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Challenges of catheter associated urinary tract infection: is prevention better than cure?

Catheterisation is a common medical procedure in which a catheter (a hollow flexible tube) is inserted into the bladder in order to facilitate the drainage of urine. Catheters are usually passed into the bladder via the urethra, either to be...

Surgical treatment of LUTS secondary to BPH

For the vast majority of patients an initial trial of medical therapy for the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is indicated [1]. In a substantial minority of cases however, a surgical intervention...

The importance of active investigation and follow-up in bladder injury

Bladder injury (BI) is uncommon, and patients are typically managed by large multidisciplinary teams, dealing concomitantly with other injuries or diagnoses. BI can be categorised by cause (traumatic vs. iatrogenic) or anatomical location (intraperitoneal vs. extraperitoneal), requiring differing approaches to...

Urolithiasis 4 - Staghorn calculus

Case scenario A 64-year-old woman with recurrent urinary tract infections and left flank pain undergoes investigations as an outpatient. Figure 1a. Figure 1b. 1. Describe Figures 1a and 1b. 2. Her co-morbidities are type 2 diabetes (which is well controlled)...

The best stone man north of the border

In this series of articles I am going to show you some of the exhibits contained in the Museum of Urology, hosted on the BAUS website (www.baus.org.uk). In 1860, Sir Henry Thompson (1820–1904), the famous 19th century English surgeon and...

Medical statistics for urologists: part 3 – diagnostic testing

Following on from the first two parts of this series (see Part 1 here, and Part 2 here), this final article aims to demonstrate how the theory of statistics applies to medical diagnostics. Probability in diagnostic testing Diagnostic tests refer...

All you need to know about percutaneous nephrolithotomy: supine versus prone and mini versus traditional

Introduction Since the first percutaneous nephrolithotomy (PCNL), the technique has undergone many innovations, including modifications in positioning, miniaturisation of instruments and combination with retrograde intra-renal surgery (see Table 1 for an outline of the history of the technique). Controversy has...

When partial nephrectomy is unsuccessful

With increasing use of partial nephrectomy (PN) to treat complex T1 tumours, the risk of conversion to radical nephrectomy (RN) increases. In this study the authors look at the incidence of conversion of robotic PN (RPN) to RN and analysed...

MRI targeted transperineal prostate biopsy: a local anaesthetic approach

Transperineal template biopsy remains the gold standard investigation in diagnosis of prostate cancer. Data from the PROMIS study demonstrated the low sensitivity of transrectal ultrasound (TRUS) biopsy as a diagnostic tool, and highlighted the need for a better diagnostic pathway....

Morbidity and mortality after surgery for LUTS

The market for bladder outflow obstruction surgery is currently wide open with new technologies such as Urolift® emerging. One of the key selling points of new technologies is the comparative safety and efficacy compared to traditional techniques such as transurethral...

Radiation in paediatric urology – PURSE study

Urological operative procedures often use fluoroscopy for diagnosis and treatment of stone disease and structural anomalies. Paediatric tissues are sensitive to the effects of ionising radiation. Paediatric radiation safety has gained concerns due to the possible long-term effects such as...

Percutaneous ultrasound guided endoscopic lavage of perinephric abscess – different, but not necessarily better

Perinephric abscess is an uncommon but serious form of urosepsis. It develops as a consequence of the extension of an infection outside of the parenchyma of the kidney in acute pyelonephritis, or more rarely from haematogeneous spread of an infection...