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Lower urinary tract symptoms (LUTS), consisting storage, voiding and post-micturition symptoms, is a comprehensive definition involving symptoms that may occur due to several causes. Instead of simply focusing on the enlarged prostate, more attention has to be paid to the entire urinary tract as well as multiple system comorbidities. Therefore, prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required. Based on current literature, this paper proposes the “3Bs” concept for managing non-neurogenic male LUTS, namely, “beyond prostate”, “beyond surgery” and “beyond urology”. The clinical application of the “3Bs” enables urologists to carry out integrated, individualized and precise medical care for each non-neurogenic male LUTS patient. Keywords: Male, Lower urinary tract symptoms, Benign prostatic hyperplasia, Benign prostatic obstruction, Detrusor overactivity, Detrusor underactivity, Prostate surgery, Comorbidities

More than 90% of bladder cancer is composed of transitional cell carcinoma (TCC), being characterized by the development of multiple tumors in the entire urinary tract over time. When cystectomy is conducted, the urinary tract must be reconstructed by various procedures, which can include an orthotopic neobladder using the patient's own intestine formed into a spherical shape anastomosed to the urethra. Using this procedure, patients can void urine from their own urethra even after cystectomy. The incidence of subsequent urethral cancer arising after cystectomy is known to be relatively high; however, if patients with a high risk of urethral recurrence are appropriately excluded, a neobladder can be safely provided for patients. Orthotopic neobladder use is reviewed from an oncological viewpoint and the patient's quality of life after cystectomy for bladder cancer.

Urethral stricture is a narrowing of the urethra due to scar tissue. It causes obstructive voiding dysfunction and can lead to long-term damage of the entire urinary tract. The probability of therapeutic success is dampened by a high rate of recurrence. Therefore, a careful taking of the patient's history and further diagnostics are crucial for finding the appropriate form of therapy. This review highlights the clinical presentation and diagnostic workup of urethral strictures.

Contrast-enhanced voiding urosonography (ceVUS) is a dynamic imaging technique that makes it possible to study the structure of the urinary tract after the administration of intravesical contrast material. Initially, ceVUS was indicated mainly to study vesicoureteral reflux (VUR); however, since the ability of ceVUS to depict the structure of the urethra was demonstrated in both sexes, ceVUS is now indicated for examination of the entire urinary tract. The main benefit of ceVUS is that it does not use ionizing radiation. In recent years, fundamental changes have occurred in the understanding of VUR. The lessening effect of VUR and the low rate of occurrence of urethral pathologic conditions have given rise to changes in the indications for tests for these conditions. In addition to being able to help confirm a diagnosis of VUR, the ceVUS technique can be used to depict obstructive and nonobstructive urethral pathologic conditions, as well as normal variants, on high-quality images. Furthermore, ceVUS enables real-time assessment of voiding function. For these reasons, ceVUS should be not only an alternative to voiding cystourethrography, but also the technique of choice for the study of the entire urinary tract in pediatric patients. Online supplemental material is available for this article. ©RSNA, 2017.

We report a striking duplication of the entire urinary collecting system in an 18-year-old male with 2 renal pelves and 2 ureters on either side, along with a complete duplication of the bladder and urethra.

The objective of this study was to compare Magnetic Resonance Urography (MRU) with Intravenous Pyelography (IVP) in evaluation of patients with hydronephrosis on ultrasonography. 49 patients of hydronephrosis on USG were enrolled for the study from Jan. 2011 to Dec. 2012. All patients under went Intravenous Urography (IVU). MRU was done to determine the anatomical details and function of each renal unit. MRU was performed on a 1.5 tesla unit (Magneton Avento; Siemens, Erlangen, Germany). Static T2-weighted Magnetic Resonance Urography (MRU) was performed by using a standard fast spin echo technique. Dynamic study was performed after injecting intravenous diuretic followed by Gadolinium contrast media. Morphological results of MRU were compared with IVU. The anatomical findings were compared with operative findings. Stastical analysis was performed and data expressed as mean ± SD. MRU showed PUJ obstruction in 41 out of 45 patients (91.1%). We concluded that MRU can provide complete diagnostic evaluation of entire urinary tract in a single session and has potential to replace IVP.

