British Journal of Medical & Surgical Urology - Articles in Press

Bladder cancer - Corrected Proof

C.R. Lunt, S.B. Maddineni, R. Brough — 2012-02-02

Bladder cancer is the seventh commonest cause of cancer death in American and British males . It is predominantly a disease of middle age and the elderly, with the incidence increasing with age . In the UK and USA the disease is becoming more prevalent and it is anticipated that with the ageing of the developed world's population this trend will continue . Bladder cancer is more common in males with a male:female ratio of 3.8:1.

Development and validation of a UK-specific prostate cancer staging predictive model: UK prostate cancer tables - Corrected Proof

Thomas B.L. Lam, Olivier Regnier-Coudert, John McCall, Sam McClinton — 2012-02-01

Summary: Objectives: To construct new prostate cancer staging lookup tables based on a dataset collated by the British Association of Urological Surgeons (BAUS) and to validate them and compare their predictive power with Partin tables.Patients and methods: Complete data on 1701 patients was collated between 1999 and 2008 across 57 UK centres. Lookup tables were created for prediction of pathological stage (PS) using PSA level, biopsy Gleason score (GS) and clinical stage, replicating Partin's original approach.Tables were generated using logistic regression (LR) and bootstrap resampling methods and were internally validated and externally validated using concordance indices (CI) and area under the receiver operating characteristic curve (AUROC) respectively.Results: The CI and AUROC analyses indicate that Partin tables performed poorly on UK data in comparison with US data.The UK prostate cancer tables performed better than Partin tables but the predictive power of all models was relatively poor.Conclusion: The study shows that the predictive power of Partin tables is reduced when applied to the UK population.Models generated using LR methodology have fundamental limitations, and we suggest alternative modelling methods such as Bayesian networks.

Tumour multiplicity as a risk factor for the development of bladder tumours after primary upper urinary tract cancer - Corrected Proof

Hideaki Ito, Nobuyuki Oyama, Katsuki Tsuchiyama, Osamu Yokoyama — 2012-02-01

Summary: Objective: To determine the independent risk factors for intravesical tumour recurrence in patients with primary urothelial cancer of the upper urinary tract.Patients and methods: Of the 60 patients who underwent nephroureterectomy for urothelial cancer of the upper urinary tract, the data from 49 patients were retrospectively reviewed. Patients with a previous history or concomitance of bladder cancer were excluded from the study. Multivariate analysis by Cox's proportional hazards model was used to determine independent risk factors for intravesical tumour recurrence.Results: Of the 49 patients reviewed, 22 (44.9%) experienced subsequent intravesical tumour recurrence during a mean follow-up period of 26 months (range 3–103). On multivariate analysis, tumour multiplicity had a statistically significant impact on the risk of intravesical tumour recurrence (P<0.01).Conclusion: Neither the pathology of the upper urinary tract cancers nor the method of treatment was associated with recurrent bladder cancers. Only tumour multiplicity had a significant impact on the incidence of intravesical tumour recurrence.

A retrospective multi-centre study on the outcome of laparoscopic simple nephrectomies - Corrected Proof

Jihène El Kafsi, Mark Sullivan, Adam Jones — 2012-01-24

Summary: Objective: A review of our experience in laparoscopic simple nephrectomies from May 2003 to May 2011 in the Urology Departments in Oxford and Reading.Method: A total of 100 patients, median age 46years (IQR=27, range 17–82) underwent a laparoscopic simple nephrectomy for benign disease in the 8-year period reviewed. Data on patient demographics, pre-operative diagnosis, operating time, operative approach, estimated blood loss, in hospital post-operative complications and length of stay were collected from electronic databases held in the departments and regularly updated.Results: 100 laparoscopic simple nephrectomies were performed between May 2003 and May 2011. Median operating time was 180min (IQR=60min, range 75–375min). Median estimated blood loss was 50ml (IQR=50ml, range 10–1000ml). Median length of stay was 3days (IQR=3, range 2–14days). No patients suffered from significant changes in renal function. Three patients were transfused between 2 and 3 units. 26 complications were recorded for 22 patients. Four were Clavien grade IIIb and 22 were grades I–II.Conclusion: Although laparoscopic simple nephrectomy is feasible and confers the usual benefits of laparoscopy it is often a technically challenging procedure. We used the Clavien Classification to standardise complications of laparoscopic simple nephrectomies. The term “simple” nephrectomy is misleading and should be changed.

