostate-speci \201 c antigen (PSA) 318 Prostate canc er \200\224PSA derivatives and kinetics: free-to-total, density, velocity, and doubling time 320 Prostate cancer: counseling before PSA testing 322 Prostate cancer: other diagnostic marker s 324 Prostate cancer: transrectal ultrasonography and biopsy 326 Prostate cancer: suspicio us lesions 330 Prostate cancer: general considerations before treatment (modi \201 ed from the 2008 UK NICE Guidance) 331 Prostate cancer: watchful waiting and active surveillance 332 Prostate cancer: radical prostatectomy and pelvic lymphadenectomy 334 Prostate cancer \200\224radical prostatectomy: post-operative care and complications 338 Prostate cancer: oncological outcomes of radical prostatectomy 340 Prostate cancer: radical external beam radiotherapy (EBRT) 344 Prostate cancer: brachytherapy (BT) 346 Prostate cancer (minimally invasive management of localized and radio-recurrent prostate cancer): cryotherapy, high-intensity focused ultrasound, and photodynamic therapy 348 Prostate cancer: management of locally advanced non-metastatic disease (T3 \200\2234 N0M0) 350 Prostate cancer: management of advanced disease \200\224hormone therapy I 352 DETAILED CONTENTS xiii Prostate cancer: management of advanced disease \200\224hormone therapy II 354 Prostate cancer: management of advanced disease \200\224hormone therapy III 356 Prostate cancer: management of advanced disease \200\224 castrate-resistant prostate cancer (CRPC) 358 Prostate cancer: management of advanced disease \200\224 palliative care 362 Urethral cancer 364 Penile neoplasia: benign, viral-related, and premal ignant lesions 368 Penile cancer: epidemiology, risk factors, and pathology 370 Penile canc er: clinical management 374 Scrotal and paratesticular tumors 377 Testicular cancer: incide nce, mortality, epidemiology, and etiology 378 Testicular cancer: pathology and staging 380 Testicular cancer: clinical presentation, inve stigation, and primary treatment 384 Testicular cancer: serum markers 386 Testicular cancer: prognostic staging system for metastatic germ cell tumors (GCT) 388 Testicular cancer: management of non-seminomatous germ cell tumors (NSGCT) 390 Testicular cancer: management of seminoma, IGCN, and lymphoma 392 8 Miscellaneous urological disease of the kidney 395 Simple and complex renal cysts 396 Calyceal diverticulum 399 Medullary sponge kidney (MSK) 400 Acquired renal cystic disease (ARCD) 402 Autosomal dominant polycystic kidney disease (ADPKD) 404 Vesicoureteric re \202 ux in adults 408 Pelviureteric junction obstruction in adults 412 Anomalies of renal fusion and ascent: hors eshoe kidney, ectopic kidney 416 DETAILED CONTENTS xiv Anomalies of renal number and rotation: renal agenesis and malrotation 420 Upper urinary tract duplication 422 9 Stone disease 427 Kidney stones: epidemiology 428 Kidney stones: types and predisposing factors 432 Kidney st ones: mechanisms of formation 434 Factors predisposing to speci \201 c stone types 436 Eva luation of the stone former 440 Kidney stones: presentation and diagnosis 442 Kidney stone treatment options: watchful waiting and the natural history of stones 444 Stone fragmentation techniques: extracorporeal lithotripsy (ESWL) 446 Intracorporeal techniques of stone fragmentation 450 Flexible ureteroscopy and laser treatm ent 454 Kidney stone treatment: percutaneous nephrolithotomy (PCNL) 456 Kidney stones: open stone surgery 462 Kidney stones: medical therapy (dissolution therapy) 464 Ureteric stones: presentation 466 Ureteric stones: diagnostic radiological imaging 468 Ureteric stones: acute management 470 Ureteric stones: indications for intervention to relieve obstruction and/or remove the stone 472 Ureteric stone treatment 476 Treatment