OBJECTIVE. MR urography (MRU) can be an alternative to CT urography (CTU) for imaging of the kidneys, urinary bladder, and collecting systems. MRU can be a challenging examination to perform and interpret, which may result in technical and interpretive errors being made. This article highlights the pitfalls associated with MRU and discusses how to recognize and avoid them. CONCLUSION. When performed properly, MRU may provide imaging quality generally comparable to that of CTU, and it enables comprehensive evaluation of the entire urinary tract.

Aim: To report and analyze the disastrous effects of ketamine abuse on the urinary system seen in young Hong Kong patients. Methods: The hospital records of 80 ketamine abusers who attended the urology clinics of Princess Margaret Hospital and Tuen Mun Hospital were retrospectively reviewed. Their blood creatinine level, cystoscopic and urodynamic findings were analyzed. Results: Up to 30–50% of our patients had either contracted bladder with diminished bladder capacity (

Objective: Investigating the influence of increasing the intraabdominal pressure by Valsalva maneuvers and/or abdominal compression to reach best visualization of the entire urinary tract in computed tomography urography (CTU).Methods: After split-bolus technique, Valsalva maneuvers, compression or a combination of both were applied in 60 patients before late phase images were acquired. The degree of opacification and distension of three segments of the urinary tract were evaluated.Results: After split-bolus CT no significant difference among the groups regarding distention and opacification. A significant increase in distension and opacification was found during Valsalva and the combination of Valsalva and compression.Conclusions: A CTU protocol including a late phase scan with prior application of compression, Valsalva maneuvers or a combination of both showed beneficial effects for the distension and opacification, a significant difference was found by taking location as a covariate.

Excellent contrast resolution and lack of ionizing radiation make magnetic resonance urography (MRU) a promising technique for noninvasively evaluating the entire urinary tract. While MRU currently lags behind CT urography (CTU) in spatial resolution and efficiency, new hardware and sequence developments have contributed to a resurgence of interest in MRU techniques. By combining unenhanced sequences with multiphase contrast-enhanced and excretory phase imaging, a comprehensive assessment of the kidneys, ureters, bladder, and surrounding structures is possible with image quality rivaling that obtained with other techniques. At the same time, formidable challenges remain to be overcome and further clinical validation is necessary before MRU can replace other forms of urography. In this article, we demonstrate the current potential of MRU to demonstrate a spectrum of urologic pathology involving the kidneys, ureters, and bladder while discussing the limitations and current status of this evolving technique.

The ability to approach the urinary tract without requiring surgical incisions has differentiated and continues to differentiate urology from many other surgical specialities. Endourology has permanently evolved over the last decades under the impulse of technological progress that has allowed the approach of the entire urinary tract and the development of modern, advanced endoscopes. Moreover, throughout the history of surgery, urology has had a leading role in the discovery and implementation of minimally invasive techniques.

Multidetector computed tomography (MDCT) is well established for the detection of stones and renal masses, but more recently MDCT urography (MDCTU) is becoming widely used for examination of the entire urinary tract aimed specifically for diagnosing urothelial lesions. Evidence is rapidly accumulating to support the use of MDCTU in this manner. Familiarity with the MDCTU signs of urothelial malignancy is a prerequisite for optimum radiological practice. This article provides a review of the appearances of transitional cell cancer in the upper urinary tract and bladder.

