Book Review

Urologic Surgery

N Engl J Med 1993; 329:439August 5, 1993

Article

Urologic Surgery
(Mastery of Surgery.) Edited by Jackson E. Fowler, Jr. 734 pp., illustrated. Boston, Little, Brown, 1992. $175. ISBN: 0-316-29011-4

This book is the first of a planned collection of subspecialty surgical works, the “Mastery of Surgery” series, edited by Nyhus and Baker. Volumes on plastic, orthopedic, and pediatric surgery are expected.

Each chapter of this book is written by a recognized master of urologic surgery. Unlike the authors of standard surgical textbooks, who strive to be objective, masters discuss their personal biases in performing urologic surgery. They offer the reader their philosophies of surgical techniques and operative complications and their opinions of alternative management strategies.

This “master plan” is mostly successful, and the result is part surgical textbook and part atlas. As in any multiauthored book, the quality of the chapters varies. There are excellent discussions of such diverse topics as inguinal lymphadenectomy for penile cancer and the role of laparoscopy as an adjunct to pediatric orchiopexy. It was nice to find chapters on rarely discussed topics such as salvage radical prostatectomy, cystectomy in female patients, and anomalies of renal fusion.

However, I found the chapters describing basic abdominal and flank incisions to be disappointing, without sufficient detail or illustration. There is only a brief discussion of radical orchiectomy, with but a single drawing; the complexity of this important urologic procedure is underestimated by residents in training. It seemed odd that an entire chapter was devoted to pediatric cutaneous ureterostomy, an operation that is no longer common. I would have preferred a detailed discussion of more contemporary techniques, such as bladder substitution and continent urinary diversion.

The best parts of the book are the special comments by the masters at the end of each chapter. They are thoughtful, provocative, and usually right on target. The chapter on ureteroscopy is followed by the comment, “some ureteroscopic procedures will prove impossible for the most experienced urologist . . . early recognition of this eventuality will usually be rewarded by a low complication rate.” The chapter on thoracoabdominal incisions concludes with the caveat,

even though the responsible surgeon may be tired at the conclusion of an operation that requires the thoracoabdominal approach, closure of the diaphragm should not be left to an assistant. Pulmonary or wound complications that result from technical errors are an inevitable by-product of this practice, because in most cases the assistant is as weary as the surgeon, but is less experienced.

How true.

Because this book is a combination of atlas and textbook, it is not as encyclopedic in scope as standard surgical atlases. For a resident planning a complicated procedure such as orthotopic bladder replacement, this would not be the first book to consult. The details of this technically demanding operation are better outlined and illustrated elsewhere. Definitely worth reading, however, are the comments of the masters about which bowel segments to use in the procedure and their expectations regarding postoperative urinary continence.

For students or residents on a limited budget, this would not be the best first textbook to purchase. For more experienced urologists seeking to refresh their memory or for nonurologists requesting a more expansive view of urologic surgery, this would be a useful reference book. It would be a nice addition to the library of any surgical department.

Barbara Bassil, M.D.
Massachusetts General Hospital, Boston, MA 02114