The 5 Minute Urology Consult

1083 Pages·2014·16.59 MB·English

by  Leonard G. Gomella

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The
5-Minute
Urology
Consult
Editor-in-Chief
3RD EDITION
Leonard G. Gomella, MD, FACS
TheBernardW.GodwinProfessorofProstateCancer
Chairman
DepartmentofUrology
SidneyKimmelMedicalCollege
AssociateDirector,JeffersonSidneyKimmelCancerCenter
ClinicalDirector,JeffersonSidneyKimmelCancerNetwork
ThomasJeffersonUniversity
Philadelphia,Pennsylvania
Associate Editors
Gerald L. Andriole, MD, FACS
Arthur L. Burnett, II, MD, MBA, FACS
Robert C. Flanigan, MD, FACS
Thomas E. Keane, MB, ChB, FRCSI, FACS
Harry P. Koo, MD, FAAP, FACS
Judd W. Moul, MD, FACS
Raju Thomas, MD, MHA, FACS
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The5-minuteurologyconsult/editor-in-chief,LeonardG.Gomella;associateeditors,GeraldAndriole[and
sixothers].–Thirdedition.
p. ; cm.
Fiveminuteurologyconsult
Includesbibliographicalreferencesandindex.
ISBN978-1-4511-8998-8(alk.paper)
I.Gomella,LeonardG.,editor. II.Title:Fiveminuteurologyconsult.
[DNLM:1.UrologicDiseases–Handbooks.WJ39]
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To Tricia, Leonard, Patrick, Andrew, and
Michael, for their understanding and
encouragement, and with appreciation
for their individual accomplishments.
“En tierra de los ciegos el tuerto es rey.”
SPANISHPROVERB
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PREFACE
Iam very pleased to present the third edition of The 5-Minute allyanytopiccanbesearchedforontheInternet,theabilitytosort
UrologyConsult.Thefirsteditionwasreleasedalmost15years throughtheinformationpresented,confirmthevalidity,andrapidly
ago,withthesecondeditionpublishedin2010.Thecontinuing findthespecificinformationneededisoftenverytime-consuming
advancesinurologyleadtothismuch-needed2015update.The andcanbepronetoerror.Multiplestudieshaveshownthatmany
goalofthisbookistoprovidethereaderwithusefulinformationin websites can contain erroneous, misleading, or out-of-date infor-
aquickreferenceformattohelpwiththeeverydaycareofpatients mation.Readersofthisbookcanbeassuredthattheinformation
withurologicproblems.Thisthirdeditionhasundergoneextensive presented is held to the highest standards possible, as it is writ-
editing and updating to reflect the most current data possible at ten,reviewed,andfurthereditedprimarilybyacademicurologists
thetimeofpublication. andotheracademicspecialists.Everyeffortismadetopresentthe
Urologicdiseasesandconditionsarecommonproblemsseenby mostup-to-datestandardsofcareatthetimeofpublication.
allhealthcareproviders.Almostone-thirdofallcongenitaldisorders Thisbook,amemberofthepopular“5-MinuteConsult’’ series
involvethegenitourinarysystem,andtheurinarytractaccountsfor publishedbyWoltersKluwerHealth,generallyfollowstheorgani-
almost25%ofallsolidtumorsinadults.Whilethisbookiswritten zationalformattingoftheotherbooksintheseries.However,there
primarilyforurologists,anyhealthcarepractitionerwhodealswith arenotableexceptions,asthisbookisfocusedonaprimarilysurgi-
urologiccomplaintsandconditionsshouldfindthebookauseful calsubspecialty.SectionI:UrologicDiseasesandConditions
resource.Studentsofurology,residentsandfellowspreparingfor providesinformationonmorethan300majortopicsinthefieldof
oral and written in-service examination, and practicing urologists urology.Thestyleofthissection,whilesimilartotheotherbooks
preparing for certification examinations will find the book a use- intheseries,focusesmoreattentiononthesurgicalmanagement,
fulstudyaid.WhileprimarilywrittenforpractitionersintheUnited where appropriate. Furthermore, evidence-based medicine refer-
States,thetableofcontentshasbeenreviewedbyourinternational ences,standardfareinthe“5-MinuteConsult’’series,areincluded
editorialboard,whichrepresentmorethanthreedozencountries,in inthisurologyedition.Thisisrepresentativeofthetrendinthefield
anattempttocaptureasmanydiseasesandconditionsaspossible ofmedicinetoassign“levelsofevidence’’totreatmentrecommen-
forinternationalreaders. dations(seepageixforafurtherdiscussion).Achallengewithany
The broad array of topics addressed in this book is based on surgicaldisciplineisthat,whenreviewingpublishedliterature,this
reviewsofpublishedliterature,majortextbooks,grandroundscase type of information is not as well represented as in other medi-
presentations,validatedInternetresources,andactualpatientcon- caldisciplines.Thereaderwillnotethatinthisedition,theuseof
sultations.Topicsaremeanttorepresent“real-world’’clinicalques- evidence-basedmedicineisidentifiedinchaptersasappropriate.
