New Techniques in Reconstructive Urology
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* R. John Honey

**NEW TECHNIQUES IN RECONSTRUCTIVE UROLOGY.** Topics in Clinical Urology Series. Edited by Jack W. McAninch. 149 pp. Illust. Igaku-Shoin Medical Publishers Inc., New York. 1996. $94. ISBN 0-89640-281-9

This is the first volume in a new series of publications from Igaku-Shoin Medical Publishers. It is a short, multiathored book, with numerous large, clear illustrations and could comfortably be read over a single weekend. It is directed to residents-in-training and practising general urologists. Those with specialized training in reconstructive urology will find this book too limited. Although it is an excellent slim volume, the title perhaps should have referred to *a selection of* new techniques in reconstructive urology, since the field of reconstructive surgery covered is limited, involving the anterior urethra, kidney, bowel segments used in bladder reconstruction and the skin of the scrotum and penis.

The section on the anterior urethra contains three chapters. The first, by Gerald Jordan, deals with strictures of the fossa navicularis. There is a brief, but useful, summary of techniques available to deal with this difficult problem and a more detailed description of his very successful ventral transverse skin island procedure. The following chapter by Kennon Miller and Jack McAninch describes their modifications of the onlay island flap urethroplasty for complex anterior urethral strictures, and the following chapter describes Duckett’s onlay island flap procedure for hypospadias. Laurence Baskin and John Duckett produce a compelling argument for preservation of the urethral plate and the use of island patches instead of island tubes in hypospadias patients with ventral penile curvature.

The section on the kidney contains three chapters. Methods of renal reconstruction after major renal injury by McAninch is a good summary for residents-in-training but is somewhat biased toward a more aggressive surgical approach to renal injuries than we are accustomed to in the majority of Canadian centres. Novick draws from his large personal experience in the chapter on renal sparing surgery for renal cell carcinoma and gives an excellent summary of contemporary surgical techniques in this situation. The chapter on endoscopic management of ureteropelvic junction obstruction by Arthur Smith and his endourology fellow is rather disappointing. Although this chapter covers Smith’s personal approach to the subject, this approach has not changed over the past few years, and there is little emphasis on recent developments.

Two chapters constitute the section on the use of bowel segments in bladder reconstruction. They cover the subject well, and if more detail is required about individual techniques, the chapter on orthotopic bladder replacement by Aboseif, Cho and Carroll contains 45 references. The indications and techniques of bladder augmentation by Anthony Stone is concise and easy to read, but there is little on indications or the urodynamic assessment of patients.

The final section on scrotum and penis consists of a single 14-page chapter by Armenatas and McAninch on the use of skin grafts in external genital reconstruction. This contains an excellent, concise section on the various types of skin graft and their properties, with brief coverage of their use in penile and scrotal skin loss.

In summary, this book is concise and easy to read, with large, clear illustrations. It covers a limited part of reconstructive urology. Future volumes of *Topics in Clinical Urology* include complications of interventional techniques, pediatric urology for the general urologist, new developments in the management of urolithiasis, new diagnostic tests and medical and surgical management of prostate cancer.