options for ureteric stones 478 Prevention of calcium oxalate stone formation 482 Bladder stones 486 Management of ureteric stones in pregnancy 488 10 Upper tract obstruction, loin pain, hydronephrosis 491 Hydronephrosis 492 Management of ureteric strictures (other than PUJO) 496 Pathophysiology of urinary tract ob struction 498 DETAILED CONTENTS xv Physiology of urine \202 ow from kidneys to bladder 499 Ureter innervation 500 Retroperit oneal \201 brosis 502 11 Trauma to the urinary tract and other urological emergencies 505 Initial resuscitation of the traumatized patient 506 Renal trauma: classi \201 cation, mec hanism, grading 508 Renal trauma: clinical and radiological assessment 512 Renal trauma: tr eatment 516 Ureteric injuries: mechanisms and diagnosis 520 Ureteric injuries: management 5 22 Pelvic fractures: bladder and ureteric injuries 526 Bladder injuries 532 Posterior ureth ral injuries in males and urethral injuries in females 535 Anterior urethral injuries 536 Testicular injuries 540 Penile injuries 542 Torsion of the t estis and testicular appendages 544 Paraphimosis 545 Malignant ureteric obstruction 546 Spinal cord and cauda equina compression 548 12 Infertility 551 Male reproductive physiology 552 Etiology and evaluation of male infertility 554 Investigation of male infertility 556 Oligozoospermia and azoospermia 560 Varicocele 562 Treatment options for male infertility 564 13 Sexual health 567 Physiology of erection and ejaculation 568 Erectile dysfunction: evaluation 572 Erectile dysfunction: treatment 576 DETAILED CONTENTS xvi Peyronie \200\231s disease 580 Priapism 584 Retrograde ejaculation 588 Premature ejaculatio n 590 Other disorders of ejaculation and orgasm 592 Late-onset hypogonadism (LOH) 594 Hypogonadis m and male hormone replacement therapy 596 Urethritis 600 Non-speci \201 c urethritis and urethral syndrome 602 14 Neuropathic bladder 603 Innervation of the lower urinary tract (LUT) 604 The physiology of urine storage and mictur ition 608 Bladder and sphincter behavior in the patient with neurological disease 610 The neuropathic lower urinary tract: clinical consequences of storage and emptying problems 612 Bladder management techniques for the neuropathic patient 614 Catheters and sheaths and the neuropathic patient 622 Management of incontinence in the neu ropathic patient 624 Management of recurrent urinary tract infections (UTIs) in the neuropathic patient 628 Management of hydronephrosis in the neuropathic patient 630 Bladder dysfunction in multiple sclerosis, Parkinson \200\231s disease, spina bi \201 da, after stroke, and in other neurological disease 632 Neuromodulation in neuropathic and non-neuropathic lower urinary tract dysfunction 636 15 Urological problems in pregnancy 639 Physiological and anatomical changes in the urinary tract 640 Urinary tract infection (UTI) 642 Hydronephrosis of pregnancy 644 16 Pediatric urology 645 Embryology: urinary tract 646 Embryology: genital tract 648 Undescended testes (UDT) 650 DETAILED CONTENTS xvii Urinary tract infection (UTI) 654 Antenatal hydronephrosis 658 Vesicoureteric re \202 ux ( VUR) 662 Megaureter 666 Ectopic ureter 668 Ureterocele 670 Pelviureteric junction (PUJ) obstruction 672 Posterior u rethral valves (PUV) 674 Cystic kidney disease 676 Hypospadias 678 Disorders of sex develop ment 682 Exstrophy \200\223epispadias complex 688 Primary epispadias 690 Urinary incontinen ce in children 692 Nocturnal enuresis 694 17 Urological surgery and equipment 697 Preparation of the patient for urological surgery 698 Antibiotic prophylaxis in urological surgery 702 Complications of surgery in general: DVT a nd PE 706 Fluid balance and the management of shock in the surgical patient 710 Patient safety in