This book summarises the entire field of adult neuro-urology in a concise, well-illustrated, and practical style. Contents include epidemiology, lower urinary tract anatomy and physiology. This is followed by coverage of the pathophysiology of various types of voiding dysfunctions and a clinical section focusing on practical evaluation and treatment. A range of treatments from behavioral, pharmacological, intra vesical, tissue engineering and surgical are explained and reviewed. Other topics such as complications, sexual function, fertility, maternity aspects, and prognostic factors round off the book. *Each topic is covered in detail and well illustrated. *The reader will gain a full understanding of every aspect of adult neuro-urology. *Facilitates improved clinical knowledge and practice. Provides an essential and complete reference tool for students and established urologists, neurologists, physiotherapists and nurses, and technicians involved in the care of patients with neurogenic bladder dysfunction.

All patients with vesico-urethral dysfunction, regardless of the nature of the neurological process causing it, are investigated with the same diagnostic tools. Textbook of the Neurogenic Bladder provides physicians—whether qualified or in training—with excellent instruction for conducting thorough, efficient, and beneficial examinations of both adults and children using a variety of instruments and tests. Features: Clarifies the differing states of neurogenic bladder dysfunction Describes the pathophysiology of neurogenic bladder dysfunction and the ways it alters vesico-urethral function Provides an overview of quality of life instruments that help determine the main outcome of interventions Covers imaging, electrophysiology, and extensive urodynamic studies in adults and children Discusses new non-surgical options and new ways to administer traditional treatments Includes a full chapter on a new classification system by its developer, Professor Anders Mattiasson This well-illustrated text includes both surgical and non-surgical treatment options from international experts. The book will enable practitioners to choose the best treatments for optimal results.

The purpose of this book is to present a focused approach to the pathophysiology, diagnosis, and management of the most common autonomic disorders that may present to the clinical neurologist. Autonomic Neurology is divided into 3 sections. The first section includes 5 chapters reviewing the anatomical and biochemical mechanisms of central and peripheral nervous system control of autonomic function, principles of autonomic pharmacology, and a clinical and laboratory approach to the diagnosis of autonomic disorders. The second section focuses on the pathophysiology and management of orthostatic hypotension, postural tachycardia, baroreflex failure; syncope, disorders of sweating, neurogenic bladder and sexual dysfunction, gastrointestinal dysmotility, and autonomic hyperactivity. The final section is devoted to specific autonomic disorders, including central neurodegenerative disorders; common peripheral neuropathies with prominent autonomic failure; painful small fiber neuropathies; autoimmune autonomic ganglionopathies and neuropathies; focal brain disorders; focal spinal cord disorders; and chronic pain disorders with autonomic manifestations. This book is the product of the extensive experience of its contributors in the evaluation and management of the many patients with autonomic symptoms who are referred for neurologic consultation at Mayo Clinic in Rochester, Minnesota. Autonomic Neurology focuses on clinical scenarios and presentation of clinical cases and includes several figures showing the results of normal and abnormal autonomic testing in typical conditions. Its abundance of tables summarizing the differential diagnosis, testing, and management of autonomic disorders also help set this book apart from other books focused on the autonomic nervous system.

This book summarises the entire field of adult neuro-urology in a concise, well-illustrated, and practical style. Contents include epidemiology, lower urinary tract anatomy and physiology. This is followed by coverage of the pathophysiology of various types of voiding dysfunctions and a clinical section focusing on practical evaluation and treatment. A range of treatments from behavioral, pharmacological, intra vesical, tissue engineering and surgical are explained and reviewed. Other topics such as complications, sexual function, fertility, maternity aspects, and prognostic factors round off the book. *Each topic is covered in detail and well illustrated. *The reader will gain a full understanding of every aspect of adult neuro-urology. *Facilitates improved clinical knowledge and practice. Provides an essential and complete reference tool for students and established urologists, neurologists, physiotherapists and nurses, and technicians involved in the care of patients with neurogenic bladder dysfunction.

When a child has a health problem, parents want answers. But when a child has cerebral palsy, the answers don't come quickly. A diagnosis of this complex group of chronic conditions affecting movement and coordination is difficult to make and is typically delayed until the child is eighteen months old. Although the condition may be mild or severe, even general predictions about long-term prognosis seldom come before the child's second birthday. Written by a team of experts associated with the Cerebral Palsy Program at the Alfred I. duPont Hospital for Children, this authoritative resource provides parents and families with vital information that can help them cope with uncertainty. Thoroughly updated and revised to incorporate the latest medical advances, the second edition is a comprehensive guide to cerebral palsy. The book is organized into three parts. In the first, the authors describe specific patterns of involvement (hemiplegia, diplegia, quadriplegia), explain the medical and psychosocial implications of these conditions, and tell parents how to be effective advocates for their child. In the second part, the authors provide a wealth of practical advice about caregiving from nutrition to mobility. Part three features an extensive alphabetically arranged encyclopedia that defines and describes medical terms and diagnoses, medical and surgical procedures, and orthopedic and other assistive devices. Also included are lists of resources and recommended reading.