Prostate cancer incidence in patients on 5α-reductase inhibitors for lower urinary tract symptoms: A 14-year retrospective study - Corrected Proof

I. Ahmad, D.R. Small, N.S. Krishna, M.N. Akhtar, H.Y. Leung — 2012-01-24

Summary: There is still much debate regarding the long-term effect of 5α-reductase inhibitors (5-ARI) on the development of prostate cancer (PC). We tested the incidence of prostate cancer and the tumour Gleason grading in a non-screened population who were prescribed 5-ARIs for lower urinary tract symptoms (LUTS). Data from a prostatic biopsy database were analysed in a retrospective study, and included a period of 14 years (01/01/1997 to 01/01/2011). Those patients who were on 5-ARIs with either finasteride or dutasteride for less than 1 year were excluded. Patients who presented with LUTS and underwent diagnostic prostatic biopsies were included in this study. This patient cohort was further categorised according to their history of 5-ARIs medication.The incidence of PC in the 5-ARI treated group was 15.4% (n=22/143), comparable to that of the untreated group (16.7%, n=332/1990) (p=0.7318). Mean Gleason sum score and respective grade was the same (7=3+4) (median sum score 7 (range 6–10)). Average age at the time of PC diagnosis was similar regardless of 5-ARIs treatment: 72 (range 50–84) and 73 (45–84) years for treated and untreated groups, respectively.In this retrospective study, patients treated with 5-ARIs for LUTS had similar risk in developing PC when compared to those who did not receive 5-ARIs. The Gleason sum scores for the cancers were similar in the two groups.

A five year review of the management of acutely presenting epididymo-orchitis in a single UK institution - Corrected Proof

T.J. Dutton, J.J. Aning, J.S. McGrath — 2012-01-20

Summary: Introduction: This audit compared the management of epididymo-orchitis within our institution against the 2010 guidelines issued by the British Association of Sexual Health and HIV.Methods: A Retrospective casenote analysis was performed on all patients diagnosed with epididymo-orchitis between August 2004 and August 2009. Patients were identified using Hospital Episode Statistics (HES) data. Data analysed included patient's age, investigations performed, treatment given, and patient follow-up.Results: In total, 232 patients were identified (mean age 41 years, range 1–96). A mid-stream urine was performed in 105 (45%) patients, 12 (5%) had a urethral swab and 82 (35%) had an ultrasound scan. Twenty patients were surgically explored to exclude torsion. The mean length of stay was 1 night (range 0–9). Antibiotics were prescribed in 94% of patients. Sexual history and advice to attend a genito-urinary clinic was documented in 16% and 4% of cases respectively. Referral for follow-up in the urology outpatient clinic occurred for 24% of patients.Conclusions: The management of epididymo-orchitis in patients referred for secondary care review is an area for significant improvement in clinical practice. Implementation and dissemination of clear local guidelines are essential to ensure appropriate patient management and minimise unnecessary in-patient admissions and outpatient follow-up.

Inguinal lymphadenectomy for squamous cell cancer of the penis—Experience of a UK supra-regional network - Corrected Proof

Thomas G. Martin, Jonathan C. Goddard, Tim R. Terry, Duncan J. Summerton — 2012-01-18

Summary: Objective: To present a case series of patients undergoing inguinal lymphadenectomy (IL) for squamous cell cancer (SCC) of the penis within an UK Supra-Regional Network (SRN).Patients and methods: Retrospective case note analysis was undertaken of all patients who underwent IL following referral from the network units across a wide region. Information was cross-referenced from clinician, pathology and hospital episode databases.Results: A total of 79 modified ILs and 11 radical ILs were performed in 49 patients over 5 years. Metastatic involvement was found in 59.1% of patients. Of these 58.6% were found to have extranodal spread at the time of operation. The finding of extranodal spread significantly impacted upon survival. One year survival rates post IL were 100% for pN0 and pN1, compared with 67% for pN3.Kaplan–Meier curves were plotted and showed a significant difference in survival from primary surgery on log rank comparison between pN0/pN1 and pN3 nodal categories. As in most series, IL has a considerable morbidity rate. No perioperative mortality was seen.Conclusions: This case series emphasizes the negative prognostic impact of finding extranodal spread (pN3) at IL. In those with unilateral intranodal metastases (pN1), IL is curative for the majority of patients.