the urology theater 712 Transurethral resection (TUR) syndrome 713 Catheters and drains in urological surgery 714 Guidewires 720 Irrigating \202 uids and techniques of bladder washout 722 JJ stents 724 Lasers in urological surgery 730 Diathermy 732 Sterilization of urological equipment 736 Telescopes and light sources in urological endoscopy 738 Consent: general principles 740 Cystoscopy 742 Transurethral resection of the prostate (TURP) 744 Transurethral resection of bladder tumor (TURBT) 746 DETAILED CONTENTS xviii Optical urethrotomy 748 Circumcision 750 Hydrocele and epididymal cyst removal 752 Nesbit \200\231s procedure 754 Vasectomy and vasovasostomy 756 Orchidectomy 758 Urological incisions 760 JJ stent insertio n 762 Nephrectomy and nephro-ureterectomy 764 Radical prostatectomy 766 Radical cystectomy 768 Ileal conduit 772 Percutaneous nephrolithotomy (PCNL) 774 Ureteroscopes and ureteroscop y 778 Pyeloplasty 782 Laparoscopic surgery 784 Endoscopic cystolitholapaxy and (open) cysto lithotomy 786 Scrotal exploration for torsion and orchidopexy 788 Electromotive drug administration (EMDA) 790 18 Basic science and renal transplant 793 Basic physiology of bladder and urethra 794 Basic renal anatomy 796 Renal physiology: glomerular \201 ltration and regulation of renal blood \202 ow 800 Renal physiology: regulation of water balance 802 Renal physiology: regulation of sodium and potassium excretion 803 Renal physiology: acid \200\223base balance 804 Renal replacement therapy 806 Renal transplant: recipient 808 Renal transplant: donor 810 Transplant surgery and complications 812 19 Urological eponyms 815 Index 820 xix Symbols and Abbreviations > < (cid:2) (cid:3) % C d i b 7 AAA AAOS AAST AAT ACCP ACE ACh ACR ACTH ADH ADT ADPKD AFP AHR AI AID AIDS a.m. AMACR AML amp AMS ANP registered trademark more than less than equal to or greater than equal to or less than per cent degree Celsius decreased increased cross-reference approximately alpha beta abdominal aortic aneurysm American Academy of Orthopedic Surgeons American Association for the Surger y of Trauma androgen ablation therapy American College of Chest Physicians angiotensin-conv erting enzyme acetylcholine albumin:creatinine ratio or acute cellular rejection adrenocort icotrophic hormone antidiuretic hormone androgen deprivation therapy autosomal dominant pol ycystic kidney disease alpha-fetoprotein acute humoral rejection androgen-independent arti \201 cial insemination donor acquired immunode \201 ciency syndrome ante meridiem (before noon) -methylacyl CoA racemase angiomyolipoma ampere American Medical Systems atrial nat riuretic peptide SYMBOLS AND ABBREVIATIONS xx a-NVH APD APF 5AR ARCD 5ARI ARPKD ART AS ASAP ASTRO ATG ATN ATP AUA AUA-SI AUR AUS AVM BAUS BCG BCR bd bFGF BHCG BLI BMI BMSFI BNI BOO BP BPE bPFS BPH BPLND BPO BPS BSE BT BTA BTX-A asymptomatic non-visible haematuria automated peritoneal dialysis antiproliferative factor 5 -reductase acquired renal cystic disease 5 -reductase inhibitor autosomal recessive pol ycystic kidney disease assisted reproductive techniques active surveillance atypical small acinar proliferation American Society of Therapeutic Radiation Oncologists antithymocyte gl obulin acute tubular necrosis adenosine triphosphate American Urological Association Americ an Urological Association Symptom Index acute urinary retention arti \201 cial urinary sph incter arteriovenous malformation British Association of Urological Surgeons bacillus Calme tte \200\223Gu rin bulbocavernosus re \202 ex bis die (twice daily) basic \201 broblast ic growth factor beta human chorionic gonadotrophin beta-lactamase inhibitor body mass inde x Brief Male Sexual Function Inventory bladder neck incision bladder outlet