This book provides a leading international reference on the diagnostic and therapeutic approach to the pediatric patient with urinary problems due to spinal cord pathologies. It represents a unique guide for specialists involved in the management of this pathology. The text is well illustrated with figures.

This issue of Clinics in Geriatric Medicine is devoted to Geriatric Urology. Guest Editor Tomas L. Griebling, MD, MPH has assembled a group of expert authors to review the following topics: Non-Surgical Treatment of Urinary Incontinence in Elderly Women; Outcomes of Surgery for Stress Urinary Incontinence in Older Women; Evaluation and Management of Pelvic Organ Prolapse in Elderly Women; Underactive Bladder in Older Adults; Translational Research and Voiding Dysfunction in Older Adults; Functional Brain Imaging and Voiding Dysfunction in Older Adults; The Role of Urodynamics in Elderly Patients; Associations Between Voiding Symptoms and Sexual Health in Older Adults; Asymptomatic Bacteriuria and Urinary Tract Infections in Older Adults; Comorbidity and Surgical Risk in Older Urologic Patients; Small Renal Masses in Older Adults; Prostate Cancer in Elderly Men: Active Surveillance and Other Considerations; Late Onset Hypogonadism and Testosterone Replacement in Elderly Men; and Contemporary Chemotherapy for Urologic Malignancies in Geriatric Patients.

This text creates a framework for the integration of urological care into the long-term management of patients with progressive neurological conditions. It begins with a general review of the neuroanatomy and physiology of the bladder, followed by a discussion of common techniques for evaluating bladder and upper tract function, and the general principles of bladder management in patients with neurogenic bladder disease. Section II narrows the scope of each chapter to focus on specific neurological disorders such as Parkinson's Disease, Alzheimer's Disease, Dementia, and Cerebral Palsy. Each chapter begins with a brief synopsis of the neurologic basis of each disease, followed by its most common urologic manifestations, specific recommendations for urologic care in each disease state, and finally a recommended pathway for integrated long-term care of these patients based on available evidence and expert opinion. The final section of the text reviews the generalized care of patients with advanced disease, including palliative and end of life options, focusing on urologic interventions. Urological Care for Patients with Progressive Neurological Conditions will be an invaluable resource for urologists, neurologists, and all health care providers treating patients with neurological diseases.