tions from very broad to very specific topics. Some of the topics Manytopicsarefurthersupportedbyalgorithmsandtheenhnaced
mayappearredundant,suchasSectionItopics“Scrotumandtes- imagelibraryavailableintheebookversionprovidedalongwiththe
ticle, mass’’ and “Testis, tumor and mass, adult, general consid- printversion.BothICD-9andpreliminaryhighlevelICD-10codes
erations.’’ There is a deliberate reason for this, namely, to frame havebeenincorporatedinpreparationfortherolloutofICD-10in
thethoughtprocesstodifferentiatescrotalmassesfromtesticular late2015.
masses when the presenting problem is not clear. If it is clearly SectionII:ShortTopics:AtoZconsistsofmorethan1,300
a testicular mass, then the one topic deals effectively with that diseases,conditions,presentingcomplaints,orkeyconceptsinthe
setting.Ifitisnotaclearmassinthetesticle,thereadercanap- fieldthatthepractitionermustbeawareofbutmaynotbeworthy
proach the problem more broadly in terms of a mass within the of a complete 2-page chapter. Section III has been greatly ex-
scrotum that may or may not involve the testicle. Coverage in- pandedandnowfeaturesnearly90visualalgorithmstoenhance
cludes adult and pediatric urology, as well as subspecialty areas manymoreclinicallyrelevanttopics.SectionIVisdedicatedex-
ofurologysuchasurologiconcology,endourology,femaleurology, clusively to a core discipline in our field, Urinalysis and Urine
neurourology,andrology,infectiousdiseases,andrenaltransplan- Studies. Section V: Alternative and Complementary Uro-
tation.Itrepresentsacoreofessential“must-know’’ andpractical logic Therapies is a focused review that is of interest to both
informationspecificallywrittenforthefieldofurology.Whilesome patients and caregivers alike. Section VI: Urologic Drug Ref-
surgicaltechniquesarediscussed,thisisnotmeanttobeacompre- erenceisaveryuniquecollectionofinformationonhundredsof
hensiveurologicsurgicaltext.Numeroushigh-qualitypublications drugsusedinurologicpracticeintheUnitedStatesaswellassome
addressthefinerpointsofurologicsurgery.Thisbookaddresses traditionally nonurologic medications that are clinically significant
preandpostoperativecareaswellassomeintra-operativetech- totheurologicpractitioner.Additionalurologicapplicationsnotof-
niques;howeverthefocusisonmoreglobalpatientmanagement tenfoundonthepackageinsertfor“off-label’’useindailycareare
issues. includedformanymedications.These“off-label’’ applicationsare
I am often surprised when asked why medical books such as notedonthebasisofpublishedliteraturewithadditionalinputand
this are even necessary as a reference in the modern world be- thepersonalobservationsoftheauthorsandeditors.Finally,Sec-
cause there is so much information readily available on devices tion VII: Reference Tables is a collection of useful reference
suchassmartphonesviatheInternet.Whiletherealityisthatvirtu- informationandforms.Amediaandimagecollectionisavailablein
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vi (cid:2) (cid:2) (cid:2) Preface
theebookversionofthisbook.Pleaseseeinformationinsidefront opportunitytoworkwith.Mypersonalinteractionswiththecompany
coveronhowtoaccessthiscontent. and their willingness to discuss any and all issues relating to the
Inanyprojectofthismagnitude,therearenumerousindividuals bookaretestimonytotheircorporatephilosophyinrespectingthe
responsibleforitssuccess.Iwouldliketothankthefollowingin- authors’opinionstodevelopthebesteducationalproductspossible
dividualswhoprovidedtheinitialguidancein1996todevelopthe inthefieldofmedicine.BrianBrown,KeithDonnellan,andBren-
firsturologyversionofthe5-MinuteConsult:LippincottWilliams& dan Huffman are the best partners a medical author could hope
WilkinseditorsCarrollCannandCraigPercy,andanearlypioneer to work with. In the final production stages, David Saltzberg and
ofthe5-MinuteConsultconcept,Dr.MarkDambro.Thankstomy Harish Kumar kept everything moving to stay on schedule. Spe-
administrativeassistantsDeniseTropeaandBarbaraDevine,who cialthankstoPhiladelphia-basedfriendandprofessionalphotog-
providedkeysupporttokeepthecontributorsandthiseditionor- rapherRobertNeroni,whocapturedthespiritofurologyinourcover
ganized.Aspecialthankstothemorethan370authorsandeditors photo.
