Functional reconstruction of the urinary tract and gynaeco-urology


  • George Webster

1st Edition 2002 : Blackwell Publishing , 960 pp, £ 215.00 , ISBN 0-865426953

Lest the reader go no further, let me first say that this remarkable text should be on the shelf of all surgeons practising in the field who enjoy their ‘trade’, and it should be required reading for those in training. These are strong words but they reflect that this life-work by the lead author presents philosophies and principles for practice that transcend any text previously published. These authors have chronicled the thought processes that allowed urologists to arrive where they are today in the field of ‘reconstructive urology’.

Richard Turner-Warwick and Christopher Chapple present an all-encompassing assessment of the field of reconstructive urology and urogynaecology in particular. The book, which comprises 16 chapters and 900 pages of exquisitely presented and illustrated text, intertwines the disciplines of urology, plastic surgery and urogynaecology to help the reader to reach a better appreciation of the field. The authors set out to prepare a ‘practice manual’, one that teaches the reader how to do an operation, as well as ‘why’ and ‘when’, and at this they have succeeded totally.

By opening with a discussion on their philosophical approach to the field, followed by a chapter on basic principles, instruments and techniques, the foundation is set for a thorough understanding of the procedures that are presented later in the text. Philosophical discussions are replayed throughout the text and allow the reader an insight into how the authors have come to understand and master this field during their years of practice. The colourful artistic illustrations throughout the volume provide an element that is so often missing in other surgical texts. These artistic interpretations assist in clearly depicting the various tissues and blood supply, and help to emphasize situations of vascular compromise and tissue damage, an important concept for all reconstructive surgeons. Additionally, intraoperative photographs are used to emphasize critical points.

The book reflects the strong opinions held by the lead author and progresses through chapters on surgical access to the urinary tract, the use of omentum and then to chapters addressing both reconstructive techniques used for the ureter and for the kidney. From there, individual chapters are devoted to the functional anatomy of female continence and incontinence, urodynamic evaluation and treatment options for urinary incontinence. These are followed by a chapter on vaginal abnormalities and developmental abnormalities of the urethra and sphincter. The emphasis on surgical techniques continues with a discussion of gynaecological injuries and fistula repair, followed by urinary diversion and cystoplasty. Other vital components include the small section on the effect of radiation on various organs and tissues as it relates to surgical repair. This portion addresses the underlying principles that make reconstructing this tissue a challenge, and uses cases scenarios and photographs to address the treatment of some challenging cases.

The chapters are subdivided into sections, each no more than two pages, making it easy to research a topic with no need to peruse an entire chapter. The scientific part of the book concludes with a final discussion on urodynamics, a subject that pervades the very appropriate functional bias of the entire text.

There is then a final ‘picture of the man’. Richard Turner-Warwick shows how to make illustrative operative notes, make a readable slide for presentation, how to swallow a pill, reuse an envelope, and mix a tasteful but weak gin!

Ultimately, the authors bring together the fields of urology, gynaecology and plastic surgery in one place, to provide an excellent read for the novice and an important resource for the experienced reconstructive urologist. The book may be used as a surgical atlas for some procedures, but it may not be helpful for the surgeon who needs a detailed review of a general procedure. Instead, the strength of the text is found in its discussion and illustration of the various surgical pitfalls and complications that must be prevented during various reconstructive procedures. There is also an emphasis on vascular supply and tension-relieving techniques, other areas so often downplayed in surgical literature.

This is an extremely personal book, reflecting as it does the opinions of the lead author, whom this reviewer believes created the field of ‘reconstructive urology’. Whilst some of the procedures described may not exactly fit the current algorithms for management, it must be said that the surgical principles are the same and this text states them strongly.