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Challenging Cases in Urological Surgery
Challenging Cases in
Urological Surgery
Cases with Expert Commentary
Edited by
Karl H. Pang MBChB, BSc(Hons), MSc, PhD, FRCS(Urol), FEBU, AFHEA
Post-CCT Clinical Fellow in Andrology, Institute of Andrology, University College London Hospitals NHS Foundation Trust;
Honorary Clinical Lecturer, University College London; Honorary Clinical Lecturer, Department of Oncology and Metabolism
and Academic Urology Unit, University of Sheffield, UK
James W.F. Catto MBChB, PhD, FRCS(Urol)
Professor in Urological Surgery, Department of Oncology and Metabolism and Academic Urology Unit, University of Sheffield, UK;
Honorary Consultant Urological Surgeon, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust
European Urology Editor- in- Chief
https://t.me/med1917
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It fur thers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2023
The moral rights of the authors have been asserted
First Edition published in 2023
Impression: 1
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a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2022930152
ISBN 978– 0– 19– 885437– 1
DOI: 10.1093/ med/ 9780198854371.001.0001
Printed in the UK by
Bell & Bain Ltd., Glasgow
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up- to- date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non- pregnant
adult who is not breast- feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
https://t.me/med1917
FOREWORD
At any national or international urology congress, the sessions delegates most enjoy
are those where experts debate the management of complex cases and in so doing dissect the evidence base and show how it should be applied. This book looks to do the
same, and a urologist who reads it will acquire a lot of knowledge and save an airfare,
a conference registration fee and a hotel bill! It’s a new concept and I think it works.
The list of subjects covered is broad ranging and very interesting; challenging in
every way. The views expressed by the authors and the experts will, I am sure, generate much debate. I’m a retroperitoneal surgeon and certainly found much to debate
in case 7 (renal oncocytoma), case 16 (upper urinary tract urothelial carcinoma) and
case 19 (growing teratoma syndrome in testis cancer). That though I think is the point,
in a challenging case there may not be a right or a wrong answer but understanding
how experts reach their decisions can be a very valuable way of learning. The book
should be a very good primer for board exams or the FRCS (Urol) examination.
So, well done to the editors, Karl Pang and Jim Catto, on pulling it all together. The
book reminded me once again of the staggering breadth of the specialty we practise
and I’m looking forward to debating with specialist registrars, fellows, and consultants
at Guy’s all 48 of the cases.
Tim S. O’Brien MA, DM, FRCS(Urol)
Consultant Urological Surgeon
Immediate past-President of BAUS
https://t.me/med1917
https://t.me/med1917
PREFACE
This is the first urological surgery book added to the Challenging Cases series.
Common cases, challenges, and controversial topics are discussed in a format utilizing
boxes to highlight learning points, evidence bases, and future directions. Using case
examples, experts provide clinical tips and personal comments on how they manage
specific presentations. Expert commentary is provided throughout each chapter with
a concluding ‘Final word’ from the expert at the end of each case. This book includes a variety of cases covering most sections outlined in the Intercollegiate Surgical
Curriculum for Urological Surgery including oncology, endourology, functional and
female urology, neurourology, andrology, trauma, transplantation, and paediatric urology. This book is a highly valuable resource for all those interested in urological
surgery, allied health professionals, trainees in the field and those sitting postgraduate
urology examinations. We thank all authors and experts for their hard work and hope
you enjoy reading this text.
Karl H. Pang and James W.F. Catto
https://t.me/med1917
https://t.me/med1917
CONTENTS
Abbreviations xi
Experts xv
Contributors xix
Curriculum map xxii
Section 1 Urinary tract infection
Case 1 Recurrent urinary tract infection 3
Christopher K. Harding
Case 2 Prostatitis 11
Uwais Mufti and Ased Ali
Section 2 Urinary tract stones
Case 3 Renal stones 25
Jonathan Glass
Case 4 Ureteric stones 35
Lisa Bibby, Mostafa Sheba, Andrea Lavinio,
Andrew Winterbottom, and Oliver Wiseman
Case 5 Bladder stone management 47
Siân Allen and Daron Smith
Section 3 Upper urinary tract benign disease
Case 6 Ureteropelvic junction obstruction 63
Sanjeev Pathak and Neil Oakley
Case 7 Oncocytoma 71
Andrew Deytrikh, Georgina Reall, James Lenton,
and Anthony Browning
Section 4 Prostate cancer
Case 8 Localized prostate cancer 81
Omer Altan, Alastair Lamb, and Freddie C. Hamdy
Case 9 Oligometastatic prostate cancer 89
Francesco Claps, Fabio Traunero, Nicola Pavan,
and Prasanna Sooriakumaran
Case 10 Newly diagnosed metastatic prostate cancer 95
Adnan Ali and Noel W. Clarke
Section 5 Bladder cancer
Case 11 Non- muscle- invasive bladder cancer 107
Samantha Conroy and Aidan P. Noon
Case 12 Muscle- invasive bladder cancer 117
Samantha Conroy and James W.F. Catto
Case 13 Progression of high- grade non- muscle- invasive
bladder cancer 127
Naomi L. Neal, Richard J. Bryant, and
Andrew Protheroe
Section 6 Upper urinary tract cancer
Case 14 Localized renal cancer with inferior vena cava
tumour thrombus 137
Tobias Klatte, Antony C.P. Riddick, Grant D. Stewart,
and Jose A. Karam
Case 15 Metastatic renal cancer 147
Joana B. Neves, Maxine G. B. Tran, and Axel Bex
Case 16 Upper urinary tract urothelial carcinoma 155
Richard Nobrega and Mark Sullivan
Section 7 Penile cancer
Case 17 Localized penile cancer 165
Ian Eardley
Case 18 Advanced and metastatic penile cancer 175
Hussain Alnajjar and Asif Muneer
Section 8 Testicular cancer
Case 19 Growing teratoma syndrome in testis cancer 185
Jennifer Clark, Thomas A. Lee, and Vijay A.C. Ramani
Case 20 Metastatic testicular cancer: post-chemotherapy
residual mass and cancer survivorship 199
Findlay MacAskill and Archie Fernando
Section 9 Functional, female, and neurourology
Case 21 Benign prostatic enlargement and acute
urinary retention 211
Emma Papworth, Joseph Jelski, and Hashim Hashim
Case 22 Chronic retention, renal failure, and diuresis 221
Cherrie Ho, James Jenkins, and Marcus Drake
Case 23 Urge urinary incontinence 229
Pravisha Ravindra and Richard Parkinson
Case 24 Stress urinary incontinence 237
Rachel Barratt and Suzanne Biers
Case 25 Bladder pain syndrome/ interstitial cystitis 247
Altaf Mangera
Case 26 Female urinary retention 253
Pravisha Ravindra and Nikesh Thiruchelvam
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