whotookthetimetocontributetothiseditionandthenumerous Our children, Leonard, Patrick, Andrew, and Michael, deserve
contributorstothepreviouseditionsthatlaidastrongfoundation creditfortheirencouragementandpatienceoverthemanyyears
for this third update. To my colleagues who served as Associate, ofmytimespentworkingonthisproject.Inthisedition,iamvery
Consulting, Specialty and International Editors, my most sincere proudthatafewoftheboyswereactuallyabletomaketangible
gratitudeandappreciationforthetimeyoutooktorecruitauthors, professionalcontributions.
createandreviewcontent.Itisalsowithgreatsadnessthatoneof Most importantly, I would like to thank my wife, Tricia, with
our international editors and an icon in the field of Urology, Pro- theusualandcustomaryaccoladesthatauthorsshareabouttheir
fessorJohnFitzpatrickpassedawayduringthecompletionofthis spousesinacknowledgingtheloveandsupportprovided.However,
book. He will be missed by all but his numerous contributions to herattentiontodetailasabehind-the-sceneseditorialpartnerand
ourfieldwillliveon. skilled reviewer for final content of this book added a degree of
ResidentsfromtheDepartmentofUrologyofThomasJefferson accuracythatIcouldneverhaveaccomplishedalone.
UniversityandfromtheUniversityofWestVirginiadeservespecial Please contact me if you have corrections or suggestions on
acknowledgement.TheysupportedthecontentofbothSectionII ways to improve future editions of the book. I hope that The 5-
“ShortTopics”andSectionIII“Algorithms.”Theirnamesappearin MinuteUrologyConsult willprovideusefulinformationtoallowall
thecontributorlistingashavingbeenauthorsbutarenotspecifically ofustocareforoururologypatientsinthebestwaypossible.
recognizedfortheirworkinthesesections.Nowhowever,theyare. LEONARDG.GOMELLA,MD
TheeditorialandproductionstaffatWoltersKluwerHealthhave [email protected]
distinguishedthemselvesasthebestpublishingteamIhavehadthe www.urologyquestion.com
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EVIDENCE-BASED MEDICINE
Evidence-based medicine (EBM) is generally defined as the ommendationscanbefound.However,werecognizethatinapri-
use of current best medical evidence to aid in making deci- marily surgical-based specialty such as urology, this area is not
sionsaboutthecareofanindividualpatient.Whiletheultimate yetaswelldefinedasinmoregeneralareasofmedicalpractice.
decision-makingprocessfororagainstagiventreatmentmustbe Asanillustrativeexampleinachapteronhypertension,theEBM
madebetweenthepatientandthehealthcareprovider,EBMseeks recommendationmightread:
toassessthequalityofevidencethataspecificcourseofaction
isbasedon.Theunderlyingprincipleistheevaluationofmedical “Use thiazide diuretics as a first-line agent for the
interventionsandtheliteraturethatsupportstheseinterventionsin treatmentofessentialhypertension,asithasthegreat-
asystematicandorganizedfashion.Sinceitsintroductionasacon- estefficacyinpreventingthevascularcomplications
ceptinthemodernmedicineover30yearsago,therehasbeenin- ofhypertension(5)[A].’’
creasedemphasisonthisconceptindailypatientcare.Whilethere
arecurrentlymanydifferentsystemsofEBM,wehaveadoptedthe TheAdesignation,asnotedinthealgorithmlater,impliesthis
5-MinuteClinicalConsultstandardofthe“SORTTaxonomy’’ from recommendationisbasedonthehighest-quality,patient-oriented
theAmericanAcademyofFamilyPhysicians.Thekeycomponents evidence, and should be followed. The number 5 refers to the
are summarized later. A full review of this article can be viewed source, which would be listed under the “References’’ heading
athttp://www.aafp.org/afp/20040201/548.html.Throughoutthis asreference#5.RecommendationsthatarelevelAevidenceare
editionofThe5-MinuteUrologyConsult,theseevidence-basedrec- shadedblueinthetext.
Strengthofrecommendation Definition
A Recommendationbasedonconsistentandgood-qualitypatient-orientedevidence.
