British Journal of Medical & Surgical Urology RSS feed: Current Issue. The British Journal of Medical and Surgical Urology , an official publication of the British Association of Urological Surgeons is a new, clinically orientated journal of urology with an emphasis on papers originating from UK-based practice. To reflect recent major changes in the field of urology, in particular the increasing importance of non-surgical management, considerable input is expected from medical urology as well as from the more surgically focused aspects of the specialty. The journal covers the whole scope of urology in five sections to align it with the BAUS specialist sections: oncology, endourology, female and reconstructive urology, andrology and academic/basic science. It publishes high-quality original research, commissioned reviews, comment articles and relevant case reports, with the overall aim of being readable, educational and relevant. The audience is primarily consultant and trainee urologists, but in the longer term it will attract specialists in fields allied to urology including uro-radiology, uro-oncology, genito-urinary medicine and nursing.http://www.bjmsu.com/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. British Journal of Medical & Surgical Urology1875-974232March 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.bjmsu.com/article/PIIS1875974210000133/abstract?rss=yesEditorial Board10.1016/S1875-9742(10)00013-3British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7iihttp://www.bjmsu.com/article/PIIS1875974210000108/abstract?rss=yesThis issue contains two original articles which really made me think when I first saw them. How often have I offered a chaperone to a male patient? Hardly ever. I was aware there was guidance that even male doctors examining male patients should offer chaperones, but it is always so much bother to get a chaperone in clinic and I had always assumed most male patients would not want a chaperone. Luckily it seems that my instinct was correct, but nonetheless I think we should all take note of this paper. My New Year resolution was that I would offer all patients a chaperone - partly because of this paper, and partly because I was so appalled by the plight of Angus Thomson, the poor gynaecologist who was the subject of vexatious allegations of which he was cleared in December. So far, all male patients to whom I have offered a chaperone have looked at me aghast and declined - consistent with the survey of Scottish urological patients in this issue (Ong et al.).EditorialJustin Vale10.1016/j.bjmsu.2010.01.005British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Editorial4545http://www.bjmsu.com/article/PIIS1875974209001992/abstract?rss=yesSummary: Introduction: General Medical Council (GMC) guidelines and the Ayling report recommend that a chaperone should be offered to all patients for every intimate examination. We wanted to establish whether these guidelines reflect men's preferences and urologists’ current practice in intimate examination.Methods: All male patients attending urology outpatient clinics over a 3 month period at two hospitals were asked to fill in a preference questionnaire. A separate questionnaire was sent to all urologists in Scotland to establish the current practice.Results: 315 patients returned evaluable questionnaires. While 227 patients (73%) felt that a chaperone should be offered, only 45 patients (14.3%) wanted a chaperone. Of these, only 15 patients (4.8%) would not have been comfortable to ask for a chaperone. 64 (75.3%) Scottish urologists responded and only 3 (4.7%) urologists offered a chaperone to all male patients. 47 (73.4%) urologists did not routinely counsel patients about intimate examination under anaesthesia as part of transurethral surgery.Conclusion: Most men do not wish a chaperone to be present. Recommended best practice will protect the small minority of patients who want to have a chaperone. This involves the offer of a chaperone to all patients and accurate record keeping in the patient's case note.Do we need chaperones for intimate examination in urology clinics? Patients’ preferences and urologists’ practice in ScotlandE. Ong, S. Garnett, J.R. MacFarlane, R. Donat10.1016/j.bjmsu.2009.11.004British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Original Articles4651http://www.bjmsu.com/article/PIIS1875974209001840/abstract?rss=yesSummary: Introduction: Gelatine is a setting agent used by the food and drug industries whose consumption is forbidden by religious and other faith groups. Gelatine-containing drugs are found in most of the drug classifications in Section 7.4 of the British National Formulary (BNF). We investigate the issues and seek to provide a solution to the use of gelatine-containing medications in urology.Methods: Forty representative urological practitioners were surveyed to ascertain if they knew of gelatine-containing urological drugs, had encountered patients enquiring about gelatine-containing medication, and where they would seek this information from.Results: Twenty-five percent of surveyed urologists had experience of patients refusing medication on the suspicion of gelatine content. 