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Psychological stress can be defined as any uncomfortable 'emotional experience' accompanied by predictable biochemical, physiological and behavioural changes or responses. Many clinical studies looking at the effects of psychological stress on male fertility have shown that stress is associated with reduced paternity and abnormal semen parameters. Enough scientific evidence exists to suggest that psychological stress could severely affect spermatogenesis, mainly as a result of varying testosterone secretion. The hypothalamic-pituitary-adrenal axis has a direct inhibitory action on the hypothalamic-pituitary-gonadal (HPG) axis and Leydig cells in the testes. The newly discovered hormone, gonadotropin-inhibitory hormone (GnIH), also has an inhibitory effect on the HPG axis. Inhibition of the HPG axis results in a fall in testosterone levels, which causes changes in Sertoli cells and the blood-testis barrier, leading to the arrest of spermatogenesis. Germ cells also become vulnerable to gonadotoxins and oxidation. However, the extent and severity of the effects of psychological stress on human testes is difficult to study and data mostly come from animal models. Despite this limitation, stress as a causative factor in male infertility cannot be ignored and patients should be made aware of its effects on testicular function and fertility and helped to manage them.

Perineal radical prostatectomy (PRP) is one of the oldest surgical procedures for prostate cancer, but its use has declined over the past 30 years. New studies show that PRP is not only minimally invasive but beneficial from an economic perspective and should not yet be abandoned in the treatment of early prostate cancer.

This second edition offers an updated multi-disciplinary and multi professional approach to the assessment, diagnosis, treatment and follow-up care of patients being investigated and treated for urological malignancies.

Renal cancer accounts for more than 90 % of all renal tumours. Men are more at risk than females with incidence increasing with age. The exact cause for RCC is unknown but several risk factors have important significance. Tobacco smoking, obesity, hypertension, lack of physical activity and occupational factors have been implicated as risk factors. Kidney cancer is now known to be a genetic disease made up of a number of different cancers each with their own histology, genetic alteration, clinical course and response to therapy. Benign kidney tumours include angiomyolipoma, papilloma and oncocytoma.

Cancer of the prostate (PCa) is now recognised as one of the most common solid tumours in men in the western world outnumbering lung and colorectal cancer. Prostate cancer affects elderly men more often than young men. Although large number of cases are diagnosed in early stages, a sizeable population still present with metastatic or locally advanced disease. Surgical intervention involves wide range of procedures ranging from radical extirpation to androgen deprivation procedures such as orchidectomy. The chapter does not include operative details but describes indications, advantages and disadvantages.

Nearly 50 % of renal tumours are found incidentally on imaging used to investigate abdominal symptoms. The classic triad of haematuria, loin pain and palpable mass is a rare occurrence now-a-days but a wide spectrum of symptoms could be expected in patients with RCC.

For many years treatment the for renal cancer (RC) has been synonymous with nephrectomy. With the trend of presentation changing, early diagnosis of renal cancer has led to evolution of newer nephron-sparing approaches. Similarly, with understanding of molecular biology, innovative drug treatments have taken a prime role in metastatic renal cancer. This chapter deals with the surgical principles in the management of RC.

The urachus usually seals off and gets obliterated by 12–13 weeks and is seen as a fibrous cord between the apex of the bladder and umbilicus. However its remnants can persist and become malignant tumours, the commonest being adenocarcinoma. Urachal cancer accounts for 0.01 % of all cancers but due to its silent course it is likely to be advanced at the time of presentation. The diagnosis is made by cystoscopic examination and advanced imaging by CT or MRI. In early cases urachectomy with excision of umbilicus is adequate in controlling the disease. Advanced cases may need chemotherapy.

HIFU (HIGH Intensity Focused Ultrasounds) allows through a mini-invasive transrectal approach to treat the prostate cancer in several situations: primary care treatment, salvage treatment after radiation or brachytherapy failure. A whole gland treatment can be done as well as a focal treatment which is particularly interesting in the era of the increasing number of diagnosis of low-risk forms of prostate cancer. HIFU does not cut the bridges in that salvage radiation treatment or salvage surgery can be done after HIFU. Published oncological outcomes compares favourably with other treatment options for low-risk and intermediate-risk forms of disease. Functional outcomes are in each situation acceptable with a wide range of complications which have been to be known in order to use properly the technique and to propose it in the right time to the right patient.