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Kavoussi, Alan W. Get help. Create an account. Free Medical Books — Arslan Library. Share Absence of Orgasm. Anorgasmia is usually psychogenic or caused by certain medications used to treat psychiatric diseases. Sometimes, however, anorgasmia may be due to decreased penile sensation owing to impaired pudendal nerve function. Most commonly, this occurs in diabetics with peripheral neuropathy.
Men who experience anorgasmia in association with decreased penile sensation should undergo vibratory testing of the penis and further neurologic evaluation as indicated. Premature Ejaculation. Men who complain of premature ejaculation should be questioned carefully because this is obviously a subjective symptom.
It is common for men to ejaculate within 2 minutes after initiation of intercourse, and many men who complain of premature ejaculation in actuality have normal sexual function with abnormal sexual expectations. However, there are men with true premature ejaculation who reach orgasm within less than 1 minute after initiation of intercourse.
This problem is almost always psychogenic and best treated by a clinical psychologist or psychiatrist who specializes in treatment of this problem and other psychological aspects of male sexual dysfunction.
With counseling and appropriate modifications in sexual technique, this problem can usually be overcome. Alternatively, treatment with serotonin reuptake inhibitors such as sertraline and fluoxetine has been demonstrated to be helpful in men with premature ejaculation Murat Basar etal, Hematospermia Hematospermia refers to the presence of blood in the seminal fluid. It frequently occurs after a prolonged period of sexual abstinence, and we have observed it several times in men whose wives are in the final weeks of pregnancy.
Patients with hematospermia that persists beyond several weeks should undergo further urologic evaluation because, rarely, an underlying etiology will be identified. A genital and rectal examination should be done to exclude the presence of tuberculosis; a prostate-specific antigen PSA and a rectal examination done to exclude prostatic carcinoma; and a urinary cytology done to exclude the possibility of transitional cell carcinoma of the prostate.
It should be emphasized, however, that hematospermia almost always resolves spontaneously and rarely is associated with any significant urologic pathology. Pneumaturia Pneumaturia is the passage of gas in the urine. In patients who have not recently had urinary tract instrumentation or a urethral catheter placed, this is almost always due to a fistula between the intestine and the bladder.
Common causes include diverticulitis, carcinoma of the sigmoid colon, and regional enteritis Crohn disease. In rare instances, patients with diabetes mellitus may have gas-forming infections, with carbon dioxide formation from the fermentation of high concentrations of sugar in the urine.
Urethral Discharge Urethral discharge is the most common symptom of venereal infection. A purulent discharge that is thick, profuse, and yellow to gray is typical of gonococcal urethritis; the discharge in patients with nonspecific urethritis is usually scant and watery. A bloody discharge is suggestive of carcinoma of the urethra.
Fever and Chills Fever and chills may occur with infection anywhere in the GU tract but are most commonly observed in patients with pyelonephritis, prostatitis, or epididymitis. When associated with urinary obstruction, fever and chills may portend septicemia and necessitate emergency treatment to relieve obstruction.
Medical History The past medical history is extremely important because it frequently provides clues to the patients current diagnosis. The past medical history should be obtained in an orderly and sequential manner. Previous Medical Illnesses with Urologic Sequelae Many diseases may affect the GU system, and it is important to listen to the patient and record previous medical illnesses. Patients with diabetes mellitus frequently develop autonomic dysfunction that may result in impaired urinary and sexual function.
A previous history of tuberculosis may be important in a patient presenting with impaired renal function, ureteral obstruction, or chronic, unexplained UTIs. Patients with hypertension have an increased risk of sexual dysfunction because they are more likely to have peripheral vascular disease and because many of the medications that are used to treat hypertension frequently cause impotence.
Patients with neurologic diseases such as multiple sclerosis are also more likely to develop urinary and sexual dysfunction. As mentioned earlier, in men with bladder outlet obstruction, it is important to be aware of. Surgical treatment of bladder outlet obstruction in the presence of detrusor hyperreflexia may result in increased urinary incontinence postoperatively. Finally, patients with sickle cell anemia are prone to a number of urologic conditions, including papillary necrosis and erectile dysfunction secondary to recurrent priapism.
There are many other diseases with urologic sequelae, and it is important for the urologist to take a careful history in this regard. Examples of genetic diseases include adult polycystic kidney disease, tuberous sclerosis, von Hippel-Lindau disease, renal tubular acidosis, and cystinuria; these are but a few common and well-recognized examples.
In addition to these diseases of known genetic predisposition, there are other conditions in which the precise pattern of inheritance has not been elucidated but that clearly have a familial tendency. It is well known that individuals with a family history of urolithiasis are at increased risk for stone formation.