The advent of Multislice Computed Tomography (MSCT) has made evaluation of the entire urinary tract with high-resolution sections during a single breath-hold a reality. Acquisition of multiple thin overlapping slices provides excellent two-dimensional (2D) and three-dimensional (3D) reformations of the urinary tract. The concept of "Multislice CT Urography (MSCTU)" has emerged from this technical improvement. As a result, a wide range of pathologies inside and outside the urinary tract can be identified. During the last several years, MSCTU has challenged intravenous urography (IVU) in the evaluation of urinary tract abnormalities. Compared with IVU, MSCT(U) is more sensitive and specific in the detection and characterization of a variety of urinary tract disorders, including renal masses and urolithiasis. The main advantage of IVU has been its ability to offer excellent delineation of pelvicalyceal and ureteral anatomy and to depict subtle uroepithelial abnormalities. MSCTU has already shown promising results for overcoming this challenge. Optimal opacification and distension appear to be an essential requirement for a thorough evaluation of the collecting system. Dedicated preparation strategies have been developed to meet these technical difficulties. The biggest disadvantage of MSCTU is the significant radiation exposure. For broad routine clinical application, there is still a need for dose reduction protocols despite the ongoing technical developments in MSCTU. In this article, we outline the different concepts of technical processing for MSCTU and summarize the current role of MSCTU in the evaluation of the upper urinary tract.

Magnetic resonance urography (MRU) can be performed on the basis of two different imaging strategies: static-fluid MRU, based on heavily T2 weighted turbo spin echo (TSE) sequences, and gadolinium-enhanced excretory MRU. Both MR urographic techniques in combination with standard MRI permit a comprehensive examination of the entire urinary tract. This pictorial review illustrates the MRU features of the a wide spectrum of pathological conditions affecting the urinary tract.

Objectives. Magnetic resonance urography (MRU) is a new technique that uses heavily weighted T2 coronal images with fat suppression pulse. Urine appears white on MRU, resembling an intravenous urogram (IVU). Contrast agents are not necessary. This study describes the use of MRU in the diagnosis and treatment of patients with hematuria. Methods. One hundred six patients with microscopic or gross hematuria and 6 normal volunteers underwent MRU between 1992 and 1995. A modified, heavily weighted T2 technique with intravenous administration of furosemide and ureteral compression was used. Thirty-two patients had other imaging techniques as well for comparison. Results. MRU provided high-resolution images in almost all cases; 73 (69%) had a normal MRU. Significant findings in the 33 patients with abnormalities included renal cysts in 17 (51%), renal cell carcinoma in 6 (18%), transitional cell carcinoma in 5 (15%), ureteropelvic junction obstruction in 3 (9%), and stones causing obstruction in 6 (18%). Five patients with renal failure also had good visualization of the entire urinary tract. MRU was comparable to other imaging modalities except in identifying nonobstructing calculi. Conclusions. MRU provides an alternative to conventional imaging of the urinary tract, especially in those patients who have contraindications to ionizing radiation and contrast agents. Improvements in resolution, technique, and cost have to be addressed before it can be used regularly in urologic practice.

Ultrasonography is often recommended as the first diagnostic imaging modality in patients with hematuria or dysuria. It can provide information relative to the capacity of the urinary bladder, changes in bladder outline, changes in wall thickness, identification of mural and luminal masses, and identification of extrinsic lesions that may displace the bladder wall causing changes in its shape. Ultrasonography allows an evaluation of the entire urinary tract (except distal urethra) in both female and male dogs as well as the sublumbar region for lymphadenopathy.

Background Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious consequences for the entire urinary tract. Its prevalence among men in industrial countries is estimated at 0.9%. It produces obstructive and irritative urinary symptoms and can ultimately impair renal function. Urethral strictures can be caused by diagnostic or therapeutic urological procedures. These procedures are being performed ever more commonly, because the population is aging; thus, urethral strictures will probably become more common as well.

透析患者の予後の改善に伴って悪性腫瘍の合併も増加している. しかし尿路に広範な腫瘍が繰り返し出現し, 全尿路摘除に至ったという症例報告は少ない. 我々は繰り返す尿路上皮癌の発生により全尿路摘除術を行った症例を経験したのでここに報告する.症例は66歳, 女性. 主訴, 肉眼的血尿. SLEによる腎不全のために紹介病院で血液透析を行っていた. 1989年5月より血尿が持続するため腎CTを行ったところ右腎盂腫瘍と診断され右腎摘除術を行った. 病理組織診断はgrade 2, 移行上皮癌 (TCC) であった. 経過観察中1990年11月再び肉眼的血尿が出現. 右尿管口と膀胱左側壁に腫瘍がみられ, 経尿道的膀胱腫瘍切除術 (TUR-Bt) を行った. 病理組織診断はgrade 1, TCCであった. その後, 1991年1月右残存尿管, 膀胱, 左尿管にも腫瘍発生が疑われたため1991年2月全尿路摘除を行った. 術後約2年経った現在再発もなく患者は定期的に経過観察されている.