Acute lower limb ischaemia following radical cystectomy - Corrected Proof

Todd Smith, Andrew Chetwood, Anoop Prasad, Ian Franklin, David Hrouda — 2012-01-06

A seventy-nine-year old man was admitted to hospital for an elective radical cystectomy and ileal conduit formation for a G3pT2 transitional cell carcinoma of the bladder (TCC). Previous medical history included hypertension and peripheral vascular disease. He had previously undergone a left femoro-popliteal bypass using great saphenous vein in 2005 for severe calf claudication. He represented in 2007 with recurrence of his symptoms and was found to have a 50% stenosis of his left common iliac artery. He was managed medically and in 2009 he was discharged from the care of the vascular surgeons with an improved walking distance.

Benign renal Schwannoma: Case report and review of the literature - Corrected Proof

J.A. Raju, G. Kingston, A. Jones — 2011-12-05

Schwannomas are tumours originating from Schwann cells of nerve sheaths and are most commonly found in the head, neck, limbs and mediastinum. They are typically benign but in rare cases can demonstrate malignant change . Retroperitoneal Schwannomas are uncommon, accounting for 0.3–3.2% of cases while visceral involvement is even rarer. Only 21 cases of benign renal Schwannoma have been reported . We present the clinico-pathological features of an additional case and review the literature.

Acute pancreatitis induced by an obstructing left ureteric calculus - Corrected Proof

C. Dospinescu, T.B.L. Lam, L. Kurban, N.P. Cohen, S.K. Swami — 2011-12-05

Summary: A 55-year-old woman with acute left-sided renal colic developed acute focal pancreatitis secondary to perinephric inflammation caused by an obstructive 6mm left upper ureteric calculus.

Germ cell tumors of undescended vs. descended testes: Population-based clinical and outcomes data - Corrected Proof

Norleena P. Gullett, Timothy A. Masterson, Peter A.S. Johnstone — 2011-12-02

Summary: Objective: Testicular cancer has been associated with undescended testes (UDT) for decades, with a relative risk of testicular cancer in cryptorchidism at 2.75–8. Tumors of UDT are infrequently encountered in clinical practice and no population-based prior analysis has described clinical patterns of care in their case.Methods: Information on malignant testicular lesions was retrieved from the population-based Surveillance Epidemiology and End Results (SEER) data for the period 1983–2005. Site codes C62.0 (UDT) were compared with C62.1 (descended testis; DT), using appropriate surgical codes for the era reported. Analysis was made of the seminomatous histology codes (ICD-03 9061–9063) vs. the nonseminomatous germ cell tumor codes (ICD-03 9065–9085). Further analysis was stratified by presenting extent of disease (local, regional, or distant).Results: 462 cases of tumors of UDT were documented; 416 (90%) were germ cell tumors (GCT). In this timeframe, 7414 cases of DT GCT were described. UDT lesions were more frequently seminoma (74.7% vs. 60.8%; p<0.0001), and diagnosed at a more advanced stage than DT lesions (χ2=18, p=0.0001). Similar frequency of RT was noted for localized seminoma, whether UDT or DT, after RadOrch (p=0.13), and was rarely delivered for NSGCT. 5-yr observed (5YOS) and relative survival (5YRS) of seminomas did not differ between the DT and UDT cohorts, or between the DT and UDT NSGCT cohorts.Conclusions: Our results support recent literature revealing seminomas are more frequent in cryptorchid testes. RT was equally used between localized UDT and DT seminomas. Penetrance of RadOrch is similar in local and regional disease by histology. Survival is equivalent for UDT compared to DT lesions in both seminomatous and NSGCT histologies.

Relationship between chronic inflammation at prostate biopsy and transition zone prostate volume enlargement in a prospectively UK screened population - Corrected Proof

