Section I: Anatomy Surgical Anatomy of the Retroperitoneum, Kidneys, and Ureters Anatomy of the Lower Urinary Tract and Male Genitalia Section II: Clinical Decision Making Evaluation of the Urologic Patient: History, Physical Examination, and Urinalysis Urinary Tract Imaging: Basic Principles Outcomes Research Section III: Basics of Urologic Surgery Basic Instrumentation and Cystoscopy Basics of Laparoscopic Urologic Surgery Section IV: Infections and Inflammation Infections of the Urinary Tract-A. Schaeffer Inflammatory Conditions of the Male Genitourinary Tract Interstitial Cystitis and Related Disorders Sexually Transmitted and Associated Diseases Urological Implications of AIDS and Related Conditions Cutaneous Diseases of the External Genitalia Tuberculosis and Other Opportunistic Infections of the Genitourinary System Section V: Molecular and Cellular Biology Basic Principles of Immunology Molecular Genetics and Cancer Biology Tissue Engineering Perspectives for Reconstructive Surgery Section VI: Reproductive and Sexual Function Male Reproductive Physiology Male Infertility Surgical Management of Male Infertility Physiology of Erectile Dysfunction: Pathophysiology, Evaluation, Nonsurgical Management Epidemiology, Evaluation, and Nonsurgical Management of Erectile Dysfunction Prosthetic Surgery for Erectile Dysfunction Vascular Surgery for Erectile Dysfunction Peyronie's Disease Priapism Androgen Deficiency in the Aging Male Female Sexual Function and Dysfunction Section VII: Male Genitalia Neoplasms of the Testis Surgery of Testicular Tumors Tumors of the Penis Surgery of Penile and Urethral Carcinoma Surgery of the Penis and Urethra Surgery of the Scrotum and Seminal Vesicles Section VIII: Renal Physiology and Pathophysiology Renal Physiology and Pathophysiology Renovascular Hypertension Section IX: Upper Urinary Tract Obstruction and Trauma Pathophysiology of Obstruction Management of Upper Urinary Tract Obstruction Upper Urinary Tract Trauma Section X: Renal Failure and Transplantation Renal Transplantation Etiology, Pathogenesis, and Management of Renal Failure Section XI: Urinary Lithiasis and Endourology Urinary Lithiasis: Etiology, Epidemiology, and Pathophysiology Evaluation and Medical Management of Urinary Lithiasis Surgical Management of Upper Urinary Tract Calculi Ureteroscopy and Retrograde Ureteral Access Percutaneous Approaches to the Upper Urinary Tract Section XII: Neoplasms of the Upper Urinary Tract Renal Tumors Urothelial Tumors of the Upper Urinary Tract Urothelial Tumors of the Renal Pelvis and Ureter Open Surgery of the Kidney Laparoscopic Surgery of the Kidney Ablative Therapy for Renal Tumors Section XIII: The Adrenals Pathophysiology, Evaluation, and Medical Management of Adrenal Disorders Surgery of the Adrenals Section XIV: Urine Transport, Storage, and Emptying Physiology and Pharmacology of the Renal Pelvis and Ureter Physiology and Pharmacology of the Bladder and Urethra Pathophysiology, Categorization, and Management of Voiding Dysfunction Urodynamic and Video dynamic Evaluation of Voiding Dysfunction Neuromuscular Dysfunction of the Lower Urinary Tract Urinary Incontinence: Epidemiology, Pathophysiology, Evaluation, and Overview of Management The Overactive Bladder Pharmacologic Management of Storage and Emptying Failure Conservative Management of Urinary Incontinence: Behavioral and Pelvic Floor Therapy, Urethral and Pelvic Devices Electrical Stimulation and Neuromodulation in Storage and Emptying Failure Retropubic Suspension Surgery for Incontinence in Women Vaginal Reconstructive Surgery for Sphincteric Incontinence Pubovaginal Slings Tension-Free Vaginal Tape Procedures Injection Therapy for Urinary Incontinence Additional Treatment for Storage and Emptying Failure Geriatric Voiding Dysfunction and Urinary Incontinence Urinary Tract Fistulae Bladder and Urethral Diverticula Surgical Procedures for Sphincteric Incontinence in the Male: The Artificial Genitourinary Sphincter Perineal Sling Procedures Section XV: Bladder Lower Genitourinary Calculi and Trauma Urothelial Tumors of the Bladder Management of Superficial Bladder Cancer Management of Metastatic and Invasive Bladder Cancer Surgery of Bladder Cancer Laparoscopic Bladder Surgery Use of Intestinal Segments in Urinary Diversion Cutaneous Continent Urinary Diversion Orthotopic Urinary Diversion Genital and Lower Urinary Tract Trauma Lower Urinary Tract Calculi Section XVI: Prostate Molecular Biology, Endocrinology, and Physiology of the Prostate and Seminal Vesicles Etiology, Pathophysiology, and Epidemiology of Benign Prostatic Hyperplasia Natural History, Evaluation, and Nonsurgical Management of Benign Prostatic Hyperplasia Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia Retropubic and Superpubic Open Radical Prostatectomy Epidemiology, Etiology, and Prevention of Prostate Cancer Pathology of Prostatic Neoplasms Ultrasonography and Biopsy of the Prostate Tumor Markers in Prostate Cancer Early Detection, Diagnosis, and Staging of Prostate Cancer Definitive Therapy of Localized Prostate Cancer: Outcomes Expectant Management of Prostate Cancer Anatomic Retrograde Retropubic Prostatectomy Radical Perineal Prostatectomy Laparoscopic and Robotic Radical Prostatectomy and Pelvic Lymphadenectomy Radiation Therapy for Prostate Cancer Cryotherapy of Prostate Cancer Treatment of Locally Advanced Prostate Cancer Management of Rising Prostate-Specific Antigen after Definitive Therapy Hormonal Therapy for Prostate Cancer Management of Hormone-Resistant Prostate Cancer Section XVII: Pediatric Urology Normal and Anomalous Development of the Urinary Tract Renal Function in the Fetus Congenital Obstructive Uropathy Perinatal Urology Evaluation of Pediatric Urologic Patient Renal Disease in Childhood Urinary Tract Infections in Infants and Children Anomalies of the Kidney Renal Dysplasia and Cystic Disease of Kidney Anomalies and Surgery of the Ureteropelvic Junction Ectopic Ureter Vesicoureteral Reflux Prune-Belly Syndrome Exstrophy and Epispadias Complex Surgical Technique for One-Stage Exstrophy Reconstruction Bladder Anomalies in Children Posterior Urethral Valves and Other Urethral Anomalies Voiding Dysfunction in Children: Neurogenic and Non-neurogenic Urinary Tract Reconstruction Hypospadias Abnormalities of External Genitalia in Boys Abnormalities of Testis and Scrotum: Surgical Management Sexual Differentiation: Normal and Abnormal Surgical Management of Intersex Pediatric Oncology Pediatric Endourology and Laparoscopy Pediatric Genitourinary Trauma

