The 5 Minute Urology Consult

3086 Pages·2014·29.15 MB·English

by  Leonard G. Gomella (ed.)

The
5-Minute
Urology
Consult
3RD EDITION Editor-in-Chief
Leonard G. Gomella, MD, FACS
The Bernard W. Godwin Professor of Prostate Cancer
Chairman
Department of Urology
Sidney Kimmel Medical College
Associate Director, Jefferson Sidney Kimmel Cancer Center
Clinical Director, Jefferson Sidney Kimmel Cancer Network
Thomas Jefferson University
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
Acquisitions Editor: Keith Donnellan
Product Development Editor: Brendan Huffman
Production Project Manager: David Saltzberg
Design Coordinator: Teresa Mallon
Senior Manufacturing Coordinator: Beth Welsh
Strategic Marketing Manager: Daniel Dressler
Production Service: Aptara, Inc.
Third Edition
Copyright © 2015 Wolters Kluwer Health
Second Edition © 2010 by Lippincott Williams & Wilkins, a Wolters Kluwer business
First Edition © 2000 by Lippincott Williams & Wilkins
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9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
The 5-minute urology consult / editor-in-chief, Leonard G. Gomella ; associate editors, Gerald Andriole [and six others]. –
Third edition.
p. ; cm.
Five minute urology consult
Includes bibliographical references and index.
ISBN 978-1-4511-8998-8 (alk. paper)
I. Gomella, Leonard G., editor. II. Title: Five minute urology consult.
[DNLM: 1. Urologic Diseases–Handbooks. WJ 39]
RC872.9
616.6–dc23
2014037959
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warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each
patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication
history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance
and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of
this work including all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional verification of
medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made
and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are
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among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or
contradictions, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range.
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LWW.com
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."
SPANISH PROVERB
PREFACE
I
am very pleased to present the third edition of The 5-Minute Urology Consult. The first
edition was released almost 15 years ago, with the second edition published in 2010. The
continuing advances in urology lead to this much-needed 2015 update. The goal of this book
is to provide the reader with useful information in a quick reference format to help with the
everyday care of patients with urologic problems. This third edition has undergone extensive
editing and updating to reflect the most current data possible at the time of publication.
Urologic diseases and conditions are common problems seen by all health care providers.
Almost one-third of all congenital disorders involve the genitourinary system, and the urinary
tract accounts for almost 25% of all solid tumors in adults. While this book is written
primarily for urologists, any health care practitioner who deals with urologic complaints and
conditions should find the book a useful resource. Students of urology, residents and fellows
preparing for oral and written in-service examination, and practicing urologists preparing for
certification examinations will find the book a useful study aid. While primarily written for
practitioners in the United States, the table of contents has been reviewed by our
international editorial board, which represent more than three dozen countries, in an attempt
to capture as many diseases and conditions as possible for international readers.
The broad array of topics addressed in this book is based on reviews of published literature,
major textbooks, grand rounds case presentations, validated Internet resources, and actual
patient consultations. Topics are meant to represent “real-world” clinical questions from very
broad to very specific topics. Some of the topics may appear redundant, such as Section I
topics “Scrotum and testicle, mass” and “Testis, tumor and mass, adult, general
considerations.” There is a deliberate reason for this, namely, to frame the thought process to
differentiate scrotal masses from testicular masses when the presenting problem is not clear.
If it is clearly a testicular mass, then the one topic deals effectively with that setting. If it is
not a clear mass in the testicle, the reader can approach the problem more broadly in terms of
a mass within the scrotum that may or may not involve the testicle. Coverage includes adult
and pediatric urology, as well as subspecialty areas of urology such as urologic oncology,
endourology, female urology, neurourology, andrology, infectious diseases, and renal
transplantation. It represents a core of essential “must-know” and practical information
specifically written for the field of urology. While some surgical techniques are discussed, this
is not meant to be a comprehensive urologic surgical text. Numerous high-quality
publications address the finer points of urologic surgery. This book addresses pre and post
operative care as well as some intra-operative techniques; however the focus is on more
global patient management issues.