Samarth Chopra, Edward Rowe, Marc Laniado, Marjorie Walker — 2011-11-07

Summary: Objective: The aim of this study was to evaluate the relationship between histological prostatic inflammation and prostate volume at the time of prostate biopsy.Patients and methods: From a prospective prostate cancer screening study, 137 men aged 50–65 years, underwent prostate biopsies negative for cancer, forming the study population. Biopsy criteria were prostate specific antigen (PSA) >4ng/ml (n=40), or between 1.1 and 4ng/ml with a percent free PSA (%fPSA) <25% (n=97). Total gland (TG) and transition zone (TZ) volumes were measured prior to TRUS guided biopsy. Histological classification included chronic inflammation (CI-lymphocyte predominant), active inflammation (AI-neutrophil predominant), and benign prostatic tissue (BPT-no inflammatory cells). A logistic regression analysis was performed using age, TPSA, %fPSA, histology, TZ and TG volume, TZ/TG ratio, PSA density, and transition zone PSA density as continuous variables. We also mailed validated self-administered symptom scores to men in the three histological subgroups (men without cancer) at a median of follow up of 6.5 years (range 5.9–7.1 years) after screening and biopsy.Results: Histological chronic inflammation (n=78, 57%) at biopsy was associated with a larger mean TG volume (30.8cc) than active inflammation (n=7, 22.7cc) and benign prostatic tissue (n=52, 25.9cc). On bivariate analysis, chronic inflammation was associated with greater TZ volume (p=0.0015) and TZ/TG ratio (p=0.0008). On multivariate analysis, chronic inflammation was the only independent variable associated with a greater ratio of the TZ to TG volume (odds ratio 478, p=0.005). IPPS symptoms scores were completed and returned by 88 men (66% compliance). In men with chronic inflammation (49), active inflammation (5), and benign tissue (30), the mean IPSS scores were 10.9, 7.2, and 8.7, respectively. These differences did not reach statistical significance p>0.05.Conclusions: In this younger screened population, chronic inflammation was associated with greater prostate gland volume secondary to transition zone volume enlargement. Further research is needed to establish a causally related link for this observation.

Re: Use of the Dundee technique to relieve penile strangulation [Br. J. Med. Surg. Urol. (4) (2011) 213–215] - Corrected Proof

D. Nasralla, R. Kinder — 2011-11-03

I read with interest the recent article by Pastides et al. . We encountered a 51-year-old gentleman in a similar predicament recently in our institution. He had managed to squeeze his penis through a 5cm segment of narrow copper piping () and presented with a grossly swollen, incarcerated glans. By the time the surgical team were called the emergency department had already tried, and failed, to remove the pipe using ring-cutters. The fire brigade had also been called to review the situation but had nothing further they could offer. As suggested by the authors, the Dundee technique was attempted with a penile block administered and multiple fenestrations made in the glans to aid decompression, but all to no avail. Shortly after his presentation, the patient was taken to theatre. Under a general anaesthetic further attempts were made to decompress the glans using the Dundee technique and direct, prolonged pressure, with little improvement seen. The orthopods were called who could only suggest using a plaster cutting saw, but this only scored the surface and looked likely to injure the friable looking tissue of the swollen glans. Bone nibblers, bolt cutters and even a hacksaw all failed to make an impression and so we had to return to 1st principles. We placed a tight tourniquet around the base of the penis to occlude arterial inflow as well as venous return. Then, 2 large bore cannulae were inserted through the glans into the corpus spongiosum, through which we were able to aspirate 30ml of blood. The effect was immediate and plain to see—the glans deflated to almost its normal size. Then, with only a small amount of additional compression and manipulation, we were able to extract it from the pipe. Remarkably, after this whole traumatic experience, the penis appeared to emerge relatively unscathed. A urethral catheter was inserted to allow the patient and his genitalia to rest for 24h, after which it was removed and he was discharged. As Pastides et al. described, innovative methods often have to be employed to deal with patients in unusual predicaments. Penile incarceration is a well recognised entity and often falls into this category. Helpfully, Bhat et al. described a grading system for these injuries in 2002 which categorises them as shown below:

Utility of renal mass biopsy in a UK tertiary referral centre - Corrected Proof

2011-11-03

Abstract: Objective: To determine the value of percutaneous biopsy in a UK cohort of patients with renal mass lesions, with particular reference to its utility for the prediction of histological cell-type, Fuhrman nuclear grade and necrosis.Patients and methods: From May 1999 to September 2009, 71 patients underwent renal mass biopsy (RMB), most for indeterminate renal masses or in those with a mass lesion and extrarenal malignancy. Approximately one-third were for small renal masses (≤4cm). Biopsy results were correlated with final surgical specimen pathology or with the outcome of surveillance in those not receiving surgery.Results: Of 71 biopsies, there were 65 (91.5%) considered diagnostic biopsies, of which 59 (90.8%) were malignant and 6 (9.2%) were benign. 30 patients with biopsy-proven malignancy underwent extirpative surgery, with a diagnostic accuracy for biopsy of 100%. Accuracy of RMB for histological sub-type, Fuhrman nuclear grade and tumour necrosis was 80.0%, 52.3% and 80.0%, respectively. Bleeding complications were seen in 2 (2.8%) patients, and there were no cases of needle track seeding.Conclusion: RMB is a safe and accurate method for determining underlying malignancy, with an acceptable non-diagnostic rate. Although concordance for histological tumour sub-type and necrosis was reasonable, values for nuclear grade were less reliable.

