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Giggle incontinence – not a laughing matter!
For many decades, the condition of giggle incontinence (enuresis risoria, giggle micturition) has remained a rare and poorly understood condition. Patients (90% female) present in their teens, with the history revealing an issue for many years. It is debilitating and...Robotic Urology Fellowship at UCLH
In November 2014, approaching my final year of training (ST7) in the West of Scotland (WoS) and just recently armed with my FRCS (Urol), I was at a crossroad in my clinical career. I was keen to pursue a consultant...Kidney stones in pregnancy
Case 1 A 28-year-old female, 19 weeks pregnant, presents with severe left loin pain. There is no past medical history of note. Blood tests show a white cell count of 14.1x109/L and creatinine of 56umol/L. An ultrasound scan (USS) reports...Nocturia – the Cinderella of lower urinary tract symptoms
Nocturia is defined as waking during the night (at least once) to urinate. The important part of the definition relates to the necessity of sleep to precede the episode (although whether sleep must follow the episode is less clear). The...
HIV-related stone disease – a potential new paradigm?
This paper discusses the management of patients with stone disease and HIV. The chronic nature of HIV infection is due in large part to the effectiveness of anti-retroviral therapies (ART). However, the role of protease inhibitors has been widely discussed...
Thiazide diuretic prophylaxis for kidney stones and the risk of diabetes mellitus
Thiazide diuretics have been used to reduce calcium nephrolithiasis recurrence as it is tolerated well, inexpensive and reduces calcium excretion in urine. It has been linked with increased risk of diabetes mellitus (DM) in the presence of hypertension (ALLHAT study),...
Increasing PSA after negative prostate biopsy - solving the clinical puzzle
There are standard guidelines for first transrectal ultrasonography (TRUS) guided biopsy in a patient presenting with elevated prostate-specific antigen (PSA) or suspicious digital rectal examination (DRE) findings. Patients are generally warned before a TRUS biopsy in respect of a false...
PDE5I in LUTS – how do they work – no proof yet
Phosphodiesterase type 5 (PDE5) inhibitors used in erectile dysfunction (ED) have been shown to improve lower urinary tract symptoms (LUTS) as well. The mechanism is not well understood. One of the hypotheses for benign prostatic hyperplasia (BPH) – LUTS is...
Intravesical cytosine arabinoside + Mitomycin C for bladder cancer – is it beneficial?
Mitomycin C (MMC) is often used as an intravesical therapy for low / intermediate risk non-muscle invasive bladder cancer. This randomised controlled trial (RCT) was designed to assess the safety and efficacy of MMC + cytosine arabinoside (Ara-C). Ara-C was...
Hypospadias – how long should follow-up be?
The optimal duration of follow-up following childhood hypospadias repair (to detect complications) is ill-defined. Several surgeons recommend it to include assessment during puberty. Some may worry that ‘rapid penile growth’, ‘erectile forces’ and ‘sexual activity’ could potentially stress previously successful...