Campbell-Walsh urology

https://pmj.bmj.com/content/postgradmedj/61/716/555.1.full.pdf

Bailey and Love's Short Practice of Surgery

Since 1945, we have operated on 786 patients with Klippel and Trénaunay's syndrome. Elongation of the impaired limb was invariably found while edema was present in 84%, varicose veins in 36%, and flat angiomata in 32%. Venography and surgical exploration have demonstrated malformation of the deep veins involving the popliteal vein in 51%; superficial femoral vein, 16%; both popliteal and superficial femoral veins; 29%; iliac veins, three per cent; and lower vena cava, one per cent. Good clinical results have been achieved following the surgical release of these deep veins in the lower limb. During childhood, when the difference in limb length is noteworthy, ligature of the popliteal vein of the shorter limb induces a compensating elongation. Klippel and Trénaunay's syndrome may be associated with lymphatic malformations, including lymphedema and malformation of the lymph vessels. Knowledge of the pathophysiology of these malformations of the deep veins enables a better understanding of the clinical manifestations of the condition, as well as the improved treatment of the serious vesical or rectal hemorrhage which occurs in one per cent of these patients.

Klippel and Trenaunayʼs syndrome: 768 operated cases

Cancer of the bladder

The potential to prevent type 2 diabetes in high-risk individuals by lifestyle intervention was established in several clinical trials. These studies had a strong focus on increased physical activity and dietary modification as well as weight reduction among overweight participants. The key issue seems to be a comprehensive approach to correct several risk factors simultaneously. Furthermore, long-term follow-up studies of lifestyle interventions lasting for a limited time period seem to have a long-lasting carry-over effect on risk factors and diabetes incidence (Table 1).