Patient selection for prostate biopsy: Risk-based or PSA-based? - Corrected Proof

2011-10-17

Summary: Aim: The AUA Best Practice Statement on PSA advocates a risk-based approach to selecting men for biopsy, based not on a PSA threshold, but on the risk of finding cancer on biopsy. We have therefore studied the association between candidate risk factors and prostate biopsy results.Method: All patients who underwent a prostate biopsy within the Epsom and St Helier NHS Trust between July 2005 and July 2007 were identified. Those with a serum PSA value of <15.0ng/ml were selected for inclusion. Univariate and multivariate logistic regression analysis was done to analyse risk factors for the presence of cancer, and of significant cancer, on biopsy. Significant prostate cancer on biopsy was arbitrarily defined as either a Gleason score of 7 or more, or the presence of cancer in 50% or more of the cores.Results: Of 400 cases, 153 (38%) were found to have prostate cancer on biopsy, of which 93 were classed as significant. On multivariate analysis, smaller prostate volume, abnormal DRE, PSA level and absence of previous negative biopsy were independent predictors of significant prostate cancer. The multivariate logistic regression results were used to create a predictive nomogram for significant cancer.Conclusion: The PSA level is merely one of several factors that predict biopsy results. A risk-based, rather than a PSA-based, approach to selecting men for prostate biopsy has the potential to both reduce the number of men undergoing biopsy, and increase the detection of significant cancers.

PSA velocity and doubling time in diagnosis and prognosis of prostate cancer - Corrected Proof

Andrew J. Vickers, Simon F. Brewster — 2011-10-05

Summary: Cancer is a growth process and it is natural that we should be concerned with how the routinely used marker of prostate cancer tumour burden – PSA – changes over time. Such change is measured by PSA velocity or PSA doubling time, described in general as “PSA kinetics”. However, it turns out that calculation of PSA velocity and doubling time is far from straightforward. More than 20 different methods have been proposed, and many of these give quite divergent results. There is clear evidence that PSA kinetics are critical for understanding prognosis in advanced or relapsed prostate cancer. However, PSA kinetics have no value for men with an untreated prostate: neither PSA velocity nor doubling time have any role in diagnosing prostate cancer or providing a prognosis for men before treatment.

Standing on the shoulders of giants: 3. John Wickham based on an interview 7/11/2009 - Corrected Proof

Dominic Hodgson — 2011-09-28

John Wickham is British Urology's great innovator, whose desire to make surgery less invasive was a constant throughout his working life and crossed specialty boundaries.

A simplified WHO checklist improves compliance and time efficiency for urological surgery - Corrected Proof

John Henderson, Timothy Fung, Jaimin Bhatt, Amarjit Bdesha — 2011-09-19

Abstract: Objective: A surgical safety checklist has been introduced throughout the UK in response to evidence that its use decreases surgical morbidity and mortality. The adaptation of this has resulted in a lengthy checklist which may be used improperly. We audited the existing and a new simplified checklist with regards to compliance, time-efficiency and relevant safety outcomes.Materials and methods: One hundred operations were observed. Fifty of these cases used the existing 14-question Briefing/Debriefing (BD) and 31-question Sign-in, Time-out and Sign-Out (STS) checklist. The subsequent 50 used a simplified 10-question BD and STS checklist. Percentage compliance, median time taken and relevant safety outcomes were recorded.Results: The median time for the BD questions decreased from 150 to 90s and the STS questions from 88 to 49s (p<0.05). The compliance improved from 68% to 73% (p=0.49) for BD questions and 53% to 92% (p<0.05) for STS questions. A clearer phrasing of the antibiotic check question in the revised checklist resulted in no administration of incorrect antibiotics.Conclusion: The nuclear and airline industries have used checklists for many years and observed that long and exhaustive checklists were often used improperly or disregarded completely. We demonstrate that a redesigned, simplified checklist improves time-efficiency and compliance with improved safety outcomes.