Other familial conditions are mentioned elsewhere in the text, but suffice it to state again that obtaining a careful history of previous illnesses and a family history of urologic disease can be extremely valuable in establishing the correct diagnosis. Medications It is similarly important to obtain an accurate and complete list of present medications because many drugs interfere with urinary and sexual function.
For example, most of the antihypertensive medications interfere with erectile function, and changing antihypertensive medications can sometimes improve sexual function. Similarly, many of the psychotropic agents interfere with emission and orgasm. In our own recent experience, we cared for a man who presented with anorgasmia. He had been to several physicians without improvement in this problem. When we obtained his past medical history, he mentioned that he had been taking a psychotropic agent for transient depression for several years, and his anorgasmia resolved when this no-longer-needed medication was discontinued.
The list of medications affecting urinary and sexual function is exhaustive, but, once again, each medication should be recorded and its side effects investigated to be sure that the patients problem is not drug related.
A listing of common medications that may cause urologic side effects is presented in Table Previous Surgical Procedures It is important to be aware of previous operations, particularly in a patient who may have surgery, because previous operations may make subsequent ones more difficult.
If the previous surgery was in a similar anatomic region, it is worthwhile to try to obtain the previous operative report. In our own experience, this small additional effort has been rewarded on numerous occasions by providing a clear explanation of the patients previous surgery that greatly simplified the subsequent operation. In general, it is worthwhile to obtain as much information as possible before any intended surgery because most surprises that occur in the operating room are unhappy ones.
Smoking and Alcohol Use Cigarette smoking and consumption of alcohol are clearly linked to a number of urologic conditions. Cigarette smoking is associated with an increased risk of urothelial carcinoma, most notably bladder cancer, and it is also associated with increased peripheral vascular disease and erectile dysfunction.
Chronic alcoholism may result in autonomic and peripheral neuropathy. Direct smooth muscle stimulants Others Smooth muscle relaxants Striated muscle relaxants. Calcium channel blockers Antiparkinsonian drugs -Adrenergic agonists Antihistamines Acute renal failure. Antihypertensives Cardiac drugs Gastrointestinal drugs Psychotropic drugs Tricyclic antidepressants.
Chronic alcoholism may also impair hepatic metabolism of estrogens, resulting in decreased serum testosterone, testicular atrophy, and decreased libido. In addition to the direct urologic effects of cigarette smoking and alcohol consumption, patients who are actively smoking or drinking up to the time of surgery are at increased risk for perioperative complications.
Smokers are at increased risk for both pulmonary and cardiac complications. If possible, they should discontinue smoking at least 8 weeks before surgery to optimize their. If they are unable to do this, they should at least quit smoking for 48 hours before surgery because this will result in a significant improvement in cardiovascular function.
Similarly, chronic alcoholics are at increased risk for hepatic toxicity and subsequent coagulation problems postoperatively. Furthermore, alcoholics who continue drinking up to the time of surgery may experience acute alcohol withdrawal during the postoperative period that can be life threatening.
Prophylactic administration of lorazepam Ativan greatly reduces the potential risk of this significant complication. Allergies Finally, medicinal allergies should be questioned because these medications should be avoided in future treatment of the patient. All medicinal allergies should be marked boldly on the front of the patients chart to avoid potential complications from inadvertent exposure to the same medications.
In summary, a careful and thorough medical history including the chief complaint and history of present illness, past medical history, and family history should be obtained for every patient.
Unfortunately, time constraints often make it difficult for the physician to spend the necessary time to obtain a full history. A reasonable substitute is to have a trained nurse or other health professional see the patient first. By using a standard history form, much of the information discussed previously can be obtained in a preliminary interview.
It then remains for the urologist to only fill in the blanks, have the patient elaborate on potentially relevant aspects of the past medical history, and then perform a complete physical examination. A complete history and appropriate physical examination is critical in the assessment of urologic patients. A complete urinalysis including chemical and microscopic analyses should be performed because this may provide important information critical to the diagnosis and treatment of urologic patients.
A complete and thorough physical examination is an essential component of the evaluation of patients who present with urologic disease. Although it is tempting to become dependent on results of laboratory and radiologic tests, the physical examination often simplifies the process and allows the urologist to select the most appropriate diagnostic studies.
Along with the history, the physical examination remains a key component of the diagnostic evaluation and should be performed conscientiously. General Observations The visual inspection of the patient provides a general overview.
The skin should be inspected for evidence of jaundice or pallor. The nutritional status of the patient should be noted. Cachexia is a frequent sign of malignancy, and obesity may be a sign of underlying endocrinologic abnormalities.
In this instance, one should search for the presence of truncal obesity, a buffalo hump, and abdominal skin striae, which are stigmata of hyperadrenocorticism. In contrast, debility and hyperpigmentation may be signs of hypoadrenocorticism. Gynecomastia may be a sign of endocrinologic disease and a possible indicator of alcoholism or previous hormonal therapy for prostate cancer. Supraclavicular lymphadenopathy may be seen with any GU neoplasm, most commonly prostate and testis cancer; inguinal lymphadenopathy may occur secondary to carcinoma of the penis or urethra.
