{"title":"The physiology and pharmacology of the lower urinary tract","authors":"Rumyana Smilevska, Sharmila Rajendran, Gina Hadley","doi":"10.1016/j.mpsur.2025.03.013","DOIUrl":"10.1016/j.mpsur.2025.03.013","url":null,"abstract":"<div><div>The lower urinary tract consists of the urinary bladder, the urethra, and the prostate in males. The primary function of the lower urinary tract is to store and voluntarily release urine. During the urine storage phase the bladder wall distention activates stretch receptors. The bladder's compliance ensures urine storage without a significant increase in the intravesical pressure. The sympathetic nervous system maintains the bladder relaxed and the internal sphincter contracted. The external sphincter is under voluntary control and prevents urination. The central nervous system regulates and suppresses the micturition reflex. This coordinated control allows the safe storage of urine until the appropriate time for urination arrives. Pathologies affecting any of these levels result in a range of lower urinary tract symptoms, leading to prevalent symptoms that can significantly affect the patient's quality of life. Pharmacological treatment aimed at alleviating these symptoms contributes to enhancing urinary function and to improving the quality of life.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 370-377"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Test yourself MCQ and single best answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2025.05.001","DOIUrl":"10.1016/j.mpsur.2025.05.001","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 416-417"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natesh Shivakumar, Matthew Trail, Feras Al Jaafari
{"title":"The practical assessment and management of male lower urinary tract symptoms","authors":"Natesh Shivakumar, Matthew Trail, Feras Al Jaafari","doi":"10.1016/j.mpsur.2025.03.016","DOIUrl":"10.1016/j.mpsur.2025.03.016","url":null,"abstract":"<div><div>Lower urinary tract symptoms (LUTS) are highly prevalent to both males and females and can be significantly troublesome for patients. Thus, knowledge of the assessment, management and prognosis of patients who present with complaints pertaining to this symptom complex is of importance to all healthcare professionals – both in primary and secondary care. In this article, we focus on male LUTS and discuss the importance of utilizing standarded terminology in the description of symptoms and signs relating to LUTS, before proceeding to take the reader on a journey through the diagnostic evaluation to a summary of the myriad of pharmacological and surgical treatment options for this ever-expanding field in urological practice.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 383-390"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of urolithiasis","authors":"Khodr Terro, Oliver Wiseman","doi":"10.1016/j.mpsur.2025.03.015","DOIUrl":"10.1016/j.mpsur.2025.03.015","url":null,"abstract":"<div><div>Urolithiasis is a common urological condition. Its incidence is increasing. It is one of the commonest urological emergencies, and has important, occasionally life-threatening, differential diagnoses. Treatment of an infected obstructed kidney is a urological emergency, and supportive treatment and swift drainage are paramount. Decision making for the treatment of stones depends upon stone size, site, patient and kidney factors, with active surveillance, ESWL, ureteroscopy and laser stone fragmentation and PCNL all possible options. Metabolic investigation of high-risk stone formers and advice regarding the prevention of stone formation are important.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 396-405"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natesh Shivakumar, Matthew Trail, Feras Al Jaafari
{"title":"Assessment of lower urinary tract symptoms","authors":"Natesh Shivakumar, Matthew Trail, Feras Al Jaafari","doi":"10.1016/j.mpsur.2025.04.003","DOIUrl":"10.1016/j.mpsur.2025.04.003","url":null,"abstract":"<div><div>Lower urinary tract symptoms (LUTS) affects a significant proportion of patients and can impact quality of life. It is a common presentation to both primary and secondary care and can be non-specific with a wide range of pathophysiological causes. Therefore, a comprehensive assessment of LUTS is required to identify the contributing factors and to allow appropriate management. This article will focus on the symptoms and signs of LUTS, clarification of commonly used terminology and the important aspects to consider when assessing LUTS. We will discuss some of the valuable tools as part the diagnostic evaluation of LUTS including validated symptom questionnaire, bladder diary, urinalysis, blood tests, imaging and urodynamics.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 378-382"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anatomy of the lower urinary tract","authors":"Peter J. Bazira","doi":"10.1016/j.mpsur.2025.03.014","DOIUrl":"10.1016/j.mpsur.2025.03.014","url":null,"abstract":"<div><div>For descriptive purposes, the urinary tract is divided into upper and lower parts. The kidneys and ureters make up the upper urinary tract with the urinary bladder and urethra forming the lower urinary tract. In this article, a detailed description of the surgical and functional anatomy of the urinary bladder is followed by a description of the clinical anatomy of the female and male urethra. There then follows a brief description of the relevant anatomy of the prostate and seminal vesicles. While not strictly involved in the conduction of urine from the bladder to the exterior, the prostate and seminal vesicles are so intimately related (both topographically and functionally) to the urethra and bladder that no account of the lower urinary tract in the male would be complete without them. It is conventional, therefore, to regard the prostate and seminal vesicles as part of the lower urinary tract.