, a LANGE medical book
Smith’s
General Urology
Seventeenth Edition
Editors
Emil A. Tanagho, MD
Professor Emeritus of Urology
University of California School of Medicine
San Francisco, California
Jack W. McAninch, MD, FACS
Professor of Urology
University of California School of Medicine
Chief, Department of Urology
San Francisco General Hospital
San Francisco, California
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
,Copyright © 2008, 2004, 2001, 2000 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of
America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or
distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the
publisher.
0-07-159331-4
The material in this eBook also appears in the print version of this title: 0-07-145737-2.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked
name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the
trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate
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TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work.
Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one
copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon,
transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use
the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may
be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS
TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK,
INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE,
AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not
warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or
error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless
of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information
accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special,
punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised
of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause
arises in contract, tort or otherwise.
DOI: 10.1036/0071457372
, For more information about this title, click here
Contents
Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1. Anatomy of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Emil A. Tanagho, MD
2. Embryology of the Genitourinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Emil A. Tanagho, MD, & Heip T. Nguyen, MD
3. Symptoms of Disorders of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Jack W. McAninch, MD, FACS
4. Physical Examination of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Maxwell V. Meng, MD, & Emil A. Tanagho, MD
5. Urologic Laboratory Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Karl J. Kreder, Jr, MD, & Richard D. Williams, MD
6. Radiology of the Urinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Scott R. Gerst, MD, & Hedvig Hricak, MD, PhD
7. Vascular Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Roy L. Gordon, MD
8. Percutaneous Endourology & Ureterorenoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Joachim W. Thüroff, MD, & Rolf Gillitzer, MD
9. Laparoscopic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
J. Stuart Wolf, Jr, MD, FACS, & Marshall L. Stoller, MD
10. Retrograde Instrumentation of the Urinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Marshall L. Stoller, MD
11. Urinary Obstruction & Stasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Emil A. Tanagho, MD
12. Vesicoureteral Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Emil A. Tanagho, MD, & Hiep T. Nguyen, MD
13. Bacterial Infections of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Hiep T. Nguyen, MD
14. Specific Infections of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Emil A. Tanagho, MD, & Christopher J. Kane, MD
15. Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
John N. Krieger, MD
16. Urinary Stone Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Marshall L. Stoller, MD
iii
Smith’s
General Urology
Seventeenth Edition
Editors
Emil A. Tanagho, MD
Professor Emeritus of Urology
University of California School of Medicine
San Francisco, California
Jack W. McAninch, MD, FACS
Professor of Urology
University of California School of Medicine
Chief, Department of Urology
San Francisco General Hospital
San Francisco, California
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
,Copyright © 2008, 2004, 2001, 2000 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of
America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or
distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the
publisher.
0-07-159331-4
The material in this eBook also appears in the print version of this title: 0-07-145737-2.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked
name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the
trademark. Where such designations appear in this book, they have been printed with initial caps.
McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate
training programs. For more information, please contact George Hoare, Special Sales, at or (212)
904-4069.
TERMS OF USE
This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work.
Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one
copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon,
transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use
the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may
be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS
TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK,
INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE,
AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED
WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not
warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or
error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless
of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information
accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special,
punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised
of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause
arises in contract, tort or otherwise.
DOI: 10.1036/0071457372
, For more information about this title, click here
Contents
Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
1. Anatomy of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Emil A. Tanagho, MD
2. Embryology of the Genitourinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Emil A. Tanagho, MD, & Heip T. Nguyen, MD
3. Symptoms of Disorders of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Jack W. McAninch, MD, FACS
4. Physical Examination of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Maxwell V. Meng, MD, & Emil A. Tanagho, MD
5. Urologic Laboratory Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Karl J. Kreder, Jr, MD, & Richard D. Williams, MD
6. Radiology of the Urinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Scott R. Gerst, MD, & Hedvig Hricak, MD, PhD
7. Vascular Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Roy L. Gordon, MD
8. Percutaneous Endourology & Ureterorenoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Joachim W. Thüroff, MD, & Rolf Gillitzer, MD
9. Laparoscopic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
J. Stuart Wolf, Jr, MD, FACS, & Marshall L. Stoller, MD
10. Retrograde Instrumentation of the Urinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Marshall L. Stoller, MD
11. Urinary Obstruction & Stasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Emil A. Tanagho, MD
12. Vesicoureteral Reflux . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Emil A. Tanagho, MD, & Hiep T. Nguyen, MD
13. Bacterial Infections of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Hiep T. Nguyen, MD
14. Specific Infections of the Genitourinary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Emil A. Tanagho, MD, & Christopher J. Kane, MD
15. Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
John N. Krieger, MD
16. Urinary Stone Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246
Marshall L. Stoller, MD
iii