obstruction blo od pressure benign prostatic enlargement biochemical progression-free survival benign prost atic hyperplasia bilateral pelvic lymphadenectomy benign prostatic obstruction bladder pain syndrome bovine spongiform encephalopathy brachytherapy bladder tumor antigen botulinum to xin-A SYMBOLS AND ABBREVIATIONS xxi BUO BXO CAA CABG CAH CAIS cAMP CAPD CBAVD CCF CCr CD CEULDCT CFU cGMP CI CIRF CJD CIS CISC CKD cm CMV CNI CNS CO2 COPD COPUM CP CPA CPB CPPS CPRE Cr CRF CRP CRPC CSS CT CTPA CTU bilateral ureteric obstruction balanitis xerotica obliterans Civil Aviation Authority coron ary artery bypass graft congenital adrenal hyperplasia complete androgen insensitivity synd rome cyclic adenosine monophosphate continuous ambulatory peritoneal dialysis complete bila teral absence of vas deferens congestive cardiac failure creatinine clearance collecting du ct contrast-enhanced ultra-low dose computed tomography colony-forming unit cyclic guanosin e monophosphate con \201 dence interval clinically insigni \201 cant residual fragment Cr eutzfeldt \200\223Jakob disease carcinoma in situ clean intermittent self catheterization c hronic kidney disease centimeter cytomegalovirus calcineurin inhibitor central nervous syst em carbon dioxide chronic obstructive pulmonary disease congenital obstructive posterior ur ethral membrane chronic prostatitis cyproterone acetate chronic painful bladder (syndrome) chronic pelvic pain syndrome complete primary repair of bladder exstrophy creatinine chroni c renal failure C-reactive protein castrate-resistant prostate cancer cancer-speci \201 c survival computed tomography or collecting tubule computerized tomography pulmonary angiogr aphy computed tomography urography SYMBOLS AND ABBREVIATIONS xxii CT-KUB CVA CXR Da DCT DE DESD DEXA DGI DH DHT DI DIC dL DMSA DMSO DNA DRE DSD CT of the kidneys, ureters, and bladder cerebrovascular accident chest X-ray Dalton distal convoluted tubule delayed ejaculation detrusor-external sphincter dyssynergia dual-energy X -ray absorptiometry (scan) disseminated gonococcal infection detrusor hyperre \202 exia di hyrotestosterone diabetes insipidus disseminated intravascular coagulation decilitre dimerc apto-succinic acid (renogram) dimethyl sulphoxide deoxyribonucleic acid digital rectal exam ination detrusor sphincter dyssynergia or disorders of sex development Drivers Vehicle Lice nsing Agency deep vein thrombosis European Association of Urology external beam radiotherap y Epstein \200\223Barr virus extracellular \202 uid electrocardiogram erectile dysfunctio n ethylene diamine tetra-acetic acid exempli gratia (for example) epidermal growth factor e stimated glomerular \201 ltration rate electrohydraulic lithotripsy enzyme immunoassay en zyme-linked immunosorbant assay electromotive drug administration electromyography early mo rning urine extended pelvic lymphadenectomy emphysematous pyelonephritis European Organizat ion for Research and Treatment of Cancer DVLA DVT EAU EBRT EBV ECF ECG ED EDTA e.g. EGF eGFR EHL EIA ELISA EMDA EMG EMU EPLND EPN EO RTC SYMBOLS AND ABBREVIATIONS xxiii EPS ER ESBL ESR ESSIC expressed prostatic secretions extended release extended spectrum B-lactamase erythrocyte s edimentation rate European Society for the Study of Bladder Pain Syndrome/Interstitial Cyst itis extracorporeal shock wave therapy et cetera full blood count Fournier \200\231s gangre ne severity index \201 ne needle aspiration follicle stimulating hormone foot/feet freque ncy volume chart gram general anesthetic G-aminobutyric acid glycosaminoglycan germ cell tu mor glomerular \201 ltration rate gastrointestinal gamete intrafallopian transfer Greek g onadotrophin-releasing hormone general practitioner glyceryl trinitrate gonococcal