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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...
Does more equal less in the management of acute renal colic?
Radiographs of kidneys, ureter and bladder (KUB) have long been used in the follow-up of patients with ureteral stones to reassess stone position and surgical planning. Emergence of computed tomography (CT) as the gold standard for the diagnosis of ureteral...
Surgical and pathological outcome of partial nephrectomy: robotic versus laparoscopic approach
Nephron sparing surgery has become the standard surgical treatment for small renal masses (<4cm). Laparoscopic partial nephrectomy (LPN) is shown to be superior to the open approach (OPN) in peri and postoperative morbidity; however, it requires advanced skills and has...
Hypospadias – can urologists achieve the unachievable?
US News & World Report (USNWR) provide rankings on a wide range of topics (education, health, money, travel, cars and law firms). In terms of healthcare, they suggest that their rankings (based on metrics) are a tool that can help...
Assessing resolution of isolated hydronephrosis – is APPD superior to the SFU system?
Antenatal scanning detects urinary tract dilatation in 1-5% of pregnancies. Isolated hydronephrosis (i.e., that not due to secondary dilatation e.g. bladder dysfunction) is known to resolve or improve in most; some patients may, however, require intervention through deterioration of obstruction...
Inguinal vs. scrotal orchidopexy
Undescended testes occur in 1-3% of newborns; the prevalence is even higher in premature babies. Traditionally the surgical approach has been inguinal orchidopexy, involving two incisions – inguinal and scrotal. In 1989, Bianchi and Squire proposed single scrotal incision orchidopexy...
Biopsy should be considered for older boys (>10 years) undergoing orchidopexy for intra-abdominal testes
Cryptorchidism is associated with a 3 to 10-fold increase in malignancy and the age at which it is undertaken matters; the risk of testicular cancer is doubled in patients undergoing orchidopexy at 13 years of age compared to that treated...
Outcomes of sarcomatoid differentiation in urothelial carcinoma
Sarcomatoid differentiation is a rare variant of urothelial carcinoma (UC) seen in 0.6% of cases. Its response to neo-adjuvant chemotherapy (NAC) has not been well reported. The authors have done a retrospective analysis of patients undergoing cystectomy between 1995 and...
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...
Synthetic mid-urethral slings for stress incontinence in neurogenic LUTD
Neurogenic lower urinary tract dysfunction (NLUTD) is heterogeneous because of the multiplicity of underlying causes and mechanisms. In women with NLUTD, stress urinary incontinence may be due to intrinsic sphincter deficiency caused by the neurological disease itself or from sphincter...
Stenting prior to URS or ESWL – does it increase ED visits and opiate prescriptions?
Ureteral stents are used to bypass obstructive stones, to dilate the ureter in order to facilitate ureteroscopy (URS), and to maintain patency / low intrarenal pressure following stone surgery. However, there can be morbidity (pain / voiding symptoms). Tasian et...
