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Fluoxetine for refractory night wetting in children – is it safe and effective?

Around 1-2% of teenagers above the age of 15 years and 2-6% of adults continue to wet the bed. Standard treatment often includes bladder advice, alarm therapy, desmopressin and anticholinergics. Tricyclic antidepressants (imipramine) can also be utilised. Unfortunately, most have...

Management of calyceal diverticular stones using ultramini PCNL

Calyceal diverticulae are congenital smooth-walled, non-secretory urothelium-lined cavities within the renal parenchyma that communicate with calyceal fornix through a diverticular neck. They were first described by Rayer in Traitements des maladies des reins [1]. Calculi occur in approximately 9.5% to...

Personal productivity tools

We live in an interconnected world that is constantly striving for a share of our attention. Smartphones, tablets and wearable computers are always by our sides, with procrastination and distractions only ever one touch away. A survey by TecMark in...

Recent advances in the management of castration resistant prostate cancer

Castrate resistant prostate cancer (CRPC) is defined by disease progression despite androgen-deprivation therapy lowering testosterone to castrate levels. It may present as a rise in serum levels of prostate specific antigen (PSA), progression of pre-existing disease, or the appearance of...

Conservative management of pelviureteric junction

Background Pelviureteric junction obstruction (PUJO) is defined as a functionally significant impairment of urine flow from the renal pelvis into the proximal ureter. For more than a century, surgery was considered the first-choice approach to management. However, the widespread use...

Demanding cases or nightmares in uro-oncology? Sep/Oct 2021

Active surveillance for prostate cancer: missing the boat Case In 2005 a 43-year-old man of Afro-Caribbean ethnicity was referred to our centre for investigation of suspected prostate cancer. Digital rectal exam revealed a firm right lobe, PSA of 2.3ng/ml, prostate...

Prostate cancer

Case 1 A 65-year-old man is referred to your two-week wait (2WW) clinic with a PSA of 7.0ng/mL. He has no lower urinary tract symptoms (LUTS), no past medical history, no family history of prostate cancer (PCa) and his performance...

Prostate cancer management 2 – metastatic disease

A 72-year-old gentleman is referred to you in the two-week wait clinic with a prostate specific antigen (PSA) of 22ug/L. He is otherwise fit and well and does not take any regular medication. His multi-parametric magnetic resonance imaging (mpMRI) shows...

Rotterdam Prostate Cancer Risk app

The widespread use of prostate specific antigen (PSA) testing has led to diagnostic difficulties for patients and urologists. The sensitivity and specificity characteristics of PSA are far from optimal. To try and improve the predictive accuracy of PSA measurements, nomograms...

Adults are just big kids: a paediatric surgeon’s experience in adult urology

As an ST8 trainee in paediatric general surgery and urology, I had firmly decided on subspecialisation in paediatric urology. Whilst preparing for the dreaded final Annual Review of Competency Progression (ARCP), the all-important question of “What next?” came to the...

Establishing a new TPPBx service during the COVID-19 pandemic

COVID-19 had a major impact on our hospital services from early in the pandemic, with almost three times as many patients being ventilated compared to the normal ITU capacity at the beginning of April. During the build-up to this point,...

A review of the diagnosis and management of urethral caruncles

Introduction The innocuous urethral caruncle is the most common benign urethral lesion in females. It can pose a significant challenge to urologists due to the plethora of differentials and poor evidence surrounding management. In 1926, Ferrier eloquently described the macroscopic...