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Burnout in surgery
When I was pregnant with my first child, I went to a talk on how to achieve work-life balance and avoid burnout. It was given by a highly respected Australian surgeon and I was eager to hear the secrets that...The role of transperineal template biopsies in the diagnosis of prostate cancer
The case In 2002, Mr A, a 64-year-old software engineer, was referred by his GP for further investigation of a raised prostate specific antigen (PSA) of 6.2. His prostate felt benign. He underwent transrectal ultrasound guided (TRUS) prostate biopsies. This...Inguino-scrotal sarcomas
A sarcoma is a malignant tumour that originates from mesenchymal cells such as adipose tissue, bone, cartilage and smooth muscle. Although these tumours histologically do not originate from the urogenital tract, urologists are often involved in their diagnosis and management...Intravesical glycosaminoglycan analogue instillations for recurrent cystitis
Introduction The symptoms of recurrent cystitis can be triggered by inflammatory or infective causes. Bladder pain syndrome (BPS) and bacterial recurrent lower urinary tract infection can both present with symptoms of recurrent cystitis and cause significant morbidity in affected individuals....The conservative assessment and treatment of mixed urinary and anal incontinence in women: a multidisciplinary approach
Mixed urinary incontinence Urinary incontinence (UI) is considered to be a highly prevalent condition; however, depending upon the definitions used, actual reported prevalence rates can vary significantly. The International Consultation on Incontinence (ICI) review [1], reported unadjusted prevalence estimates for...Consent: your obligations in the modern, post-Montgomery era
There has been so much recent discussion and so much emphasis placed on the fundamental right that we all have to determine what is or is not done to us, the right to self-determination, that it would be either a...Lasers in benign prostatic hyperplasia
Clinical benign prostatic hyperplasia (BPH) impacts on the quality of life of many men. It is intimately related to ageing, but exact calculations of its prevalence remain difficult since an accurate clinical definition still eludes us. Histological BPH has been...The master’s degree in urology – a personal perspective
I have recently completed a master’s degree in urology, based jointly with the University of Edinburgh and the Royal College of Surgeons of Edinburgh. I began the course three months after commencing ST3 in urology. I had begun exploring the...The PROMIS trial – time for multi-parametric MRI before a first prostate biopsy
Whilst the relatively random process of 12 core transrectal ultrasound guided (TRUS) prostate biopsy remains by far the most widely employed approach to prostate cancer diagnosis in the UK, its flaws as a standalone diagnostic strategy are increasingly apparent. TRUS-biopsy...
PSA screening in limbo: how low should we go?
One may wonder how the management of prostate cancer could have evolved differently if it had followed a path similar to breast cancer. In breast cancer, early detection in the 1970s relied heavily on imaging because no reliable circulating biomarker...Management of recurrent cystitis
Acute uncomplicated infective cystitis is most commonly seen in healthy women with a frequency of around 0.5-0.7 episodes per woman per year [1]. Around 10% of women report having had an episode of urinary tract infection (UTI) each year and...