Because of the position of the liver, the right kidney is somewhat lower than the left. In children and thin women, it may be possible to palpate the lower pole of the right kidney with deep inspiration.
However, it is usually not possible to palpate either kidney in men, and the left kidney is almost always impalpable unless it is abnormally enlarged. The best way to palpate the kidneys is with the patient in the supine position. The kidney is lifted from behind with one hand in the costovertebral angle Fig. On deep inspiration, the examiners hand is advanced firmly into the anterior abdomen just below the costal margin.
At the point of maximal inspiration, the kidney may be felt as it moves downward with the diaphragm. With each inspiration, the examiners hand may be advanced deeper into the abdomen.
Once again, it is more difficult to palpate kidneys in men because the kidneys tend to move downward less with inspiration and because they are surrounded with thicker muscular layers. In children, it is easier to palpate the kidneys because of decreased body thickness. In neonates, the kidneys can be felt quite easily by palpating the flank between the thumb anteriorly and the fingers over the costovertebral angle posteriorly.
Transillumination of the kidneys may be helpful in children younger than 1 year of age with a palpable flank mass. Such masses are frequently of renal origin. A flashlight or fiberoptic light source is positioned posteriorly against the costovertebral angle. Fluid-filled masses such as cysts or hydronephrosis produce a dull reddish glow in the anterior abdomen. Solid masses such as tumors do not transilluminate. Other diagnostic maneuvers that may be helpful in examining the kidneys are percussion and auscultation.
Although renal inflammation may cause pain that is poorly localized, percussion of the costovertebral angle posteriorly more often localizes the pain and tenderness more accurately. Percussion should be done gently because in a patient with significant renal inflammation, this may be quite painful. Auscultation of the upper abdomen during deep inspiration may occasionally reveal a systolic bruit associated with renal artery stenosis or an aneurysm.
A bruit may also be detected in association with a large renal arteriovenous fistula. Every patient with flank pain should also be examined for possible nerve root irritation. The ribs should be palpated carefully to rule out a bone spur or other skeletal abnormality and to determine the point of maximal tenderness. Unlike renal pain, radiculitis usually causes hyperesthesia of the overlying skin innervated by the irritated peripheral nerve.
This hypersensitivity can be elicited with a pin or by pinching the skin and fat overlying the involved area. Finally, the pain experienced during the pre-eruptive phase of herpes zoster involving any of the segments between T11 and L2 may also simulate pain of renal origin.
Kidneys The kidneys are fist-sized organs located high in the retroperitoneum bilaterally. In the adult, the kidneys are normally difficult to. Bladder A normal bladder in the adult cannot be palpated or percussed until there is at least mL of urine in it.
At a volume of about mL, the distended bladder becomes visible in thin patients as a lower midline abdominal mass. Percussion is better than palpation for diagnosing a distended bladder. The examiner begins by percussing immediately above the symphysis pubis and continuing cephalad until there is a change in pitch from dull to resonant.
Alternatively, it may be possible in thin patients and in children to palpate the bladder by lifting the lumbar spine with one hand and pressing the other hand into the midline of the lower abdomen. A careful bimanual examination, best done with the patient under anesthesia, is invaluable in assessing the regional extent of a bladder tumor or other pelvic mass.
The bladder is palpated between the abdomen and the vagina in the female Fig. In addition to defining areas of induration, the bimanual examination allows the examiner to assess the mobility of the bladder; such information cannot be obtained by radiologic techniques such as CT and MRI, which convey static images. Penis If the patient has not been circumcised, the foreskin should be retracted to examine for tumor or balanoposthitis inflammation of the prepuce and glans penis.
Most penile cancers occur in uncircumcised men and arise on the prepuce or glans penis. Therefore in a patient with a bloody penile discharge in whom the foreskin cannot be withdrawn, a dorsal slit or circumcision must be performed to adequately evaluate the glans penis and urethra. Figure Bimanual examination of the bladder in the female.
From Swartz MH. Textbook of physical diagnosis. Philadelphia: Saunders; The position of the urethral meatus should be noted. It may be located proximal to the tip of the glans on the ventral surface hypospadias or, much less commonly, on the dorsal surface epispadias. The penile skin should be examined for the presence of superficial vesicles compatible with herpes simplex and for ulcers that may indicate either venereal infection or tumor.
The presence of venereal warts condylomata acuminata , which appear as irregular, papillary, velvety lesions on the male genitalia, should also be noted. The urethral meatus should be separated between the thumb and the forefinger to inspect for neoplastic or inflammatory lesions within the fossa navicularis.