urethrit is (or genitourinary) genitourinary medicine gray hour hydrogen ion hexaminolevulinic acid hemoglobin human chorionic gonadotrophin bicarbonate ion high-dose rate high-intensity focu sed ultrasound hypoxia-inducible factor human immunode \201 ciency virus human leucocyte a ntigen 3-hydroxy-3-methyl-glutaryl-CoA reductase 5-hydroxymethyl tolterodine ESWL etc FBC FGSI FNA FSH ft FVC g GA GABA GAG GCT GFR GI GIFT Gk GnRH GP GTN GU GUM Gy h H + HAL Hb HCG HCO3 HDR HIFU HIF HIV HLA HMG-CoA 5-HMT SYMBOLS AND ABBREVIATIONS xxiv HPCR HPF H2O HO HoLAP HoLEP HoLRP HPA 2 \200\223 HPO4 \200\223 H2PO4 HPV HRO HRP HTLA Hz I C ICD i.e. IFIS ISC ICF ICS ICSI ICU IDC IDO IELT IFN Ig IGCN IGF IIEF IL ILP IM INR IPC IP SS ISC ISD ISF high pressure chronic retention high-powered \201 eld water house of \201 cer holmium la ser ablation of the prostate holmium laser enucleation of the prostate holmium laser resect ion of the prostate Health Protection Agency phosphate ion phosphoric acid human papilloma virus high reliability organization horseradish peroxidise human T lymphotropic virus Hertz intermittent catheterization or interstitial cystitis implantable cardioverter de \201 br illator id est (that is) intraoperative \202 oppy iris syndrome intermittent catheterizat ion intracellular \202 uid International Continence Society intracytoplasmic sperm inject ion intensive care unit indwelling catheter idiopathic detrusor overactivity intravaginal e jaculatory latency time interferon immunoglobulin intratubular germ cell neoplasia insulin- like growth factor International Index of Erectile Function interleukin interstitial laser prostatectomy intramuscular international normalized ratio intermittent pneumatic calf comp ression International Prostate Symptom Score intermittent self-catheterization intrinsic sp hincter de \201 ciency interstitial \202 uid SYMBOLS AND ABBREVIATIONS xxv ISSM ITU IU IUI IV IVC IVF IVP IVU J JGA K+ kcal kD/kDa Kf kg KGF kHz kJ kPa Ksp KTP KUB L LA LDH LDL LDR LDUH LFT LH LHRH LMWH LNI LoH LOH LRP LSD LUT LUTS m International Society for Sexual Medicine intensive treatment unit international unit intra uterine insemination intravenous inferior vena cava in vitro fertilization intravenous pyel ography intravenous urography Joule juxtaglomerular apparatus potassium kilocalorie kilodal ton formation product kilogram keratinocyte growth factor kilohertz kilojoule kilopascal so lubility product potassium titanyl phosphate (laser) Kidneys, ureter and bladder (X-ray) li ter local anesthetic lactate dehydrogenase low density lipid low-dose rate low-dose unfract ionated heparin liver function test luteinizing hormone luteinizing hormone-releasing hormo ne low molecular weight heparin lymph node invasion Loop of Henle late-onset hypogonadism l aparoscopic radical prostatectomy lysergic acid diethylamide lower urinary tract lower urin ary tract symptom meter SYMBOLS AND ABBREVIATIONS xxvi mA A MAB MAG3 MAGPI MAPP MAPS MAR MCDK mcg MCUG MDCTU MDP MDRD mEq MESA MET mg mGy MHC MH z MI MIBG min MIS MIT mL MMC mmol MNE mo mOsm MPA MPOA MPR MRCoNS MRI mRNA MRSA MSMB MRU milliampere microampere maximal androgen blockade mercaptoacetyl-triglycyine (renogram) mea tal advancement and granuloplasty Multidisciplinary Approach to Pelvic Pain Men After Prost ate Surgery (study) mixed antiglobulin reaction (test) multicystic dysplastic kidney microg ram micturating cystourethrography multidetector CT urography methylene diphosphonate modi \201 cation of diet in renal disease milliequivalent microsurgical epididymal sperm aspira tion medical expulsive therapy milligram milligray major histocompatibility complex megaher tz myocardial infarction meta-iodo-benzyl-guanidine minute M llerian inhibiting