I am often surprised when asked why medical books such as this are even necessary as a
reference in the modern world because there is so much information readily available on
devices such as smartphones via the Internet. While the reality is that virtually any topic can
be searched for on the Internet, the ability to sort through the information presented, confirm
the validity, and rapidly find the specific information needed is often very time-consuming
and can be prone to error. Multiple studies have shown that many websites can contain
erroneous, misleading, or out-of-date information. Readers of this book can be assured that
the information presented is held to the highest standards possible, as it is written, reviewed,
and further edited primarily by academic urologists and other academic specialists. Every
effort is made to present the most up-to-date standards of care at the time of publication.
This book, a member of the popular “5-Minute Consult” series published by Wolters Kluwer
Health, generally follows the organizational formatting of the other books in the series.
However, there are notable exceptions, as this book is focused on a primarily surgical
subspecialty. Section I: Urologic Diseases and Conditions provides information on more
than 300 major topics in the field of urology. The style of this section, while similar to the
other books in the series, focuses more attention on the surgical management, where
appropriate. Furthermore, evidence-based medicine references, standard fare in the “5-Minute
Consult” series, are included in this urology edition. This is representative of the trend in the
field of medicine to assign “levels of evidence” to treatment recommendations (see page ix for
a further discussion). A challenge with any surgical discipline is that, when reviewing
published literature, this type of information is not as well represented as in other medical
disciplines. The reader will note that in this edition, the use of evidence-based medicine is
identified in chapters as appropriate. Many topics are further supported by algorithms and
the enhnaced image library available in the ebook version provided along with the print
version. Both ICD-9 and preliminary high level ICD-10 codes have been incorporated in
preparation for the rollout of ICD-10 in late 2015.
Section II: Short Topics: A to Z consists of more than 1,300 diseases, conditions,
presenting complaints, or key concepts in the field that the practitioner must be aware of but
may not be worthy of a complete 2-page chapter. Section III has been greatly expanded and
now features nearly 90 visual algorithms to enhance many more clinically relevant topics.
Section IV is dedicated exclusively to a core discipline in our field, Urinalysis and Urine
Studies. Section V: Alternative and Complementary Urologic Therapies is a focused
review that is of interest to both patients and caregivers alike. Section VI: Urologic Drug
Reference is a very unique collection of information on hundreds of drugs used in urologic
practice in the United States as well as some traditionally nonurologic medications that are
clinically significant to the urologic practitioner. Additional urologic applications not often
found on the package insert for “off-label” use in daily care are included for many
medications. These “off-label” applications are noted on the basis of published literature with
additional input and the personal observations of the authors and editors. Finally, Section
VII: Reference Tables is a collection of useful reference information and forms. A media and
image collection is available in the ebook version of this book. Please see information inside
front cover on how to access this content.
In any project of this magnitude, there are numerous individuals responsible for its success.
I would like to thank the following individuals who provided the initial guidance in 1996 to
develop the first urology version of the 5-Minute Consult: Lippincott Williams & Wilkins
editors Carroll Cann and Craig Percy, and an early pioneer of the 5-Minute Consult concept,
Dr. Mark Dambro. Thanks to my administrative assistants Denise Tropea and Barbara Devine,
who provided key support to keep the contributors and this edition organized. A special
thanks to the more than 370 authors and editors who took the time to contribute to this
edition and the numerous contributors to the previous editions that laid a strong foundation
for this third update. To my colleagues who served as Associate, Consulting, Specialty and
International Editors, my most sincere gratitude and appreciation for the time you took to
recruit authors, create and review content. It is also with great sadness that one of our
international editors and an icon in the field of Urology, Professor John Fitzpatrick passed
away during the completion of this book. He will be missed by all but his numerous
contributions to our field will live on.
Residents from the Department of Urology of Thomas Jefferson University and from the
University of West Virginia deserve special acknowledgement. They supported the content of
both Section II “Short Topics" and Section III “Algorithms." Their names appear in the
contributor listing as having been authors but are not specifically recognized for their work in
these sections. Now however, they are.
