Hinman’s Atlas of Pediatric Urologic Surgery


Edited by FrankHinman Jr and Lawrence SBaskin Saunders/Elsevier ; 2008 ; 2nd edition; hardcover , 992 pp; price: £192 ; ISBN-10 : 0721606458 ; ISBN-13 : 978-0721606453

Geographical atlases are going out of fashion, with book sellers reporting falling sales as people turn to the Internet and satellite navigation for their information. A similar fate had been predicted for surgical atlases, which many thought would be rapidly superseded by educational CDs and DVDs of operative surgery. However, the digital revolution in this particular area of medical publishing has been slow to take hold and the editors and publishers of Hinman’s Atlas clearly believe there is still a market for textbooks of operative surgery. They are probably right. Clear, well-drawn line diagrams have a unique ability to concentrate the reader’s attention on the key points of anatomy and technique in a format uncluttered by superfluous visual information. Surgical atlases are technical manuals, and as such are portable and easy to use in the workplace. Most urologists will probably still find it easier and quicker to access information on a specific procedure by consulting an index and turning the pages of a book than loading a DVD and exploring its contents by use of the ‘skip’ and ‘fast forward’ buttons.

Frank Hinman and Lawrence Baskin’s impressive textbook epitomises many of the virtues of the surgical atlas format. As an added bonus virtually every chapter is accompanied by one or more insightful commentaries contributed by recognised experts in the relevant field. Many of these are gems; concise yet hugely informative. Whilst some have been contributed by leading contemporary urologists others encapsulate the accumulated experience and wisdom of some of the legendary names in paediatric and reconstructive urology, including Turner-Warwick, Tanagho, Leadbetter and Gregoir.

Totalling almost 1000 pages, and with 136 contributors, this is a magnum opus. Herein lies the problem with this ambitious project, i.e. the inordinate length of time it has taken to bring to fruition. The foreword dates from 1992 and no fewer than 18 contributors are listed as having died or retired during the course of the book’s preparation. Consequently much of the book seems dated (or frankly outdated) and whilst it includes chapters on laparoscopic and endoscopic urology, the overall emphasis is very much on conventional practice and open surgery.

The introductory chapters address such topics as preparation for surgery, anaesthesia and basic operative management. In this context, a chapter devoted to the fundamentals of endoscopic urology and instrumentation would have been welcome. Similarly, the chapter on the principles of paediatric laparoscopic urological surgery is disappointingly sparse, comprising little more than a page of text unaccompanied by any illustrations.

Surgery of the kidney and adrenal gland is comprehensively covered in 150 pages encompassing open pyeloplasty, nephrectomy and heminephrectomy, renal transplantation and oncological surgery. Laparoscopic nephrectomy and heminephrectomy are well described, but many urologists will regard the absence of a chapter devoted to laparoscopic pyeloplasty as an unforgivable omission in an operative textbook published in 2009.

A variety of open procedures for the correction of VUR are described but, by contrast, the coverage of endoscopic correction of reflux (STING) is limited to one page of text with three diagrams. When one considers the scale on which endoscopic injection has replaced open surgery for the treatment of mild to moderate reflux, more comprehensive coverage would surely have been merited, with information on instrumentation (injection endoscopes, needles, etc.) in addition to the technique of injection itself.

Arguably the most successful section of the book is the one devoted to lower tract reconstruction, which includes the primary correction of bladder exstrophy and anorectal anomalies. Enterocystoplasty, continent diversion and conduit diversion are well covered and the chapter on the Yang-Monti procedure is particularly clear and well illustrated.

More than 100 pages are allocated to hypospadias surgery, but whilst many of the procedures featured in this section have withstood the test of time, others are unquestionably obsolete. The account of the tubularised incised plate (Snodgrass) operation is limited to two diagrams and two brief commentaries accompanying the illustrated chapter on the Thiersch-Duplay procedure. Many readers will justifiably feel short-changed in not being given the opportunity to read a more detailed ‘start to finish’ account of what is currently the standard hypospadias repair in most specialist units.

Circumcision and cystoscopy are amongst the commonest paediatric urological procedures yet whilst circumcision has been included, cystoscopy has not. Similarly, the reader will find no guidance on ascending ureterography nor the endoscopic insertion of a JJ stent.

Paediatric stone disease is barely touched upon, with no account of the modern surgical methods such as percutaneous nephrolithotomy, ureteroscopy and laser lithotripsy, which now play an integral role in treating stones in children as well as adults. More surprisingly, conventional open procedures for stone disease have not been included either.

It would be unfair to dwell unduly on the omissions in what is in many respects an impressive account of operative paediatric urology. Nevertheless, it would difficult to recommend this atlas as ‘required reading’ for urologists in training, as too many of the routine procedures of paediatric urology have been overlooked. Likewise, important developments in minimally invasive and endoscopic paediatric urology are under-represented in a book which, in many areas, owes more to the 20th century rather than the first decade of the 21st.

However, despite these limitations, Hinman’s Atlas is clearly destined to fulfil a valuable role as an informative work of reference for specialist paediatric urologists and trainees. To get the most from this book I recommend you keep it ‘close to the action’ and readily available in the operating theatre or coffee room, rather than sitting on a library shelf.