Magnetic resonance (MR) urography, in conjunction with traditional MR imaging sequences, offers the potential for a comprehensive evaluation of the entire urinary tract. In addition to defining anatomic form, MR imaging excels at tissue differentiation and can estimate renal function. Most importantly, this information can be obtained without ionizing radiation or iodinated contrast media. Therefore, MR urography has become of particular interest in certain populations, including children, pregnant women, and renal transplant donors and recipients. Despite the challenges inherent in imaging a dynamic system with often subtle abnormalities, recent advances in MR technology and field strength, coupled with expanding functional capabilities, promise a bright future for MR urography.

The advent of multi-detector computed tomography (MDCT) has enabled evaluation of the entire urinary tract during a single breath-hold, with a concomitant reduction in respiratory misregistration and partial-volume effect. In addition, the acquisition of multiple, thin, overlapping slices of optimally distended and opacified urinary tract potentially provides excellent two-dimensional (2-D) and three-dimensional (3-D) reformations of the urinary tract [1]. The concept of multi-detector CT urography (MDCTU) has emerged from these technical improvements. MDCTU may be defined as MDCT examination of the urinary tract in the excretory phase following intravenous contrast administration [2]. The range of indications for MDCTU has rapidly expanded, and the technique has replaced intravenous urography at many institutions for almost all indication. Refinement of MDCTU protocols remains controversial and is still a work in progress, with a variety of protocols being used at different centres.

404 Background: According to several guidelines, the standard therapy for carcinoma in situ (CIS) of the upper urinary tract is total nephroureterectomy. However, it is difficult to determine a treatment strategy for elderly patients. Bacillus Calmette-Guerin (BCG) therapy has already been established as a treatment for non-muscle invasive bladder cancer. However, although there are several reports indicating the effectiveness of BCG perfusion therapy for the upper urinary tract CIS, it has not been established yet. We conducted a retrospective study to assess the long-term effects of BCG perfusion therapy for the upper urinary tract CIS for elderly patients. Methods: We treated 34 patients with upper urinary tract CIS at our clinic between August 2004 and March 2015. 29 patients (22 men and 7 women) with the age of 65 years or older were enrolled. 11 subjects had the entire urinary tract CIS, 8 had bilateral, 10 had unilateral CIS of the upper urinary tract. The average period of observation was 45.5 months ( 5 to 151 ), and the average subject age was 76.5 years (66 to 90 ). We used a double-J catheter for 22 cases, a transvesical single-J catheter whose curl was positions in an upper calyx for 6 cases, and a straight ureteral catheter inserted for ureterocutaneostomy for 1 case. We used 80 mg of BCG for the first 4 cases, 40 mg for the late 25 cases. The BCG treatment was given once a week for consecutive 6 weeks. Urine cytology was performed to assess the treatment validity. Results: Urine cytology tests became negative in 22 of the 29 subjects (75.9%) who underwent upper urinary tract perfusion therapy. Among these 22 subjects who had negative tests, 6 subjects had a recurrence in their upper urinary tracts. Side effects were observed in 28 subjects (89.7%), and the most common side effect was bladder irritation. Localized renal tuberculosis which was successfully treated with conservative therapy was seen in two cases. Conclusions: BCG perfusion therapy for the upper urinary tract CIS is safe and effective for elderly patients. Results also suggested that this could be one of the effective treatment options. However, we have to be careful for severe side effects.

One of the major dilemmas facing pediatric urologists today is discerning obstruction in the dilated urinary tract. Apparently similar anatomic obstructions can result in very dissimilar consequences. The authors focus on the physiologic response of the bladder and upper tracts to infravesical obstruction. They caution against treatment focused merely on the obstruction, noting that the entire urinary tract must be addressed.

