Book Review

Smith's Textbook of Endourology

N Engl J Med 2008; 358:653-654February 7, 2008

Article

Smith's Textbook of Endourology
Second edition. Edited by Arthur D. Smith, Gopal Badlani, and Demetrius Bagley, with eight others. 972 pp., illustrated, plus index, with CD-ROM. Hamilton, Ont., Canada, BC Decker, 2007. $299.95. ISBN: 978-1-55009-365-0

Surgery is constantly evolving, with refinements to technique being made to optimize outcomes while minimizing morbidity. Correspondingly, minimally invasive procedures have assumed a more prominent role in many surgical disciplines. For example, laparoscopic cholecystectomy was introduced in 1989, and within 5 years had virtually replaced the traditional open procedure. Urology is no exception to these trends. More than 10 years ago, the founding fathers of endourology published the first edition of Smith's Textbook of Endourology (St. Louis: Quality Medical Publishing, 1996). At that time, the highly specialized techniques of minimally invasive endourology were performed by a limited number of surgeons.

Since the publication of that first edition, the landscape of the field has changed dramatically. For example, data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample showed that over the past 15 years, an increasing proportion of renal malignancy has been treated by laparoscopic approaches. By 2003, 16% of all total and partial nephrectomy procedures were performed laparoscopically, and the proportion continues to grow today. Similarly, minimally invasive techniques are becoming increasingly common for the treatment of prostate cancer, particularly since the introduction in 1997 of the da Vinci Surgical System for robotically assisted minimally invasive surgery. In the second edition of Smith's Textbook of Endourology, many of these advances in minimally invasive surgery are described, along with the fundamental technological principles underlying these procedures.

The book is organized into several main sections, including basic principles and instrumentation, the management of stones in the urinary tract, laparoscopic surgery, robotically assisted surgery, and surgery of the prostate and lower urinary tract. Each of these sections is well thought out and begins with a review of the physics or technological devices that support each subset of endourologic procedures. Some of the reviews provide an excellent resource for novice surgeons and residents in training, explaining the jargon of modern minimally invasive urology. In this regard, the material on lasers, the physiologic effects of pneumoperitoneum, minimally invasive urologic reconstructive techniques, and robotically assisted urologic surgery setup warrant particular mention.

Each section also includes more advanced chapters with detailed descriptions of technically challenging procedures. Several of these chapters were written by the founders of this field. For example, chapter 59, “Renal Surgery,” chapter 61, “Laparoscopic Ureteral Reconstructive Surgery,” and chapter 66, “Laparoscopic Radical Prostatectomy,” provide high-quality stepwise descriptions of complex minimally invasive urologic procedures, making this book useful at the master surgeon level.

On the whole, more than 200 authors contributed to this book, and it provides detailed insights from specialists on a wide variety of topics. However, the data on procedural effectiveness and treatment outcomes must be reviewed with caution. For example, unlike several other well-established endourologic techniques such as laparoscopic pyeloplasty or laparoscopic nephrectomy, the specific role of minimally invasive techniques in the management of prostate cancer requires additional study. The treatment algorithm for clinically localized prostate cancer is extremely complex, taking into account such factors as tumor stage and grade, age, and coexisting conditions (for more information, see “Localized Prostate Cancer” by Walsh et al. in the December 27, 2007, issue of the Journal). Because long-term data are not yet available to confirm oncologic and functional outcomes of some of the newer endourologic treatments, their place in the management algorithm of this disease remains in evolution.

In summary, the past decade has witnessed a technological revolution, resulting in a paradigm shift for the treatment of numerous urological conditions. This important book provides an invaluable reference for both young and seasoned urologists interested in expanding their technical skill set.

Edward M. Schaeffer, M.D., Ph.D.
Johns Hopkins Medical Institutions, Baltimore, MD 21287
eschaeffer@jhmi.edu