The assessment and peri-operative management of diabetes mellitus in urological day case surgery—Outcomes of the North West of England Regional Audit - Corrected Proof

Niyukta Thakare, Rono Mukherjee, Andrew M. Sinclair, Sherif Elsobky, Ian Pearce — 2011-09-15

Summary: Objective: To determine whether patients with diabetes undergoing day surgery in urology units in the North West of England were managed in accordance with published national guidelines.Patients and methods: Data on day cases were collected from 14 NHS Trusts in the region. Proformas including details of pre-operative assessment, peri-operative care and discharge were completed by independent data collectors in individual units. These were audited against the British Association of Day Surgery guidelines for management of patients with diabetes as day cases.Results: 7 patients with type 1 diabetes and 77 with type 2 underwent day case procedures. At pre-operative assessment, 71% patients had a documented glycosylated haemoglobin (HbA1C), 32% had stable serum glucose and 62% had no history of hypoglycaemic attacks. Peri-operatively, 69% had a blood glucose <10mmol/l, 17% had a blood glucose >10mmol/l and in 14% it was not documented. A Glucose-potassium-insulin infusion was commenced in 91% of patients on insulin. On discharge, less than 25% patients were given written advice.Conclusion: Whilst compliance with published guidelines is generally good throughout the region, there is significant room for improvement particularly with respect to documentation and discharge planning. Implementation of dedicated protocols can bring about consistent improvement in practice.

PSA testing and its relationship with social deprivation - Corrected Proof

Benjamin L. Jackson, Katrina Hope, Christopher L. Jackson, Simon T. Williams — 2011-08-22

Summary: Objective: To determine whether social deprivation influenced the rate of PSA testing per head of male population within the catchment area of our institution.Patients and methods: We retrospectively collated all PSA tests performed by general practitioners within an 18-month period in the catchment area of our institution (n=10,695). PSA testing frequency within each lower super output area (LSOA) within the catchment area of our hospital was determined. The social deprivation of each LSOA was assessed using the Index of Multiple Deprivation 2007 index (IMD). Using these data, the percentage of men undergoing PSA tests in each LSOA was calculated as was the percentage of positive tests amongst those tested. Logistic regression analysis was performed with age and IMD 2007 scores as covariates.Results: Increasing IMD 2007 score was independently associated with a decreased likelihood of PSA testing (odds ratio 0.976 (95% confidence interval 0.959–0.994) p=0.008). There was no association between IMD 2007 score and the rate of positive tests (odds ratio 0.997 (0.984–1.009) p=0.60).Conclusions: Increasing levels of social deprivation demonstrate a small but significant association with a lower incidence of PSA testing in the catchment area of our institution.

Transvaginal cystectomy for complete bladder prolapse - Corrected Proof

Hashim U. Ahmed, Dan Wood, David Griffin, Frederick Banks — 2011-08-11

A 29 year old woman presented with an introital mass that had increased in size over a number of weeks. At age 5 years, primary incontinence, as a result of non-ambulant spina bifida, resulted in formation of an ileal conduit urinary diversion. She had subsequently undergone a right nephrectomy for intractable infections secondary to nephrolithiasis. On examination under anaesthesia, the mass measured approximately 10cm by 4cm with a smooth pale appearance. It was reducible and was in place of her urethral meatus (). A diagnosis was made of remnant bladder prolapse with complete eversion through her urethral meatus.

Analgesic ketamine use leading to cystectomy: A case report - Corrected Proof

K. Shahzad, A. Svec, O. Al-koussayer, M. Harris, S. Fulford — 2011-07-26

Ketamine has been used for the induction and maintenance of anaesthesia since 1965 . It is also used in the management of chronic pain and recently has been proposed as a fast acting anti-depressant (reviewed by ).

Benign Schwannoma of seminal vesicle presenting as haematospermia - Corrected Proof

2011-07-21

Schwannomas (also known as neurilemmomas) are benign tumours arising from nerve sheath cells (Schwann cells) found along peripheral nerves . Schwannoma of the seminal vesicles are extremely rare and to our knowledge only three cases have been reported in the literature. We report on a further case of this condition.