Stress urinary incontinence (SUI) is a prevalent symptom among women, but it also affects men, primarily caused by surgery of the prostate. Even though it is not life-threatening, it seriously affects quality of life. Bulking agents, which have been offered as a treatment option for both women and men, have been used in the treatment of incontinence for many decades. Even though injectables have improved in recent years and their short-term efficacy has been satisfactory, there is still a concern regarding durability of effect. Despite these concerns, the minimally invasive nature of the technique, with uncommon and self-limited complications, has made injectables quite popular among both physicians and patients [1]. All this demonstrates a need for a reliable treatment option that is easy to perform and long lasting, and if possible, restores physiologic functioning [2]. When tissue engineering was introduced in urology approximately two decades ago, it became possible to grow urothelial cells in the laboratory. It became achievable to grow large amounts of cells over several passages, which would be by far sufficient to cover the entire urinary tract in several layers. Technical problems of separation, characterization and sometimes differentiation of isolated cell culture, obtaining an adequate scaffold, its transfer into individual patients, and strict production requirements for human use are some possible reasons only anecdotal reports about clinical applications have appeared to date. Covering mucosal surfaces is not the only goal we want to achieve with tissue engineering in urology.

Purpose: Defects of the entire urinary tract are sometimes so extensive that a colonic conduit appears to be the only viable therapeutic option. However, if an incontinent diversion is unacceptable, an alternative must be found.Materials and Methods: We report on a new technique for achieving a continent diversion in which ileocecal intestinal segments are used as a continent reservoir and substitute for both ureters.Results: At 2-year followup excellent results were achieved in terms of renal function, continence and quality of life as confirmed by symptomatic evaluation and radiographic investigations.Conclusions: We demonstrate the feasibility of reconstruction of the entire urinary tract with a continent reservoir using intestinal segments with a pure colonic pouch and prevalvular ileal segment as a substitute for both ureters.

We report the clinical and pathological findings of a case of congenital desquamative squamous epithelium of the entire urinary tract associated with body dysmorphism. This entity has not been described previously in the literature.

We describe 3 sets of twins with discordance for urological malformations. Zygosity was documented by HLA and blood group typing. It is suggested that evaluation of the identical twin of an affected patient should include the entire urinary tract because of the potential for different lesions.

Urothelium that lines almost the entire urinary tract acts as a permeability barrier and is involved in the pathogenesis of major urinary diseases, including urothelial carcinoma, urinary tract infection, and interstitial cystitis. However, investigation of urothelial biology and diseases has been hampered by the lack of tissue-specific approaches. To address this deficiency, we sought to develop a urothelium-specific knockout system using the Cre/loxP strategy. Transgenic mouse lines were generated in which a 3.6-kb mouse uroplakin II (UPII) promoter was used to drive the expression of Cre recombinase (Cre). Among the multiple tissues analyzed, Cre was found to be expressed exclusively in the urothelia of the transgenic mice. Crossing a UPII-Cre transgenic line with a ROSA26-LacZ reporter line, in which LacZ expression depends on Cre-mediated deletion of a floxed “stop” sequence, led to LacZ expression only in the urothelium. Gene recombination was also observed when the UPII-Cre line was crossed to an independent line in which a part of the p53 gene was flanked by the loxP sequences (floxed p53). Truncation of the p53 gene and mRNA was observed exclusively in the urothelia of double transgenic mice harboring both the UPII-Cre transgene and the floxed p53 allele. These results demonstrate for the first time the feasibility and potentially wide applicability of the UPII-Cre transgenic mice to inactivate any genes of interest in the urothelium.