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 358-369"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nocturia","authors":"Tim Lane","doi":"10.1016/j.mpsur.2025.04.002","DOIUrl":"10.1016/j.mpsur.2025.04.002","url":null,"abstract":"<div><div>Nocturia is a poorly understood symptom complex. It is seldom the result of obstructive lower urinary tract symptoms alone. Its association with multiple medical comorbidities and nocturnal polyuria explains the generally poor response to interventions aimed at improving outflow obstruction or lessening the impact of bladder instability. Nocturia is increasingly recognized as a surrogate marker for poor health and one that carries with it an increased risk of mortality. The management of nocturia needs to address not only the underlying medical conditions, but also the impact of nocturnal polyuria – the latter through anti-diuretic pharmacology or by manipulating the timing of an individual's diuresis to avoid periods of sleep. Those interventions which increase the time before the first wake to void in an individual with several episodes of nocturia should be deemed of greater clinical significance than those that simply reduce the total number of voided episodes. In this respect an understanding of the restorative function of deep slow-wave sleep should not be underestimated. A failure to understand the fundamental causes of nocturia frequently results in an ineffective polypharmacy which further impacts on the quality of life in a predominantly senescent population.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 391-395"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anatomy of the kidney and ureter","authors":"Peter J. Bazira","doi":"10.1016/j.mpsur.2025.03.011","DOIUrl":"10.1016/j.mpsur.2025.03.011","url":null,"abstract":"<div><div>For descriptive purposes, the urinary tract is divided into upper and lower parts. The kidneys and ureters make up the upper urinary tract with the urinary bladder and urethra forming the lower urinary tract. This article discusses the anatomy of the kidney and ureter highlighting key aspects that are of relevance to their function and to the surgeon. The article also includes a brief account of the anatomy of the suprarenal gland because of the close anatomical relationship between it and the upper urinary tract.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 349-357"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Genitourinary trauma","authors":"Alexander West, Christine Gan","doi":"10.1016/j.mpsur.2025.03.012","DOIUrl":"10.1016/j.mpsur.2025.03.012","url":null,"abstract":"<div><div>Genitourinary trauma occurs in up to 10% of all trauma cases and can be associated with significant morbidity and long-term complications if not managed appropriately. The majority of patients presenting with trauma will have had a CT trauma protocol scan which will guide management, but injuries are still missed and good clinical evaluation of the patient is crucial. Iatrogenic injuries, especially to the ureters, bladder and urethra, are common, and prompt recognition and management are vital to ensure a good outcome. The management of genitourinary trauma has shifted in recent years towards a more conservative approach. Interventional radiology offers excellent alternative management options in many cases. Where surgical exploration is indicated, the aims are to achieve haemostasis, debride necrotic tissue, but also to preserve as much functioning tissue as possible. This article outlines the incidence, investigation and management of trauma to the genitourinary system.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 6","pages":"Pages 406-415"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Varicose veins","authors":"Manj Gohel","doi":"10.1016/j.mpsur.2025.03.010","DOIUrl":"10.1016/j.mpsur.2025.03.010","url":null,"abstract":"<div><div>Varicose veins are dilated, tortuous bulging veins in the legs caused by superficial venous reflux, most commonly in the great and short saphenous veins. This is part of a spectrum of chronic venous disease which is a significant cause of patient distress and health service burden. The assessment of patients with venous disease involves a detailed history and careful examination of the legs for the distribution of veins and skin changes. The gold-standard investigation is duplex ultrasound scanning to identify reflux and obstruction in superficial and deep veins. Superficial venous reflux is the most common abnormality seen and there have been significant advances in recent years away from traditional surgical stripping operations, to minimally invasive endovenous ablation modalities. Modern varicose vein procedures are performed under local anaesthesia with small incisions, low risks of complications and a rapid return to normal activities. Careful patient consent is imperative as is a shared decision-making process with the patient to identify their priorities and adopt the optimal treatment strategy to achieve the best outcomes.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"43 5","pages":"Pages 277-285"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143931409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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