View this table:

Table 1 
Long-term effectiveness of diabetes prevention trials



The research evidence has inspired national and local authorities and health care providers all over the world to start programs and activities to prevent type 2 diabetes and its complications. Based on the experiences from the clinical trials, as well as from the “real world” implementation programs, the IMAGE (Development and Implementation of a European Guideline and Training Standards for Diabetes Prevention) Study Group collated information in a systematic manner. The IMAGE deliverables include a European evidence-based guideline for the prevention of type 2 diabetes, a toolkit for the prevention of type 2 diabetes in Europe, and the quality indicators for the prevention of type 2 diabetes in Europe.

What is needed now is political support to develop national action plans for diabetes prevention. The prerequisites for successful prevention activities include involvement of a number of stakeholders on the governmental and nongovernmental level as well as on different levels of health care. Furthermore, structures to identify high-risk individuals and manage intervention, follow-up, and evaluation have to be established.

Observational studies have provided firm evidence that multiple lifestyle-related factors either increase or decrease the risk of type 2 diabetes. Thus, in type 2 diabetes prevention, it is important to pay attention not only to one single factor such as obesity but …

Long-Term Benefits From Lifestyle Interventions for Type 2 Diabetes Prevention Time to expand the efforts

Background Urinary bladder carcinoma is common urological malignancy. Although epidemiological evidence favors role of occupational exposure to chemical carcinogen as the aetiological factor of bladder carcinoma, many cases arise with no obvious occupational exposure to chemical carcinogen. Tobacco and cigarette smoking is common in both rural and urban areas of Nepal. Objective The objective of this study was to determine the impact of smoking and age in urinary bladder carcinoma with related clinicopathological correlations. Method A total of 56 (44 males and 12 females) cases of urinary bladder cancer treated at Dhulikhel Hospital, Kathmandu University Teaching Hospital during time period of January 2004 to December 2013 were included in the study. Data of patients with Urinary bladder cancer were obtained from hospital records and evaluated for age, sex, history of smoking, clinical presentations, cystoscopic findings and histopathological characteristics. Results Out of 56 cases, 51 (91.1%) of the patients had hematuria. History of smoking was found in 44 patients. Smoking was found much higher in males (88%) than females (41.66%). Transitional cell carcinoma (TCC) was the most common histological variety, which was seen in 51 (91.07%) patients. The significant impact of smoking was found in terms of grade of TCC. Conclusion The incidence of bladder carcinoma is higher in male and TCC is the most common variety of Urinary bladder malignancy. History of smoking correlated with grade. Kathmandu Univ Med J 2013; 11(4): 292-295

Urinary bladder carcinoma: impact of smoking, age and its clinico-pathological spectrum.

Background Benign prostatic hyperplasia is a condition occurring in elderly men in which the prostate gland is enlarged, hence the condition also known as benign enlargement of prostate. Benign hyperplasia can lead to both obstructive and irritative symptoms. Transurethral resection of prostate (TURP) still remains the gold standard modality of surgical treatment of obstructive lower urinary tract symptoms due to Benign hyperplasia. Objectives The objective of this study was to evaluate the outcomes of TURP in large prostate (>80 grams) in comparison to small prostate (<80 grams) in terms of efficacy, safety and complications. Methods A total of 65 cases included in this prospective study, which were operated by a single surgeon with conventional monopolar TURP using standard technique. Intra -operative and post-operative complications, pre and post- operative quality of life (QoL) and international prostate symptom score (IPSS), operative time, time to removal of catheter and hospital stay were evaluated between small and large prostate gland volumes. Results

Outcomes of transurethral resection of the prostate in benign prostatic hyperplasia comparing prostate size of more than 80 grams to prostate size less than 80 grams.