Spinal dysraphism (SD) is a congenital malformation that to a varying extent, often severely, affects the life of the child and the family. Most individuals with SD suffer from neurogenic bladder and bowel dysfunction—with the risk of urinary tract infections, renal deterioration, urinary and fecal incontinence—that affects social participation and quality of life negatively. In newborns with SD, early detection of neurogenic bladder dysfunction and determination of post-void residual urine are required to determine the need of clean intermittent catheterization (CIC) and follow-up. The non-invasive method of four-hour voiding observation with provocation test (VOP) was used to evaluate bladder function in 50 newborn children with SD. Voiding patterns for the children were described and compared with those of 50 healthy newborns evaluated with VOP in an earlier study. Comparison revealed significant differences among several variables. In particular, leakage at provocation test and not voiding with a stream were common in newborns with SD but did not occur in healthy newborns. VOP is a non-invasive standardized method to determine residual urine in newborns with SD. It also adds information on voiding pattern, frequency, voiding with a stream and leakage at provocation. Findings in neonatal VOP of the same cohort of newborns with SD were then related to radiology, presence of urinary tract infections during the first year, and urodynamic findings and use of CIC at the age of one year. It was found that, in children with SD, not voiding with a stream may have a predictive value for the need of CIC at the age of one year, followed probably by lifelong CIC. Despite this, the presence of an open SD per se has stronger predictive value, and each child needs to be evaluated individually while considering a number of factors. The main value of VOP may be as a structured non-invasive screening method to uncover neurogenic bladder-sphincter dysfunction in the newborn. Studies with a larger number of subjects than the present are needed to evaluate the potential of VOP in newborns with closed spinal dysraphism in whom the neurological consequences vary. A retrospective analysis detected renal damage on DMSA scintigraphy in 5 of 41 children with SD who were followed according to a proactive national program with minimal use of surgery. Median follow-up time was 10 years. High baseline pressure was confirmed as a risk factor for renal damage. Compliance with treatment and follow-up is likely to be an important factor for renal health. Therefore, efforts to support children and their families are crucial. A questionnaire-based study of 107 children with SD (age 6–16y) in Sweden and Norway examined aspects of treatment for neurogenic bowel dysfunction focusing on incontinence, independence, general satisfaction and quality of life. It was found that transanal irrigation (TAI) and antegrade colonic enemas (ACE) are effective treatments, but are time-consuming and difficult to perform independently. The majority of children using TAI (72%) and ACE (63%) never went to the toilet alone to empty their bowels. As children achieving independence on the toilet reported higher quality of life, efforts to support independence are beneficial. Continent, self-managing children with healthy kidneys enjoy high quality of life and contribute more fully to society. Therefore, further research is required to investigate and develop existing and new technologies and methods that mitigate the problems related to SD, and to make them accessible to all children with spinal dysraphism. Under de senaste 50 åren har det skett en enastående utveckling av möjligheterna för barn som föds med ryggmärgsbråck. Tidigare har majoriteten av barn med ryggmärgsbråck avlidit redan som spädbarn men idag överlever de flesta till vuxen ålder. Utan aktiva insatser och uppföljning är dock risken för medicinska problem och allvarlig påverkan på livet mycket stor. Nu när nästan alla barn överlever ligger fokus på att också nå okad livskvalitet och självständighet för personer med ryggmärgsbråck. Nästan alla med ryggmärgsbråck måste hantera en allvarlig påverkan på blåsan och tarmen med risk för njurskador, inkontinens och förstoppning. I avhandlingens två första studier värderade vi en metod att, med minimalt obehag för barnet, bedöma blåsfunktionen. Detta för att kunna skilja ut de barn som behöver genomgå mer avancerade undersökningar och få hjälp med blåstömningen genom täta tappningar med kateter, sa kallad ren intermittent kateterisering, RIK. När vi jämförde resultatet av testet för 50 nyfödda med ryggmärgsbråck med samma undersökning av 50 friska nyfödda fann vi stora skillnader. Mest tydligt var att de flesta nyfödda med ryggmärgsbråck (69%) men inga friska nyfödda läckte urin när man tryckte över blåsan. Av nyfödda med ryggmärgsbråck kissade de flesta (74%) inte med stråle vilket alla friska nyfödda gjorde. Att inte kissa med stråle talade också starkt för att barnet skulle komma att behöva hjälp med RIK för att tomma blåsan vid ett ars ålder, och då sannolikt livet ut. Sammantaget visade avhandlingens två första arbeten att den metod för bedömning av blåsfunktion vi undersökt kan användas för att styra uppföljning och behandling av nyfödda med ryggmärgsbråck. Avhandlingens tredje studie visade att aktiv uppföljning av barnen enligt ett nationellt vårdprogram lyckades förhindra njurskador hos de flesta, men att höga tryck i urinblåsan och återkommande urinvägsinfektioner ökade risken för skador. Även familjernas förmåga att i en pressad vardag klara av att genomföra de ofta krävande behandlingar och undersökningar som rekommenderas verkade vara viktig för att förhindra njurskador. Stöttning av familjerna är därför viktig. Avhandlingens fjärde arbete berörde tarmen som nästan alltid är påverkad vid ryggmärgsbråck, med risk för svår förstoppning och avföringsläckage. Detta har påtaglig påverkan på barnen och deras familjer. En tredjedel av de 107 familjerna i vår enkätundersökning i Sverige och Norge (barn 6-16 år) beskrev att man fått avstå från aktiviteter såsom resor på grund av barnets tarmproblem och de barn som hade avföringsläckage rapporterade tydligt lägre livskvalitet än andra. Trots denna allvarliga påverkan finns det hittills inga studier som jämför de olika behandlingar som barnet kan använda. I vår enkät kartlade vi därför vilka metoder som användes och hur bra de fungerade. Vi ställde frågor till både barn och föräldrar, särskilt om avföringsläckage, hur nöjd man var med metoden, barnens livskvalitet och självständighet på toaletten. Det var utifrån svaren tydligt att båda de vanligaste typerna av tarmsköljning var effektiva men tidskrävande och svara för barn och ungdomar att klara att utföra på egen hand. Ingen metod visade sig överlägsen den andra men de barn som klarade att skota tarmtomningen själva skattade sin livskvalitet klart högre än övriga. Vi drar därför slutsatsen att det är viktigt att vårdpersonal diskuterar de olika behandlingsalternativen med barn och föräldrar, och tillsammans med dem väljer den metod som passar det enskilda barnet bäst. Då skapas bästa förutsättningar för att gemensamt arbeta vidare för att uppnå största möjliga självständighet. Självständiga individer, med friska njurar och utan urin- och avföringsinkontinens upplever högre livskvalitet och behöver mindre sjukvård och andra samhällsinsatser. Det behövs mer forskning för att utveckla existerande och nya metoder att hantera de allvarliga komplikationer som riskerar att drabba barn och vuxna med ryggmärgsbråck.

This textbook provides a guide to reconstructive surgery of genitourethral problems in male patients. The first section covers all aspects of urethral reconstruction, including the functional anatomy of the urethra, etiology, epidemiology, and demographic differences in urethral pathology. The second section focuses on surgical reconstruction of penile and scrotal anomalies and dysfunctions. Textbook of Male Genitourethral Reconstruction aims to aid the management of male genitourethral reconstruction patients by reviewing the recent advancements in technology and surgical technique. This book is relevant to urologists, plastic and reconstructive surgeons, medical students, and health care professionals working within urology and plastic surgery.Chapter “Tissue Transfer Techniques in the Management of Urethral Stricture Disease: Flaps and Grafts” is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com.