53% were unsure if urological drugs could contain gelatine, while 22%, wrongly, thought they did not. Regarding acquisition of drug constituent information, approximately a third did not know, a third looked to incorrect resources and a third referred to their pharmacy's drug information service.Conclusion: Most urologists are unaware of the issues surrounding the prescribing of gelatine-containing urological medications, the most important being those given for the management of prostatic hypertrophy. A knowledge of alternative prescribing options can help avoid belief violation for our diverse community in the UK.The problems of gelatine and prescribing urologically specific medication to a diverse population in the UK. An initial studyHazel E. Warburton, Mark S. Payne, Stephen R. Payne10.1016/j.bjmsu.2009.10.005British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Original Articles5258http://www.bjmsu.com/article/PIIS1875974210000029/abstract?rss=yesSummary: Objectives: To determine if the TNM tumour staging and serum alkaline phosphatase levels (SAP) can be used to identify which patients with renal cell carcinoma (RCC) are at greatest risk of osseous metastases.Patients and methods: A retrospective review of patients with histologically proven RCC was conducted. All patients had initial CT or MRI staging scans of the chest and abdomen. Patients also underwent bone scintigraphy and all abnormal areas were further evaluated with either serial or collaborative imaging to determine their nature.Results: 91 patients including 66 men and 25 women, with a mean age of 61, were included in the study. The incidence of bone metastases was 17.6%. The incidence of bone metastases in T1-4 disease was 4%, 31.3%, 31.8% and 66.7%, respectively. Patients with >T1N0M0 disease, as defined by initial staging scans, accounted for 53% of the cohort and included all instances of proven osseous disease. Thus ‘>T1N0M0’ was 100% sensitive and 57.3% specific as a predictor of bone metastases. Conversely, a raised SAP (>129U/L) was only 25% sensitive but had a specificity of 94.3%.Conclusions: Patients with >T1N0M0 staging should undergo bone scintigraphy. SAP is a far less sensitive predictor and its concurrent use is unwarranted.The value of TNM tumour staging and serum alkaline phosphatase levels in predicting the presence of bone metastases in patients with renal cell carcinomaM.J. George, J. Buscombe, M. Al-Akraa10.1016/j.bjmsu.2010.01.001British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Original Articles5964http://www.bjmsu.com/article/PIIS1875974210000042/abstract?rss=yesAbstract: Background: To identify the most cost-effective treatment for ureteric stones ≤15mm in our department, by using an economic model to compare the total cost of shockwave lithotripsy (SWL) versus ureteroscopy with Holmium:YAG laser lithotripsy (URSL).Patients and methods: Data for patients treated with the same lithotriptor were retrospectively analyzed. The financial department provided data about the cost of procedures. This model accepted a 100% stone-free rate for URSL in outpatients, and a 50% rate of insertion of a ureteric stent. The cost for each procedure to render a patient stone-free was estimated by the following equations:Results: Records of 228 patients with previously untreated solitary radiopaque ureteric stones ≤15mm were reviewed. The total cost for SWL (cSWL) was £1491/patient, while the total cost for URSL (cURSL) was £2195/patient. The difference was highest in the upper ureter (over £1000), and lowest in the distal part (URSL about 40% more expensive). For lower ureteric stones >10mm, SWL was over £500 more expensive than URSL.Conclusion: Using data from the department to calculate cost-effectiveness for ureteric stones ≤15mm a difference in favour of SWL versus URSL was found. Uniform guidelines incorporating cost are impossible considering differences between countries; each centre should probably assess their data individually.SWL is more cost-effective than ureteroscopy and Holmium:YAG laser lithotripsy for ureteric stones: A comparative analysis for a tertiary referral centreA.N. Argyropoulos, D.A. Tolley10.1016/j.bjmsu.2010.01.002British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Original Articles6571http://www.bjmsu.com/article/PIIS1875974209001268/abstract?rss=yesIntrauterine contraceptive devices (IUCD) have been used for many years as an effective method of contraception. Following insertion initial problems of expulsion and perforation are well described