Background Surgical site infections (SSI) are the common nosocomial infection in surgical patients, and are a significant source of postoperative morbidity resulting in increased hospital stay, morbidity and cost. Objective The objective of this study was to obtain the incidence of SSI and determine various risks factors influencing the SSI rate with special reference to the National Nosocomial Infections Surveillance System risk index in Kathmandu University Hospital, Kavre, Nepal. Method Six hundred and thirty eight patients who underwent various surgeries in Dhulikhel Hospital, Kathmandu University Hospital during a three-month period were included. Using a pre designed questionnaire with follow up to 30 days and in orthopedic cases, where metal implants were used as internal fixation devices, with follow up to 90 days data were collected. Infected cases were identified using Centre for Disease Control and Prevention definition for surgical site infections. Swabs were obtained from wounds and were processed without delay using standard microbiological methods. Result Overall SSI rate was 2.6%. The most common pathogen isolated was Escherichia coli (5 isolates, 29.4 %). The SSI rate was 0.0% for clean wounds, 2.9%, 15.3% and 18.7% for clean-contaminated, contaminated and dirty wounds respectively. Increased incidence of surgical site infections were associated with higher grades of wound, emergency surgeries, American Society of Anesthesiologists score >2 and increased in National Nosocomial Infections Surveillance System risk index. Conclusion The incidence of SSI in this study meets the standard of center for disease prevention and control. Increases in surgical wound class, National Nosocomial Infections Surveillance System risk index, American Society of Anesthesiologist score >2 and emergency surgeries were associated with increased SSI rates.

Incidence and Risk Factors of Surgical Site Infections in Kathmandu University Hospital, Kavre, Nepal

Women in nursing professions are at high risk for developing varicose veins as it requires physical work and prolonged standing. The aim of the study is to estimate the current prevalence of varicose veins among nurses at Dhulikhel Hospital and assess its risk factors. A cross sectional study was carried out among 181 female nurses from different clinical settings of Dhulikhel Hospital. A structured questionnaire was administered to gather the demographic, work related and medical history information. The participants underwent Doppler ultrasound for varicose veins confirmation. Varicose veins was defined as Doppler finding of reflux or vein diameter equal or greater than 5 mm. A total of 181 nurses participated in this study and 83 (46%) had varicose veins. The mean standing time was 4.28 (0.8) hours /day, mean sitting time was 1.28 (0.6) hours/day, mean walking time was 2.37 (0.8) hours/day. In the adjusted model the odds of having varicose veins was 27 times greater with every 1 hour increase in standing time per day (adjusted OR: 27.44; 95% CI 4.09–180.77; p-value <0.00). Varicose veins was prevalent among nurses’ at Dhulikhel Hospital. Prolonged standing was found to be a significant factor for varicose veins.

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Varicose veins and its risk factors among nurses at Dhulikhel hospital: a cross sectional study

Introduction: Varicose veins are swollen, tortuous, and sometimes painful veins that are filled with an abnormal collection of blood. Varicose veins are known to be common among professionals such as teachers, traffic police, nurses, shopkeepers, and bus conductors, who have to stand for a long time daily. Other risk factors include age, obesity, pregnancy, smoking, and family history. If left untreated, it can lead to several complications such as ulcers, bleeding, and thromboembolism. Objective: The objective was to assess the risk of varicose veins among traffic police officers of Kathmandu Metropolitan City. Methods: An analytical cross-sectional study was conducted. Data were collected by interview technique and observation method which consisted of self-constructed semi-structured questionnaire for sociodemographic data, descriptive rating scales for symptoms, and observational checklist for signs of varicose veins. Nonprobability convenient sampling technique was used. Results: Out of 200 respondents, 24 (12%) were at risk of varicose veins, out of which 22 were male and the rest were female. Conclusion: The results of the study suggest that overall risk of varicose vein is 12%, with males accounting for 12.3% and females for 9.5%. In the study, the risk of varicose veins is statistically significantly associated with the family history of varicose vein and smoking.

Robin Man Karmacharya

Papers

Urinary bladder carcinoma: impact of smoking, age and its clinico-pathological spectrum.

Outcomes of transurethral resection of the prostate in benign prostatic hyperplasia comparing prostate size of more than 80 grams to prostate size less than 80 grams.

Incidence and Risk Factors of Surgical Site Infections in Kathmandu University Hospital, Kavre, Nepal

Varicose veins and its risk factors among nurses at Dhulikhel hospital: a cross sectional study

Risk assessment of varicose veins among the traffic police of Kathmandu Metropolitan City, Nepal