Book Review

Smith's General Urology

N Engl J Med 1993; 329:438August 5, 1993

Article

Smith's General Urology
Thirteenth edition. Edited by Emil A. Tanagho and Jack W. McAninch. 743 pp., illustrated. Norwalk, Conn., Appleton and Lange, 1992. $38. ISBN: 0-8385-8608-2 Urologic Surgery. By Hector Bensimon, with contributions by John F. Bresette and Richard H. Bensimon. 451 pp., illustrated. New York, McGraw-Hill, 1991. $150. ISBN 0-07-004795-2.

In their preface to Smith's General Urology, the editors state that their goal “has been to keep the book current, to-the-point, and readable.” That goal has been admirably met in the present edition (the first was published in 1957). Smith's is not intended to be a definitive, encyclopedic review of the entire theory and practice of urologic surgery, but a concise yet thorough reference for both urologists and nonspecialists -- more than a simple pocket manual but less intimidating than a multivolume textbook. The book has been completely revised since its last printing (1988) and includes several entirely new chapters covering such diverse topics as laser surgery, chemotherapy, urinary diversion, and bladder substitution.

The book is simply and logically organized, with the first chapters devoted to an overview of the basic principles and concepts of urology. These topics include anatomy, embryology, laboratory evaluation, and physical examination. Imaging and instrumentation are of particular importance to the practice of urology, and these topics are dealt with in a clear manner. The chapter on radiologic examination of the urinary tract deserves special mention. Although the radiographs reproduced are small, they are extremely well annotated, each with a brief clinical synopsis. A section comparing cross-sectional imaging techniques with conventional radiographic techniques is extremely useful.

The editors are also to be commended on the structure and layout of the individual chapters. Illustrations are clean pen-and-ink drawings, with many useful summary charts accompanying the text. Main topics are highlighted in boldface type, followed by their subject matter in expanded outline form. The chapters themselves are in general short, easy to read, and extremely well referenced.

Although Smith's has not been radically altered, it does include several new chapters, some of which deserve specific mention. The discussion of the treatment of urologic oncology has been completely rewritten and expanded. Unlike previous editions, which contained a single chapter on genitourinary tumors, this edition covers the material in four chapters -- on urothelial tumors, renal parenchymal tumors, prostate tumors, and genital tumors. Although these chapters have been written by different authors, each provides a nice overview of the incidence, pathogenesis, diagnosis, and treatment of the lesion in question. Where necessary, charts of both the traditional and the TNM (tumor-node-metastasis) staging systems are included. The chapters on shock-wave lithotripsy and laser surgery are welcome in any modern textbook of urology. The principles and uses of the respective techniques are discussed so that nonphysicists can easily understand them.

Specific complaints about the book are few. As mentioned previously, many of the radiographic reproductions are small. Some of the chapters in the latter half of the book attempt to cover broad topics in too brief a fashion. Finally, the coverage of pediatric urology is cursory. However, it is likely that those interested in pediatric urology already own one of the major multivolume textbooks.

In summary, this edition of Smith's General Urology is an improvement over the already excellent previous editions. Although its coverage is not in-depth enough for it to serve as the sole textbook for residents or attending physicians in urology, its short, to-the-point chapters make it extremely useful as a reference for a quick review of most topics in urology. Its simple, clear style should also earn it a place on the bookshelves of many practitioners of general medicine, an attractiveness enhanced by its reasonable price.

Urologic Surgery is a testimonial to the author, who has presented the accumulated pearls of more than 40 years of clinical experience. Bensimon does not purport to demonstrate the only way to perform the many procedures detailed in his surgical atlas; he is quite explicit in his introduction that the methods described are those he developed during his years of practice. If he lacked experience in an area of urology, he either did not include that field (e.g., pediatric urology) or enlisted the expertise of other authors (e.g., the sections covering microsurgery and female urology).

The organization of the book is straightforward. The first chapter discusses general principles of surgery, including asepsis, suturing, and instrument selection. Physicians already advanced in their training would probably find this material too basic, but it would be appreciated by medical students and junior residents. The next chapter offers a clear and thorough discussion of surgical anatomy. This builds on the following section, which discusses surgical incisions in good detail. Throughout, the focus is consistently maintained on issues that are clinically relevant. The result is a compendium of clinical pearls that only years of surgical experience can produce.

The remainder of the book is a review of surgical procedures according to anatomical system. This makes a given procedure easy to locate, which distinguishes this book from other atlases. The list of urologic procedures in adults is extensive. Also included are several nonurologic procedures often encountered by urologists, including the creation of colostomies and myocutaneous flaps. All discussions are exhaustive, including those on preparation of patients, the set-up of the operating room, and immediate postoperative care. Bensimon's discussion of endoscopic surgery is particularly commendable. Beginning with the basics of cystoscopy, he proceeds through a detailed and well-illustrated presentation of transurethral resection of the prostate and bladder.

Urologic Surgery follows the large format typical of most textbooks of surgical technique. It is amply illustrated with black-and-white drawings, many of which have been reproduced from classic books and articles. The illustrations are appropriate and descriptive. At times, figures do not appear on the same pages as the accompanying text, which can lead to bothersome page flipping.

Urologic Surgery deserves serious consideration from those in search of a surgical atlas of urology. It strikes a fine balance between conventional textbooks of urology and other atlases, which at times are simply illustrated how-to books.

Brian Saltzman, M.D.
Barry Duel, M.D.
Beth Israel Hospital, Boston, MA 02215