The dorsal shaft of the penis should be palpated for the presence of fibrotic plaques or ridges typical of Peyronie disease. Tenderness along the ventral aspect of the penis is suggestive of periurethritis, often secondary to a urethral stricture. Scrotum and Contents The scrotum is a loose sac containing the testes and spermatic cord structures. The scrotal wall is made up of skin and an underlying thin muscular layer.
The testes are normally oval, firm, and smooth; in adults, they measure about 6 cm in length and 4 cm in width. Peters provide more than 3, multiple-choice questions with detailed answers that help you master the most important elements in urology, while interactive questions, self-assessment tools, an extensive image bank, and more are available on Expert Consult.
Prepare for the written boards and MOC exams with the most reliable, efficient review available, from the same team that has made Campbell-Walsh Urology the most trusted clinical reference in the field. Stay up to date with new topics covered in the parent text, including evaluation and management of men with urinary incontinence, minimally-invasive urinary diversion, laparoscopic and robotic surgery in children, and much more.
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Partin, and Craig A. Walter S. Kerr, Jr.Campbell Walsh Urology 11th Edition Campbell walsh urology 11th edition pdf free download. Following the same chapter structure as the authoritative Campbell-Walsh Urology, 11th Edition, this trusted review covers all the core material you need to know for board exam preparation and MOC exams. Scott McDougal, Campbel J. Wein, Louis R. Kavoussi, Alan W. Partin, and Craig A. Drake find your love mp3 free download provide more than 3, multiple-choice questions with detailed answers that help you master the most important elements in urology, while interactive questions, self-assessment tools, an extensive image bank. Key Features. Prepare for the written boards and MOC exams with the most reliable, efficient review available, from the same team that has made Campbell-Walsh Urology the most trusted clinical reference in the field. Autores: W. Partin, Craig A. Peters Editorial: Else. Free Zippyshare. Alan J. WeinAlan W. PetersLouis R. KavoussiUrology campbell walsh urology 11th edition pdf free download, W. [Download] PDF Campbell-Walsh Urology 11th Edition Review, 2e => Get This Parasitology Book Free Download Parasitology Books PDF. Read "Campbell-Walsh Urology 11th Edition Review E-Book" by W. Scott McDougal, MD, MA (Hon available from Rakuten Kobo. Following the same chapter. Campbell-Walsh Urology 4 Volume Set 11th Edition PDF - If you found this book helpful then please MB PDF. Free Download Here. This article contains Campbell-Walsh Urology 11th Edition PDF for free download. This book has been authored by Alan J. Wein. [Read] EBOOK Campbell-Walsh Urology 11th Edition Review, 2e => https://impotenzberatung.com?asin=X. See Table in Campbell-Walsh Urology, 11th edition for the International If the hemoccult is positive, the patient should be on a red meat–free diet for 3. Campbell Walsh Urology - Free ebook download as PDF File .pdf), Text File .txt) or read book online for free. Urology. version of the 11th edition will have updates by key opinion leaders added periodically to reect. Campbell-Walsh Urology - 11th Edition, covers all the core material you need to know for board exam preparation and MOC exams. With new and updated questions based on Campbell-Walsh-Wein Urology 12th Edition content, this comprehensive review covers all the core. Campbell-Walsh Urology 11th Edition Review: Medicine Available at a lower price from other sellers that may not offer free Prime shipping. For patients with persistent or recurrent AMH, repeat evaluation within 3 to 5 years should be considered. Pharmacologic agents, particularly -adrenergic antagonists, may interfere with bladder neck closure at time of orgasm and result in retrograde ejaculation. Bold and italicized text draws attention to important topics, while "High-Yield Boxes" highlight vital information. Penile Pain. Gilbert, MD, and Joseph A. Inflammation of the mucosa of a hollow viscus such as the bladder or urethra usually produces discomfort, but the pain is not nearly as severe. The patients symptoms need to be clarified for details and quantified for severity. Intact erythrocytes in the urine undergo hemolysis when they come in contact with the reagent test pad, and the localized free hemoglobin on the pad produces a corresponding dot of color change. Ownership of the 11th edition includes the print product, access to the full text online, and a downloadable eBook version through ExpertConsult. In rare instances, patients with diabetes mellitus may have gas-forming infections, with carbon dioxide formation from the fermentation of high concentrations of sugar in the urine. When associated with urinary obstruction, fever and chills may portend septicemia and necessitate emergency treatment to relieve obstruction. Thus it is important for the urologist to be aware of the common causes of abnormal urine color, and these are listed in Table Nocturia is nocturnal frequency. However, increased levels of ascorbic acid in the urine do not interfere with dipstick testing for hematuria. Such patients may void most of their urine normally but have a continuous amount of small urinary leakage that may be misdiagnosed for many years as a chronic vaginal discharge.