Surgery RSS feed: Current Issue. Surgery is an authoritative, comprehensive collection of educational reviews that present the current knowledge and practice of surgery Surgery also indicates recent advances that improve the understanding of disease and the safe and effective treatment of patients It comprises concise and systematically updated contributions that are produced over a three-year cycle. Surgery is an excellent didactic tool to help consultant surgeons train their junior staff to become safe and competent surgeons.http://www.surgeryjournal.co.uk/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Surgery0263-9319287July 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.surgeryjournal.co.uk/article/PIIS0263931910001262/abstract?rss=yesContents10.1016/S0263-9319(10)00126-2Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4OFCOFChttp://www.surgeryjournal.co.uk/article/PIIS0263931910001286/abstract?rss=yesEditorial Board10.1016/S0263-9319(10)00128-6Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4iihttp://www.surgeryjournal.co.uk/article/PIIS0263931910000700/abstract?rss=yesAbstract: The lower urinary tract consists of the bladder and urethra and, in the male, the prostate. The function of the lower tract is the storage of urine produced by the upper tract and the voluntary expulsion of urine at an appropriate time and place. The lower tract may be affected by functional disorders such as bladder overactivity and urinary incontinence or by carcinoma, lithiasis and obstructive disorders such as prostatic enlargement and stricture disease. A thorough knowledge of the relevant anatomy is vital to understand the pathophysiological mechanisms and appropriate management of these conditions. There are considerable variations in the anatomy and biomechanics of the male and female urinary tract and we depict these, in addition to providing a comprehensive description of the histology, vasculature and innervation of the lower urinary tract organs.Anatomy of the lower urinary tractAltaf Mangera, Anand K. Patel, Christopher R. Chapple10.1016/j.mpsur.2010.03.002Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Basic Science307313http://www.surgeryjournal.co.uk/article/PIIS0263931910000979/abstract?rss=yesAbstract: This paper describes the anatomy of the kidney and ureter. It begins with the embryological development and the mechanism for some congenital anomalies. The microscopic anatomy is described; as well as the gross anatomy of the kidneys, ureters and suprarenal (adrenal) glands including anatomical relations, arterial supply and venous and lymphatic drainage. Nerve supply and pain are also discussed.Surgical anatomy of the kidney and uretersDan Wood, Tamsin Greenwell10.1016/j.mpsur.2010.04.009Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Basic Science314316http://www.surgeryjournal.co.uk/article/PIIS0263931910000785/abstract?rss=yesAbstract: The urinary bladder is a storage vessel for most of the time, when intravesical pressure remains low and the outflow resistance high. During voiding the reverse occurs when intravesical pressure rises and the outflow relaxes. The initiation and control of this change of function are carried out by a complex interplay between sensory mechanisms in the bladder, coordination of responses in the brain and sacral spinal cord and control over bladder and outflow muscle tone. Lower urinary tract (LUT) function can become disorganized and manifests commonly as overactive bladder (OAB) symptoms of urgency and frequency, with or without incontinence. The causes may be associated with neurogenic disorders, outflow tract obstruction or be idiopathic in the majority of cases. Several pharmaceutical approaches to manage OAB are possible which rely predominantly on manipulating mechanisms that generate detrusor contraction or reduce the magnitude of outflow obstruction. The introduction of successful agents requires knowledge of the mechanisms that generate contraction in LUT tissues both in the normal and overactive bladder. Several other potential approaches, such as reducing sensations from the urinary tract or modulating central nervous system pathways, are also briefly described.The physiology and pharmacology of the lower urinary tractChristopher H. Fry, John S. Young10.1016/j.mpsur.2010.03.010Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Basic Science317322http://www.surgeryjournal.co.uk/article/PIIS0263931910000694/abstract?rss=yesAbstract: Taking a history from, and the examination of, patients is key to determining the nature of their illness and its effect upon their quality of life. Whilst modern medicine has replaced many clinical skills with investigative techniques, the patient interview and examination is still vital to determine the correct treatment plan. Here we review the salient points necessary to make a urological diagnosis and discuss briefly modern investigative technologies. In particular we detail the common urological tests used in contemporary practice and illustrate their use with disease examples.Urological diagnosis – history and investigationsJames W.F. Catto, Christopher R. Chapple10.1016/j.mpsur.2010.03.001Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Renal and Urology I323330http://www.surgeryjournal.co.uk/article/PIIS0263931910000773/abstract?rss=yesAbstract: Obstruction of the urinary tract can occur at any point from the calyces to the external urethral meatus. Obstruction within the urinary tract is best divided into upper tract and lower tract obstruction. Obstruction can be acute or chronic. Acute upper tract obstruction is most commonly due to a calculus and acute lower tract obstruction in men is often due to benign prostatic enlargement. Chronic upper tract obstruction in the Western world is most commonly due to calculi or pelvi-ureteric junction obstruction. Chronic lower tract obstruction in men will again be due to benign prostatic enlargement in a majority of cases.In