substance minimally invasive treatment milliliter mitomycin C millimole monosymptomatic nocturnal enu resis month milliosmole mycophenolate medial preoptic area multiplanar reformatting methici llin-resistant coagulase-negative staphylococci magnetic resonance imaging messenger ribonu cleic acid meticillin-resistant staphylococcus aureus microseminoprotein-beta magnetic reso nance urography SYMBOLS AND ABBREVIATIONS xxvii MS MSA MSK MSU mSV MUCP MUI MUSE MVAC Na+ NA NAAT NaCl NAION NB NBI NDO NE ng NGU NICE NIDD K multiple sclerosis multisystem atrophy medullary sponge kidney mid-stream urine milliSevert maximal urethral closure pressure mixed urinary incontinence Medicated Urethral System for Erection methotrexate, vinblastine, adriamycin, cisplatin sodium noradrenaline nucleic aci d ampli \201 cation test sodium chloride non-arteritic anterior ischaemic optic nerve neur opathy nota bene (take note) narrow-band imaging neurogenic detrusor overactivity nocturnal enuresis nanogram non-gonococcal urethritis National Institute for Health and Clinical Exc ellence National Institute of Diabetes and Digestive and Kidney Diseases National Institute of Health National Institute of Health Chronic Prostatitis Symptom Index nanometer non-mon osymptomatic nocturnal enuresis nanomole nuclear matrix protein number needed to detect num ber needed to treat nitric oxide nocturnal polyuria non-steroidal anti-in \202 ammatory dr ug non-seminomatous germ cell tumors non-speci \201 c urethritis non-visible haematuria om ni die (once daily) overactive bladder oligoasthenoteratospermia onlay island \202 ap NIH NIH-CPSI nm NMNE nmol NMP NND NNT NO NP NSAID NSGCT NSU NVH od OAB OAT OIF SYMBOLS AND ABBREVIATIONS xxviii OLND OP OSA Pabd PAOD PaCO2 PaO2 PAG PAIS PBS/IC PC PCNL PCO2 PCR PCT PD PDD PDE5 Pdet PDGF PDT PE PEC PEP PESA PET PFMT PFS PGE1 PGF2 PIN PLAP PLESS PMC PMNL PN PNE PO PO2 POP POPQ PPS obturator lymphadenectomy open prostatectomy obstructive sleep apnoea intra-abdominal press ure peripheral artery occlusive disease partial pressure of carbon dioxide (in arterial blo od) partial pressure of oxygen (in arterial blood) periaqueductal gray matter Partial andro gen insensitivity syndrome painful bladder syndrome/interstitial cystitis prostate cancer p ercutaneous nephrolithotomy carbon dioxide tension polymerase chain reaction proximal convo luted tubule Parkinson \200\231s disease photodynamic detection phosphodiesterase type-5 de trusor pressure platelet-derived growth factor photodynamic therapy premature ejaculation o r pulmonary embolism perivascular epithelioid cell post-exposure prophylaxis percutaneous e pididymal sperm aspiration positron emission tomography pelvic \202 oor muscle training p ressure \202 ow studies prostaglandin E1 prostaglandin F2 prostatic intraepithelial neopl asia placental alkaline phosphatase Proscar Long-term Ef \201 cacy Safety Study pontine mi cturition center polymorphonuclear leukocytes partial nephrectomy peripheral nerve evaluati on orally (per os) oxygen tension pelvic organ prolapse pelvic organ prolapse quanti \201 cation pentosan polysulphate sodium SYMBOLS AND ABBREVIATIONS xxix PR PREDICT PRP PSA PTFE PTH PTN PTTI PTNS PUJ PUJO PUNLMP PUV PVD Pves PVN PVN PVP PVR QALY qds Qmax QoL RBC RBF RCC RCT RFA RI RNA RP RPD RPF RPLND RPR RR RT RTA RTK s SARS SC pulse rate Prospective European Doxazosin and Combination Therapy prion protein prostate sp eci \201 c antigen polytetra \202 uoroethylene parathyroid hormone levels posterior tibia l nerve parenchymal transit time index posterior tibial nerve stimulation pelviureteric jun ction pelviureteric junction obstruction papillary urothelial neoplasm of low malignant pot ential posterior urethral valves peripheral