Bipolar transurethral resection of prostate: Current status in the management of bladder outflow obstruction - Corrected Proof

M. Bolgeri, S. Naji, A. Sahai, F. Anjum, S. Madaan, S. Sriprasad, I. Dickinson — 2011-07-21

Summary: Monopolar transurethral resection of prostate has been the preferred surgical treatment of benign prostatic hyperplasia. Even in modern series there are significant risks such as haemorrhage requiring transfusion and TUR syndrome, although their incidence is lower than previously. Over the last decade or so newer technologies have emerged that have proven to be at least equivalent to monopolar TURP. Bipolar transurethral resection of the prostate in normal saline is a potentially safer option to monopolar resection but with equivalent efficacy in the medium term. This is supported by 2 recent meta-analyses. This review describes the technology, efficacy and safety profile of bipolar transurethral resection of the prostate.

Emphysematous prostatitis - Corrected Proof

J.L. Douglas-Moore, L.J. Turnbull, M. Moazzam, A.T.F. Lee, A.M. Peracha — 2011-07-13

Few cases of emphysematous prostatitis with associated prostatic abscess have been reported in the literature. These have occurred exclusively in diabetic or immunocompromised patients .

An unusual cause of delayed bowel obstruction due to a misplaced suprapubic catheter. A case report - Corrected Proof

Kunal Shetty, Rajesh Kavia, Omer Karim — 2011-06-06

A 71 year old woman presented with a 2 day history of generalised abdominal pain, vomiting and having not opened her bowels. Past medical history included diverticular disease, a cholecystectomy and cerebellar ataxia with resultant urinary incontinence. An Addacath SPC had been inserted 9 months previously without any problems under cystoscopic guidance to manage her incontinence secondary to her neurological diagnosis. It had been changed 2 weeks prior to this admission. Clinically she had classical signs of bowel obstruction and a computed tomography (CT) scan of her abdomen as displayed in the image showed dilated small bowel up to around the site of the inflated balloon of the SPC. A laparatomy was performed where dilated small bowel (ileum) was found up to a point where the SPC had pierced the mesentry of the ileum and had caused a superficial abrasion to the serosal layer of the ileum. The catheter behaved like a band across the ileum causing obstruction and this was relieved on removal of the SPC. The serosal abrasion was repaired and no bowel resection was necessary as it was found to be viable. Her SPC was replaced under visual guidance extraperitoneally below and slightly lateral to the midline wound. Post-operatively she made an uneventful recovery and was discharged from hospital 4 days later ().

The Uro-Clavien–Dindo system—Will the limitations of the Clavien–Dindo system for grading complications of urological surgery allow modification of the classification to encourage national adoption within the UK? - Corrected Proof

Andy Myatt, Victor Palit, Neil Burgess, Chandra Shekhar Biyani, Adrian Joyce — 2011-06-06

Summary: Although quality outcome assessment is gaining widespread recognition, there is still no consensus about grading postoperative complications in urology. There have been several attempts to grade surgical complications. The Clavien–Dindo system has been standardised and validated. However there are limitations when using the system to grade urological complications. We suggest modification of the Clavien–Dindo system to include intraoperative complications. Widespread implementation of the grading system could benefit the transparent reporting of complications to demonstrate quality outcomes.

Secondary haemorrhage following transurethral resection of bladder tumour – is it always related to infection? - Corrected Proof

2011-05-19

Abstract: Background: We reviewed the empirical use of antibiotics in patients with secondary haemorrhage following transurethral resection of bladder tumour.Patients and methods: A retrospective review of 2830 patients undergoing TURBT between January 2006 and April 2009 was performed from two large independent urology centres in the UK. Patients with secondary haemorrhage were identified and their urine culture results and risk factors for bleeding were studied.Result: Secondary haemorrhage causing hospital admission was seen in 2% (51 cases). However, only 14% of these cases had significant bacteriuria on urine culture. In patients with secondary haemorrhage we show potential risk factors for bacteriuria: resection weight greater than 2g (71% versus 28%), muscle invasive bladder cancer (43% versus 20%) and macroscopic residual disease (43% versus 12%); although they did not reach statistical significance. Interestingly there was no significant difference in the clinical parameters supportive of infection between patients with bacteriuria and sterile urine – in particular only 1/51 had a temperature of greater than 37.5°C. Nevertheless, 73% (37/51) of patients were treated with antibiotics.Conclusion: Typically, patients with secondary haemorrhage following TURBT do not have evidence of demonstrable infection and only a few had evidence of bacteriuria. Routine prescription of antibiotics in secondary haemorrhage following TURBT is therefore not justified.

