Book Review

Surgical Management of Urologic Disease: An Anatomic Approach

N Engl J Med 1993; 328:590-591February 25, 1993

Article

Surgical Management of Urologic Disease: An Anatomic Approach
Edited by Michael J. Droller. 1300 pp., illustrated. St. Louis, Mosby-Year Book, 1992. $139. ISBN: 0-8016-0398-6

All surgery is, in essence, an exercise in applied anatomy. This new textbook offers an explication of surgical techniques for the urinary system, grounded in the anatomical relations of the organs involved. The book achieves its aim with varying degrees of success.

The book is organized around a core of chapters covering the techniques of specific urologic procedures, both open and endoscopic. The open procedures are grouped together according to major anatomical regions (retroperitoneum, upper abdomen, pelvis, perineum, and external genitalia). An introductory chapter for each region offers an overview of the pertinent normal anatomy, including the embryologic development of the area. In most chapters, there is an organic flow from basic anatomy to specific points of operative technique. In other sections, however, the anatomical review material is patched into place, without apparent connection to the techniques that follow.

The context of patient care for all these procedures is provided by a preliminary section on the preoperative evaluation of the patient. A section on the radiologic assessment of the urinary system follows, encompassing conventional radiography, ultrasonography, computerized tomography, nuclear scanning, magnetic resonance imaging, and interventional radiologic procedures. Both these sections are thorough, clear, and current.

The remainder of the book focuses on specialized techniques (prostheses, neurologic pacemakers, use of bowel in the urinary tract, and renal transplantation) and the panoply of new technologic devices (lasers, lithotriptors, and laparoscopes) that are now a part of the surgeon's armamentarium. This section is up to date, with references through 1991. However, the increasing replacement of direct vision with complete reliance on video endoscopy, in order to minimize contact with potentially hazardous body fluids, is not discussed.

This book has strong similarities to standard multiauthored atlases such as Glenn's Urologic Surgery (4th ed. Philadelphia: J.B. Lippincott, 1991). In fact, Droller's book duplicates the contributions of a number of authors to Glenn's book, including chapters on such major topics as radical nephrectomy, percutaneous removal of kidney stones, female incontinence, and urethral-stricture surgery. These common contributions make up 20 percent of the two books. The emphasis on preoperative assessment in this book is novel and welcome. On the other hand, surgical techniques for the treatment of specific conditions in children (such as Wilm's tumor, bladder exstrophy, posterior urethral valves, and ambiguous genitalia) are mentioned briefly, if at all.

The authors of the individual chapters have produced clear and readable texts. With more vigorous editorial oversight, the chapters could have been streamlined, referring back to the regional overview sections, to eliminate repetition. Typographical errors are not infrequent.

The usefulness of a surgical atlas depends critically on the quality of its illustrations. A glaring shortcoming of Droller's book is the shoddy reproduction. In laying out the book, a decision was evidently made to reprint “classic” anatomical drawings from several standard anatomy textbooks (Gray's Anatomy [37th ed. New York: Churchill Livingstone, 1989] and Pansky's Review of Gross Anatomy [5th ed. New York: Macmillan, 1984], among others), with subtle modifications and new legends to emphasize specific anatomical details pertinent to each procedure. (The pedagogic value of such repetition is debatable and needs to be balanced against economy of space and materials.) Unfortunately, the quality of the second- or third-generation reproductions is very poor; subtle distinctions are lost, and in many cases the illustrations are frankly unintelligible. Illustrations are included whose labels are not consistent with the text, or they are not labeled at all, eliminating any instructive value they might have had. The chapters in which the authors have provided original or first-generation reproductions of simple line drawings are generally more intelligible and successful.

This is a handsome and hefty volume (1271 pages of text), but no textbook can be all things to all readers. The resident in training who desires an overview of the spectrum of adult urology techniques, accompanied by a review of the anatomical relations involved, will appreciate this book. The review of perioperative assessment and imaging methods may prove especially useful for those preparing for in-service or board certification (or recertification) examinations. The practicing urologist may well enjoy the attention to the newest urologic technology, as well as standard approaches. With adherence to exacting production standards in future editions, this book can provide both current and future urologists with insight into the applied anatomy that is the fabric of surgical craft.

Todd J. Garvin, M.D.
Doctors Clinic, Bremerton, WA 98310