vascular disease intravesical pressuer paravent ricular nucleus peripheral vascular disease photoselective vaporization of the prostate pos t-void residual quality-adjusted life year fourth die sumendus (to be taken 4 times per day ) maximal \202 ow rate quality of life red blood count renal blood \202 ow renal cell c arcinoma randomized control trial radiofrequency ablation resistive index ribonucleic acid radical prostatectomy renal pelvis diameter retroperitoneal \201 brosis or renal plasma \202 ow retroperitoneal lymph node dissection rapid plasma regain respiratory rate radioth erapy renal tubular acidosis receptor tyrosine kinase second sacral anterior root stimulato r subcutaneous SYMBOLS AND ABBREVIATIONS xxx SCC SCI SCr SEM SHBG SHIM SHO SIRS SL SLE SNAP SNM SNS s-NVH SOP SPC SpR SRE SSRI ssRNA STD STI SUI TAL TB TBW TC TCC tds TEAP TEDs TENS TESA TESE TET TGF TIN TIP TNF TNM TOT squamous cell carcinoma spinal cord injury serum creatinine standard error of the mean sex hormone binding globulin Sexual Health Inventory for Men senior house of \201 cer systemic in \202 ammatory response syndrome sublingual systemic lupus erythematosus synaptosomal a ssociated protein sacral nerve modulation sacral nerve stimulation symptomatic non-visible haematuria standard operating procedures suprapubic catheter specialist registrar skeletal- related events serotonin reuptake inhibitor single-stranded ribonucleic acid sexually trans mitted disease sexually transmitted infection stress urinary incontinence thick ascending l imb (of Loop of Henle) tuberculosis total body water testicular cancer transitional cell ca rcinoma ter die sumendus (to be taken 3 times per day) transurethral ethanol ablation of th e prostate thromboembolic deterrent stockings transcutaneous electrical nerve stimulation t esticular exploration and sperm aspiration testicular exploration and sperm extraction tuba l embryo transfer transforming growth factor testicular intratubular neoplasia (synonymous with IGCN) tubularized incised plate tumor necrosis factor tumor, node, metastasis transobt urator tape SYMBOLS AND ABBREVIATIONS xxxi TOV TPIF TRUS TS TSE TUIP TULIP trial of void transverse preputial island \202 ap transrectal ultrasonography tuberous sc lerosis testicular self-examination transurethral incision in the prostate transuretheral u ltrasound-guided laser-induced prostatectomy transurethal microwave thermotherapy transuret hal radiofrequency needle ablation transurethral resection transurethral resection of bladd er tumor transurethral resection of the ejaculatory ducts transurethral resection of prosta te transurethral resection syndrome transureteroureterostomy transurethral electrovaporizat ion of the prostate transurethral vaporization resection of the prostate total vaginal leng th tension-free vaginal tape tension-free vaginal tape obturator route trial without cathet er transition zone (international) unit urethral diverticulum undescended testis urea and e lectrolytes urinary incontinence United Kingdom ultra-low dose computed tomography ureterop elvic junction obstruction United States (of America) ultrasound scan urinary tract infecti on urge urinary incontinence unilateral ureteric obstruction upper urinary tract transition al cell carcinoma volt post-prostatic massage urine variant Creutzfeldt \200\223Jakob disea se voiding cystourethrography TUMT TUNA TUR TURBT TURED TURP TURS TUU TUVP TUVRP tvl TVT TVTO TWOC TZ U UD UDT U & E UI U K ULDCT UPJO USA USS UTI UUI UUO UUT-TCC V VB3 vCJD VCUG SYMBOLS AND ABBREVIATIONS xxxii VEGF VEGFR VH VHL VLAP VQ VRE vs VTE VUJ VUJO VUR VURD VVF W WBC WCC WHO wk WW XGP y YAG ZI FT vascular endothelial growth factor vascular endothelial growth factor receptor visible haem