upper tract obstruction imaging is the cornerstone of investigation. The most commonly used radiological investigation being a stone protocol non-contrast computed tomography scan of kidneys, ureters and bladder (NCCT–KUB). Acute and chronic lower tract obstruction is often treated in the initial stages by the passage of a urethral catheter. Chronic lower tract obstruction can be high or low pressure. High-pressure chronic retention is potentially fatal due to renal failure and therefore monitoring of fluid status and serum electrolytes is essential. The initial treatment for obstruction is dependent on the presence or absence of renal impairment and sepsis. If either of these is present then some form of upper tract decompression may be warranted, either in the form of percutaneous nephrostomy tubes or JJ stents.Obstruction of the upper and lower urinary tractKate D. Linton, James Hall10.1016/j.mpsur.2010.03.009Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Renal and Urology I331337http://www.surgeryjournal.co.uk/article/PIIS026393191000075X/abstract?rss=yesAbstract: Urolithiasis is common, affecting 10% of Caucasian men. Factors affecting stone formation can be intrinsic to the individual and are influenced by environmental factors.Patients presenting with loin/groin pain to the surgical team are common and ureteric colic should be considered in this group. The relevant investigations with regards to blood, urine and imaging tests to diagnose stone disease are discussed. In addition, the absolute indications for urgent intervention are reviewed.Treatment for ureteric stones and renal calculi includes a wide armamentarium of endourological techniques including extracorporeal shock wave lithotripsy, ureteroscopy and percutaneous nephrolithotomy, if conservative therapy fails.Therapy is guided by anatomical factors, stone factors, previous treatment failures as well as the patient’s wishes.Indications, contraindications and complications of the common procedures are discussed.Management of stone diseaseBeverley Wilkinson, James Hall10.1016/j.mpsur.2010.03.007Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Renal and Urology I338344http://www.surgeryjournal.co.uk/article/PIIS0263931910000712/abstract?rss=yesAbstract: Trauma to the genitourinary tract often occurs in association with other injuries. Initial assessment of the trauma patient should include securing the airway, controlling external bleeding and resuscitation of shock, as required. In many cases, physical examination is carried out during the stabilization of the patient. The kidney is the most commonly involved genitourinary organ. Iatrogenic injuries are often seen in high-volume surgical centres performing complex abdominal surgery. Appropriate radiological investigation is necessary to stratify patients for urgent surgical intervention or conservative measures. Assessment and treatment options are discussed in the following article.Trauma to the genitourinary tractThomas Watcyn-Jones, Sanjeev Pathak, Patrick Cutinha10.1016/j.mpsur.2010.03.003Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Renal and Urology I345352http://www.surgeryjournal.co.uk/article/PIIS0263931910000748/abstract?rss=yesAbstract: Abnormalities of the lower urinary tract may range from frequent and very minor with no significant consequences to the rare but severe requiring major intervention and lifelong monitoring. While discussion of all infravesical congenital abnormalities of the lower urinary tract is beyond the scope of this article, the main abnormalities encountered in clinical practice are listed and discussed.Congenital abnormalities of the lower urinary tract: infravesical anomaliesPrasad Godbole10.1016/j.mpsur.2010.03.006Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Renal and Urology I353356http://www.surgeryjournal.co.uk/article/PIIS0263931910000724/abstract?rss=yesAbstract: Abnormalities of the lower urinary tract may range from frequent and very minor with no significant consequences to the rare but severe requiring major intervention and lifelong monitoring. While discussion of all rare bladder abnormalities is beyond the scope of this article, the main conditions encountered in clinical practice are listed and discussed below.Congenital abnormalities of the lower urinary tract: rare bladder abnormalitiesPrasad Godbole10.1016/j.mpsur.2010.03.004Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Renal and Urology I357359http://www.surgeryjournal.co.uk/article/PIIS0263931910000736/abstract?rss=yesAbstract: Paediatric urological conditions range from those that are infrequent but severe and require referral to a specialist to those that may present to primary care physicians or adult urologists/general surgeons. The National Definitions Set No. 23 for Specialised Childrens' Services defines specialist paediatric urology. Adult general surgeons, adult urologists, general paediatric surgeons, general practitioners/primary care physicians, paediatricians and emergentologists will come across non-specialist or general paediatric urology which is referred to in this article. The management of paediatric urinary tract infection is beyond the scope of this article and readers are referred to recent guidelines issued by the National Institute for Health and Clinical Excellence. Management of common conditions and indications for specialist referral are addressed.General paediatric urologyPrasad Godbole10.1016/j.mpsur.2010.03.005Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Renal and Urology I360365http://www.surgeryjournal.co.uk/article/PIIS0263931910000761/abstract?rss=yesFor questions 1–4, select the statements which are true and which are false. The correct answers are given below. When considering anatomy of the lower urinary tract:Test yourself: MCQ and extended matchingMichael G. Wyatt10.1016/j.mpsur.2010.03.008Surgery 28, 7 (2010)2010-07-01Surgery2010-07-01287S0263-9319(10)X0008-4Test yourself366367