(cid:2)
Highest-quality resource, such as a systematic review. This is a summary of the medical literature on a given topic
thatusesstrict,explicitmethodstoperformathoroughsearchoftheliteratureandthenprovidesacriticalappraisalof
theindividualstudiesconcludinginarecommendation.TheCochranereviewsareconsideredbymanytobethemost
prestigiouscollectionofsystematicreviews(www.cochrane.org).
B Recommendationbasedoninconsistentorlimited-qualitypatient-orientedevidence.
(cid:2)
Thisimpliesthatthedatareferencedarederivedfromhigh-qualityrandomizedcontrolledtrialsthatwereperformedto
minimizebiasintheiroutcome.Biasisanythingthatmayinterferewiththetruth;inthemedicalliterature,itisoften
unintentionalbutismorecommonthanweappreciate.Inshort,alwaysassumethatsomedegreeofbiasexistsinany
researchendeavor.
C Recommendationbasedonconsensus,usualpractice,opinion,disease-orientedevidence,orcaseseries
forstudiesofdiagnosis,treatment,prevention,orscreening.
(cid:2)
Thisimpliesthatthereferenceuseddoesnotmeethet“A’’or“B’’requirements;theseareoftentreatmentsrecommended
byconsensusgroups(suchastheAmericanCancerSociety).Insomecases,theymaybethestandardofcare.But
implicitinagroup’srecommendationsisthebiasofthegrouporauthorthatsupportsthereference.
ModifiedfromDominoFJ,ed.The5-MinuteClinicalConsult2010.Philadelphia:LippincottWilliams&Wilkins;2009.
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EDITORS
EDITOR-IN-CHIEF Judd W. Moul, MD, FACS
JamesH.Semans,MDProfessorofSurgery
Leonard G. Gomella, MD, FACS DivisionofUrologicSurgery
TheBernardW.GodwinProfessorofProstateCancer DukeUniversityMedicalCenter
Chairman Durham,NorthCarolina
DepartmentofUrology
Raju Thomas, MD, MHA, FACS
SidneyKimmelMedicalCollege
ProfessorandChairman
AssociateDirector,JeffersonSidneyKimmelCancer
DepartmentofUrology
Center
TulaneUniversitySchoolofMedicine
ClinicalDirectorJeffersonSidneyKimmelCancerNetwork
NewOrleans,Louisiana
ThomasJeffersonUniversity
Philadelphia,Pennsylvania
SECTION EDITORS
ASSOCIATE EDITORS T. Ernesto Figueroa, MD, FAAP, FACS
ClinicalAssociateProfessor
Gerald L. Andriole, MD, FACS
SidneyKimmelMedicalCollege
RobertK.RoyceDistinguishedProfessor Chief,DivisionofPediatricUrology
ChiefofUrologicSurgery Nemours/AlfredI.DuPontHospitalforChildren
DivisionofUrologicSurgery Wilmington,Delaware
WashingtonUniversity Uropharmacology,Pediatric
St.Louis,Missouri
Deborah Tova Glassman, MD
Arthur L. Burnett, II, MD, MBA, FACS ClinicalAssistantProfessor
PatrickC.WalshProfessorofUrology DepartmentofUrology
DepartmentofUrology SidneyKimmelMedicalCollege
TheJamesBuchananBradyUrologicalInstitute ThomasJeffersonUniversity
Baltimore,Maryland Philadelphia,Pennsylvania
ShortTopics
Robert C. Flanigan, MD, FACS
Kevin R. Loughlin, MD, MBA, FACS
AlbertJ.Jr.andClaireR.SpehProfessor
ProfessorofSurgery(Urology)
Chair,DepartmentofUrology
DivisionofUrology
LoyolaUniversityStritchSchoolofMedicine
Brigham&Women’s Hospital
Chicago(Maywood),Illinois
Boston,Massachusetts
Thomas E. Keane, MB, ChB, Uropharmacology
FRCSI, FACS
Franklin C. Lowe, MD, MPH
ProfessorandChairman
ProfessorofClinicalUrology
DepartmentofUrology
ColumbiaUniversityCollegeofPhysicians&Surgeons
TheMedicalUniversityofSouthCarolina
NewYork,NewYork
Charleston,SouthCarolina
Alternative&ComplementaryUrologicTherapies
Harry P. Koo, MD, FAAP, FACS J. Ryan Mark, MD
ChiefofPediatricMedicine Chief
DepartmentofUrology DepartmentofUrology
JosephM.SanzariChildren’s Hospital ThomasJeffersonUniversity
HackensackUniversityMedicalCenter Philadelphia,Pennsylvania
Hackensack,NewJersey VideoEditor
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