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Pediatric urology
  1. P S J Malone

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Edited by John P Gearhart. New Jersey: Humana Press, 2003, $125 (hardback), pp 319. ISBN 1 58829 110 3

Paediatric urology has come of age over the past few years, with it now being formally recognised as a distinct subspecialty of both urology and paediatric surgery within the European Union. In parallel with this development there has been a rapid expansion in the number of paediatric urologists practising in the United Kingdom. With this increasing specialisation there is a risk of isolation, and developments in the field of urology may go unrecognised in the broader areas of paediatrics, paediatric surgery, and urology. Therefore there is a need for publications to highlight recent developments. The non-specialist rarely reads major reference textbooks (of which there were two published in 2002) outside their own field, and smaller texts providing a general overview for associated specialities are required. I am uncertain what audience this book has been written for but I believe it goes some way to meet the requirement of an update for the generalist.

For a multiple author book it is well edited and there is little repetition. It is relatively inexpensive and generally a very enjoyable read. It is well illustrated and well referenced. It should not be regarded as a reference text but rather as one that can easily be read from start to finish over a short period, and I believe it will update the reader with most of what is happening in paediatric urology. I do not think the specialist paediatric urologist will find much new here and the book will be of far more interest for the general paediatrician, paediatric surgeon, urologist, and trainees in those areas.

The book covers most of the major areas (but not all) of urinary tract pathology, including: prenatal diagnosis, vesicoureteral reflux, duplex systems, voiding dysfunction, neuropathic bladder, bladder exstrophy, stones, oncology, hypospadias, undescended testis, and urological emergencies.

One chapter deserves special mention: “Developmental perspectives of children with genitourinary anomalies”. Conditions such as incontinence and genital abnormalities can be particularly worrying for children and adolescents, and the point is clearly made that “identity becomes entwined with anomaly” and as a result adolescents may become developmentally blocked. The importance of identifying abnormal development to prevent problems and to treat psychological conditions that have already developed, and the need for every paediatric urology service to have formal psychological and psychiatric support is clearly made. It is encouraging to see such a holistic approach to patient care.

The chapters on vesicoureteral reflux provide an excellent overview, and it is refreshing to find an American text adhering to evidence based principles on the role of surgery. Although the topic of urinary tract infection is alluded to in a number of chapters, it is disappointing that it was not covered in a separate chapter dealing with presentation, investigation, and treatment. I also think it would have been useful to include a general chapter on urinary tract obstruction rather than have it dealt with under prenatal diagnosis.

The chapters on hyospadias and bladder exstrophy are excellent, but for the general reader there is perhaps a little too much surgical detail. It is as if the authors were undecided about which audience they were aiming at. I also think it would have been useful if the chapter on exstrophy addressed long term management rather than concentrating on the initial closure of the bladder in infancy. This is of particular importance in the United Kingdom setting where the management of exstrophy is now limited to two national centres, and there is a need for referring paediatricians to know what will happen to their patients.

Despite these shortcomings, overall I think this book is a valuable contribution, and most paediatric and urology departments would benefit from having it on the shelves of their libraries.

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