Can redesigning a laboratory request form reduce the number of inappropriate PSA requests without compromising clinical outcome - Corrected Proof

L.A.R. Powles, A.E. Rolls, B.W. Lamb, E. Taylor, J.S.A. Green — 2011-05-13

Abstract: Introduction: Unnecessary laboratory utilization due to inappropriate test-ordering behaviour among hospital clinicians and community general practitioners is an ongoing problem in many hospitals and primary care trusts throughout the UK and abroad. In January 2007, our hospital removed the ‘tick box’ for PSA from its laboratory tests request form, in a managed way, with the intention of reducing unnecessary requests for this test. Here we address the impact this action had on the number of PSA tests being requested and its downstream effects on prostate cancer diagnosis.Methods: Using our laboratory database we compared the number of hospital and local GP requests for PSA, before and after modification of our laboratory form (requests from 2004 to 2006 were compared to 2007). We then correlated this data with the number of fast-track target referrals (2 week wait) from primary care for suspected prostate cancer, the results of prostate biopsies, and the number of prostate cancers being diagnosed, over the same time period.Results: Mann–Whitney non-parametric testing demonstrated a 17% reduction in the median number of PSA requests since the change was introduced (p=0.001). Subset analysis revealed an 18% reduction in GP requests (p=0.002). However no change was found in the number of prostate cancer diagnoses being made (p=0.86) and the number of target referrals for suspected prostate cancer (p=0.59) in the months of April, May, June, July, August and September of 2004–2006 as compared to the same months in 2007. The rate of patients undergoing biopsy increased in the post intervention period from 15.5 to 18.5 patients per month. The rate of negative biopsies remained stable, changing from 7.2 to 7.3 per month, and the rate of positive biopsies increased from 8.3 to 11.2 per month. This change reduced the false negative rate (suspected cancer, negative biopsy) from 46% to 40% in the period following the intervention. The rate of target referrals leading on to cancer showed a small increase after the intervention from 2.9 to 3.3 per month.Conclusions: Our study shows that with this simple modification to the design of our laboratory request form, whereby the doctor must make an active written decision to order a PSA test, there was a significant reduction in the number of PSA requests, both in the hospital and in the community, without patient safety being compromised as measured by maintaining the number of fast-track target referrals for suspected prostate cancer and the number of prostate cancers diagnosed.

Bochdalek's hernia causing functional upper ureteric obstruction - Corrected Proof

Nadir Osman, Suresh Venugopal, Gerry Doyle, Christopher S. Powell — 2011-05-05

A 65-year-old male presented with recurrent intermittent right flank pain induced by the consumption of 4–5 pints of beer. There were no lower urinary tract symptoms or haematuria. He had a past history of left renal calculi which where treated endoscopically and had been stone free for the past decade. Clinical examination was unremarkable and urine dipstick testing showed no evidence of blood or infection. Serum urea and creatinine were within normal limits and he subsequently underwent an abdominal ultrasound scan. This demonstrated bilateral hydronephrosis as well as a large simple cyst of the left kidney.

Bilateral giant ureteric calculi—A case report and management in the modern era - Corrected Proof

2011-03-21

Giant ureteric calculi, defined as calculi greater than 5cm in maximum dimension or weighing 50g or more , are rare and often associated with urinary tract malformations . With modern endourological treatments, open ureterolithotomy for ureteric calculi is reserved for such large ureteric calculi . We present a case of bilateral giant ureteric calculi associated with a bilateral duplex system, with a unilateral ureterocoele, and contra lateral ectopic ureteric insertion.

An anastomosing haemangioma: A rare vascular tumour presenting as a solid renal mass - Corrected Proof

2011-03-08

A 57 year-old woman, with stage IV chronic renal failure and immunotherapy for pANCA vasculitis, presented with vague abdominal pain. MRI demonstrated a 2.2cm right-sided, solid, perihilar tumour () with DMSA scintigraphy demonstrating 46% right-sided function. Anatomical position precluded partial nephrectomy and radical nephrectomy was deemed high-risk for precipitating end-stage renal failure, thus surveillance was undertaken.