occurring in approximately 5 per 100 and 2 per 1000 insertions, respectively . These rates do not vary with the type of device but may be linked to the inexperience of the practitioners . More rare are the cases of ‘forgotten’ devices where events suggest to the woman that the structure must no longer be present and where apparently unrelated and inexplicable symptoms arise some years later. Two cases are described who presented with lower urinary tract symptoms and bladder stone subsequently identified as being associated with an IUCD inserted some years previously.Presumed expulsion of intrauterine contraceptive devices—Advice following ‘paradoxical pregnancy’Seshikanth Middela, Rono Mukherjee, Thiru Gunendran, Nicholas George10.1016/j.bjmsu.2009.08.003British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Case Reports7274http://www.bjmsu.com/article/PIIS187597420900127X/abstract?rss=yesAbstract: We present a case of rapid metastasis to the scrotum and penis within 2 months following a laparoscopic radical cystoprostatectomy in a 61-year-old male. The aim of this case report is to highlight the potential risk of rapid metastasis to both urologist and urological oncologist in all patients undergoing a laparoscopic radical cystoprostatectomy.Rapid metastasis to the scrotum and penis following laparoscopic radical cystoprostatectomyNikhil Vasdev, Dougal Brown, Ralph Marsh, Trevor Armitage, Pravin Menezes10.1016/j.bjmsu.2009.08.004British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Case Reports7577http://www.bjmsu.com/article/PIIS1875974209001311/abstract?rss=yesAbstract: Spontaneous bladder perforation is a rare presenting feature of bladder malignancy. We report a case that presented with peritonitis and underwent emergency radical surgery with good postoperative recovery.Emergency radical cystoprostatectomy for a perforated bladder tumour presenting with peritonitisGhulam Mustafa Nandwani, Karen L. Ramsden, Jay A. Gokhale, Brian J. Chaplin10.1016/j.bjmsu.2009.08.008British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Case Reports7880http://www.bjmsu.com/article/PIIS1875974209001323/abstract?rss=yesWe present the rare case of an impacted urethral calculus in an otherwise previously well 2-year-old boy. His only symptom was episodic severe dysuria and penile pain, a condition we have termed urethralgia fugax.Paediatric dysuria: Leave no stone unturnedR.J. Cetti, R. Singh, J. Douglas, B.H. Walmsley10.1016/j.bjmsu.2009.08.007British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Case Reports8183http://www.bjmsu.com/article/PIIS1875974209001566/abstract?rss=yesThe most striking aspect of this sensational case report (and I have used that word advisedly) is an absence of any clinical or laboratory proof that the patient described had actually suffered genuine spinal cord damage. Myelopathy is a highly eloquent condition in terms of producing clinical finings on neurological examination with which to substantiate the organic basis for someone's loss of lower limb power. No mention is made in the reported history of pathologically increased lower limb weakness or extensor plantar responses. Furthermore, in a case of such importance as this, standard tests of spinal function such as lower limb somatosensory evoked potentials or central motor conduction tests should have been requested from Clinical Neurophysiology.“Paraplegia as a complication of intravesical Botulinum toxin A (Dysport®) injection for overactive bladder” by Awsare and Jones [Br. J. Med. Surg. Urol. 2 (2009) 127–128]Clare J. Fowler10.1016/j.bjmsu.2009.09.024British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Correspondence8485http://www.bjmsu.com/article/PIIS1875974209001578/abstract?rss=yesWe thank Professor Fowler for her comments. As she has rightly pointed out, there is no proof that the patient described in our case report had suffered genuine spinal cord damage. Professor Fowler states that we have not mentioned if our patient had ‘pathologically increased lower limb weakness or extensor plantar response’. We have mentioned however that the patient had signs of upper motor neuron paraplegia (pathologically increased lower limb tone and decreased power). The plantar response was equivocal. When presented with this shocking clinical situation we urgently ruled out other nonrelated causes to make sure there was no other management necessary. We ruled out spinal cord compression and obvious vascular problems and rehabilitation was started. Communication with the patient then broke down.Paraplegia following intravesical botulinum toxin A (Dysport®) injection for overactive bladderNinaad Awsare, David Jones10.1016/j.bjmsu.2009.09.025British Journal of Medical & Surgical Urology 3, 2 (2010)2010-03-01British Journal of Medical & Surgical Urology2010-03-0132S1875-9742(10)X0002-7Correspondence8585