Controversies and Innovations in Urological Surgery

Book excerpt: The title of this book is a challenge. Anyone with the least knowledge of present day urology will know that there are many very controversial aspects of this subject. Urology is not alone in this unsettled environment for there are similar debates in almost all other aspects of surgery. In addition to the rapid changes in technology, an important part of the explanation for these controversies is simply that more surgeons are prepared to admit that no area of their work is so established that it does not bear further scrutiny and assessment. Argument can be tedious but debate is healthy. This book aims to present material that is debatable: experienced practitioners of each topic explain why an opinion or preference can be sustained. The purist might wish to have these opinions resolved by a well-planned clinical trial, but experience of clinical trials shows that they do not always produce results that are easily translated into a positive change in clinical practice. Would the reader be persuaded more by a statistically significant difference or by an experienced clinician who has reached certain conclusions? Both are risky, but since surgical techniques are often not easily converted into appropriate studies or trials the Editors have obtained the best opinion on each controversy and innovation. The media adore controversy for its own sake. The medical profession accepts controversy but knows that few events in medicine are absolute and few procedures can be done only by one method.