In these times of rapid advances in radiographic imaging, intravenous urography should be performed in an optimal way. The urographic examination should involve consultation between the referring physician and the radiologist. Necessary patient information should be accessible. McClennan said "patient selection for urographic studies should be efficacious with the radiologist exerting appropriate control so that the urogram is truly a consultative imaging service integrated into the total patient management." We share this view, and it is an extension of the philosophy of practice emphasized by other leaders in uroradiology. Cost containment, new imaging technologies, risk/benefit considerations, and evolving patterns of patient care have had a significant influence on genitourinary tract imaging. In addition, current debate about contrast media, digital radiography, efficacy, and utilization will undoubtedly have an influence on imaging during the next decade. Utilization of intravenous urography has decreased significantly in the past 15 years. Our volume of examinations has declined approximately 50% since 1970. This decline in our practice is attributed to several complex factors such as previous overutilization of screening urography for hypertension; the impact of US and CT for evaluation of obstruction, retroperitoneal disease (adenopathy and fibrosis), renal failure, and renal masses; concern about contrast medium-induced renal failure; and fewer repeat studies because of improved quality of intravenous urography in general radiology practice. In addition, overutilization of urography in patients with hematuria, prostatism, history of urinary tract infection, etc, continues to be debated in the medical community. In our integrated group practice, we have also observed overutilization of "high-tech" procedures in lieu of urography for evaluation of suspected urinary tract disease. Swings of the pendulum are inevitable in diagnostic imaging because of evolving technology and the art of medical practice. Although some differences of opinion about the details of urographic technique and indications for urography may exist, most would agree on the philosophy of producing a high-quality urographic examination. That philosophy focuses on producing the highest quality examination in each patient so that a diagnosis of normal or abnormal can be made accurately and confidently. Failure to demonstrate the entire urinary tract is a common cause of diagnostic error and one that can largely be eliminated by careful attention to the technical details of the examination.

It was Hendren's contribution to introduce an aggressive restorative procedure for the entire urinary tract in children with the megaureter syndrome. Our own experience in applying this method enabled us to more critically assess its value and prompted us to introduce some modifications. Instead of longitudinally resecting the dilated ureter we applied a method in which the dilated ureter wall is folded. This prevents injury to the ureter wall and its necrosis. We have given up excessive shortening of the elongated ureter, since the elongation proved to be spurious. We have also given up reconstruction of the upper part of the ureter.

A review of equine urolithiasis is presented. Special emphasis is placed on clinical diagnosis and management. Although somewhat uncommon, urolithiasis is a potentially serious condition with an apparent predilection for male horses. Although the entire urinary tract is at risk for urolith formation, the bladder and urethra are most commonly affected. The principal signs include stranguria, hematuria, and dysuria. Severe abdominal discomfort is often observed in patients suffering from distal urinary tract obstructions. If urolithiasis is promptly identified, a variety of surgical techniques may be applied to resolve and treat this condition.

The urologist is frequently summoned to the operating room to assist with urethral catheterization. This article presents the authors' method and techniques for dealing with the "impassible urethra." Oftentimes the patient has been traumatized. A sequential plan is presented that allows for maximal evaluation of the entire urinary tract along with eventual urethral catheterization. In the case of the disrupted urethra, diversion must be accomplished. The authors have found that the placement of a urethral catheter along with division of intact puboprostatic ligaments in the stable patient frequently limits the eventual morbidity of the trauma.

A technique for obtaining multiple urograms is presented which can be used in the average clinic or hospital, requiring no special and expensive apparatus. Complete cooperation between the urologist and the roentgenologist is essential. Fluoroscopy is an important part of the technique. Pressure, other than gravity, should not be used in the filling process. The advantages of the technique given are considered. The entire urinary tract, as well as extra-urinary structures, is included in the field of study.

CLINICAL application of intravenous urography makes it necessary to consider normal and pathologic morphology and physiology of the entire urinary tract. Adequate analysis of intravenous urograms necessitates a division of the physiologic activity into secretion, or filtration which cannot be directly visualized, and dynamic excretion, or the transportation of urine which can be demonstrated. Dynamics vary markedly and sometimes almost specifically in various disease entities and emphasis on these variables permits intelligent interpretation and clinical application of the information revealed. The study is best approached by stressing urinary peristalsis. We do not believe this dynamic function can be studied advantageously when compression or other artificial interference is employed. There are unknown physiologic, neurogenic, and anatomic factors which enter into normal renal function and there is some speculation and theorizing as to the mechanism by physiologists, anatomists, and medical writers. Muc...