The editorial and production staff at Wolters Kluwer Health have distinguished themselves
as the best publishing team I have had the opportunity to work with. My personal
interactions with the company and their willingness to discuss any and all issues relating to
the book are testimony to their corporate philosophy in respecting the authors’ opinions to
develop the best educational products possible in the field of medicine. Brian Brown, Keith
Donnellan, and Brendan Huffman are the best partners a medical author could hope to work
with. In the final production stages, David Saltzberg and Harish Kumar kept everything
moving to stay on schedule. Special thanks to Philadelphia-based friend and professional
photographer Robert Neroni, who captured the spirit of urology in our cover photo.
Our children, Leonard, Patrick, Andrew, and Michael, deserve credit for their
encouragement and patience over the many years of my time spent working on this project.
In this edition, i am very proud that a few of the boys were actually able to make tangible
professional contributions.
Most importantly, I would like to thank my wife, Tricia, with the usual and customary
accolades that authors share about their spouses in acknowledging the love and support
provided. However, her attention to detail as a behind-the-scenes editorial partner and skilled
reviewer for final content of this book added a degree of accuracy that I could never have
accomplished alone.
Please contact me if you have corrections or suggestions on ways to improve future editions
of the book. I hope that The 5-Minute Urology Consult will provide useful information to allow
all of us to care for our urology patients in the best way possible.
LEONARD G. GOMELLA, MD
[email protected]
www.urologyquestion.com
EVIDENCE-BASED MEDICINE
E
vidence-based medicine (EBM) is generally defined as the use of current best medical
evidence to aid in making decisions about the care of an individual patient. While the
ultimate decision-making process for or against a given treatment must be made between the
patient and the health care provider, EBM seeks to assess the quality of evidence that a
specific course of action is based on. The underlying principle is the evaluation of medical
interventions and the literature that supports these interventions in a systematic and
organized fashion. Since its introduction as a concept in the modern medicine over 30 years
ago, there has been increased emphasis on this concept in daily patient care. While there are
currently many different systems of EBM, we have adopted the 5-Minute Clinical Consult
standard of the “SORT Taxonomy” from the American Academy of Family Physicians. The
key components are summarized later. A full review of this article can be viewed at
http://www.aafp.org/afp/20040201/548.html. Throughout this edition of The 5-Minute
Urology Consult, these evidence-based recommendations can be found. However, we recognize
that in a primarily surgical-based specialty such as urology, this area is not yet as well
defined as in more general areas of medical practice. As an illustrative example in a chapter
on hypertension, the EBM recommendation might read:
“Use thiazide diuretics as a first-line agent for the treatment of essential
hypertension, as it has the greatest efficacy in preventing the vascular
complications of hypertension (5)[A].”
The A designation, as noted in the algorithm later, implies this recommendation is based on
the highest-quality, patient-oriented evidence, and should be followed. The number 5 refers
to the source, which would be listed under the “References” heading as reference #5.
Recommendations that are level A evidence are shaded blue in the text.
EDITORS

EDITOR-IN-CHIEF
Leonard G. Gomella, MD, FACS
The Bernard W. Godwin Professor of Prostate Cancer
Chairman
Department of Urology
Sidney Kimmel Medical College
Associate Director, Jefferson Sidney Kimmel Cancer Center
Clinical Director Jefferson Sidney Kimmel Cancer Network
Thomas Jefferson University
Philadelphia, Pennsylvania
ASSOCIATE EDITORS
Gerald L. Andriole, MD, FACS
Robert K. Royce Distinguished Professor
Chief of Urologic Surgery
Division of Urologic Surgery
Washington University
St. Louis, Missouri
Arthur L. Burnett, II, MD, MBA, FACS
Patrick C. Walsh Professor of Urology
Department of Urology
The James Buchanan Brady Urological Institute
Baltimore, Maryland
Robert C. Flanigan, MD, FACS
Albert J. Jr. and Claire R. Speh Professor
Chair, Department of Urology
Loyola University Stritch School of Medicine
Chicago (Maywood), Illinois
Thomas E. Keane, MB, ChB, FRCSI, FACS
Professor and Chairman
Department of Urology
The Medical University of South Carolina
Charleston, South Carolina
Harry P. Koo, MD, FAAP, FACS