THE question proposed may appear of minor significance compared to the many important problems of roentgenology. However, each roentgenologist has, in the course of the activities of his own practice, many times wondered, Why the film size? The physical dimensions of the x-ray film currently manufactured for our purpose appear to have followed the standard sizes used for generations in the photographic industry. Upon investigation, no other reason could be discovered. All have experienced the dissatisfaction of being unable to obtain a demonstration of the entire barium-filled colon on one film, and, on the other hand, it is frequently observed that the lower third of the chest film is useless from a diagnostic standpoint, and, therefore, wasted. The films now in use are occasionally too short for demonstration of the entire urinary tract on one film, presenting difficulty in proper positioning, while at the same time there is considerable waste in the width of the film. The present sizes are poorly adapt...

In the pregnant patient when visualization of the ureters is requested, excretory urography is often ordered. We propose the use of digital radiography using single exposure as an alternative to conventional urography. This technique allows significant dose reduction while visualizing the entire urinary tract. It can be performed on most current-generation computerized tomographic scanners. In addition to dose reduction, the ability to manipulate, magnify, and avoid repeat exposures makes this an attractive alternative to the conventional film-screen technique.

With currently available treatment modalities it is possible to replace the entire urinary tract. The only requirement is a functioning kidney. The ureter and bladder can be replaced by gut, the urethra by skin and the sphincter mechanisms by an artificial device (for example). Fortunately, such extensive surgery is rarely required, but the fact remains that it is possible to make anybody continent, regardless of the nature of their problem. 1. What is required to restore or produce continence and adequate voiding with respect to the patient’s adequately evaluated and objectively demonstrated urodynamic abnormalities? 2. Is the surgical intervention required justifiable with regard to the patient’s general condition, circumstances and motivation?

Traumatic rupture of the fixed portion of the male urethra is a most serious injury, both in its immediate aspect and remote consequences: immediately serious, because of leakage of urine following the several classical paths of extravasation, with subsequent decomposition, or on account of complicating lesions of osseous or soft tissues; remotely so, owing to formation of traumatic stricture, with its attendant urinary stagnation and infection of the entire urinary tract. The force causing a rupture of the urethra acts in one of two ways—in a direct manner, the patient falling astride an object, or indirectly, the pelvic bones being crushed together, the force usually acting in the coronal plane of the body. Produced in a direct manner, the urethral tear may be in a part anterior, within, or posterior to the layers of the triangular ligament, usually without complicating factors. Indirectly produced by crushing force, the tear in the

The modern urologist no longer relies solely on static anatomic and morphologic observations in evaluating disease. In the last decade, dynamic studies of urinary tract function have assumed increasing importance; a growing body of recent literature attests to the expanding role of functional measurements in urologic diagnosis. A single source of information, suitable for both neophyte and expert, has been lacking until now. Urodynamics is the product of an international workshop on urodynamics and, as such, is a multiauthored collection of articles on all aspects of the subject. The presentations are comprehensive and include anatomic and physiologic studies of the entire urinary tract from the pyelocaliceal system to the urethral meatus. Methods and techniques of measurement include manometry, electromyography, roentgenography, and pharmacodynamics—separately and in combination. As in any workshop publication, some chapters are entirely new contributions, others extend previous studies, and still others are restatements of previously published work. However

WHEN THE occurrence of anuria or oliguria leads to a diagnosis of acute renal shutdown the physician must not only plan appropriate supportive therapy but must at the same time institute any measures which might reverse the process which has led to diminished urine flow. Unless there is virtual certainty that the cause resides within the kidney, investigation of the entire urinary tract is obligatory, since obstructive lesions may occur at any site. Stones as well as neoplasms can obstruct both ureters simultaneously or successively. Persons who, as a result either of disease or of developmental anomaly, have only one functioning kidney will develop apparent acute renal shutdown as the result of obstruction to the sole ureter. 1 Dehydration, with or without salt depletion, is one of the commonest causes of oliguria encountered today. Pure water depletion without electrolyte loss generally leads to a concentrated urine. However, when there is