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Standard versus expanded cultures to diagnose UTIs in women

Clinicians are well aware of the limitations of the so-called Kass criteria applied to standard urine culture (SUC) techniques as well as the limitations of empiric antibiotic prescribing for symptoms that are known to overlap with chronic conditions such as...

Planning and doing a fellowship: advice during the COVID-19 era

To paraphrase Shakespeare, to do, or not to do a fellowship, that is the question. That may be your question; whether or not to pursue a fellowship, even more so due to the uncertainty of the COVID-19 pandemic. There are...

Are standard repeat biopsies during active surveillance for prostate cancer still necessary?

Active surveillance (AS) has emerged as a key strategy for managing low-risk prostate cancer (PCa), offering an alternative to immediate treatment. Initially, AS relied on prostate specific antigen (PSA) testing, digital rectal examinations (DRE), and systematic biopsies. Early studies using...

Adrenal incidentalomas: what next?

An incidentaloma refers to an adrenal lesion >1cm discovered incidentally during radiologic examination. Identifying a malignant and / or functioning lesion is critical for management. However, as the majority of lesions are benign, the challenge is the identification of malignant...

I wasn’t expecting that! A series of unexpected radiology findings

Case 1 A 76-year-old diabetic man with a long-term catheter presents to the Emergency Department with rigors and non-specific abdominal pain. He has an elevated white cell count (WCC) and C-reactive protein (CRP). An abdominal and pelvic CT scan was...

Infections and inflammation: Part 2

See also Part 1 and Part 3. Case 1 A 43-year-old lady presented to the urologist with a history of pain during bladder filling and associated frequency / urgency. She underwent standard microbiological and radiological investigations that are normal. She...

SUSPEND suspended MET

This review is on the recent groundbreaking evidence on medical expulsive therapy (MET). MET using alpha adrenergic blockers (like tamsulosin) are in regular clinical practice. Even though it is an off label prescription, it is well accepted and practised world...

Non-urothelial bladder malignancies

Case 1 An 80-year-old gentleman presented with a history of visible haematuria and recurrent urinary tract infections (UTIs). He has been performing intermittent self catheterisation (ISC) for detrusor underactivity for over 20 years. A flexible cystoscopy showed these appearances of...

Risk factors for BC after minimally invasive RNU

Bladder cancer (BC) after radical nephroureterectomy (RNU) has an approximate incidence of 20-50%. This contemporary multicentre study will inform the ongoing debate on risk factors for BC after minimally invasive RNU and how it may be prevented. Three hundred and...

Can transcutaneous peroneal nerve stimulation treat OAB?

The peroneal nerve follows sacral, pudendal, and tibial nerves as a target for overactive bladder (OAB) treatment. This multicentre prospective randomised RCT compared a transcutaneous electrical neuromodulation system (eTNM) at-home treatment once daily for 30 minutes to solifenacin 5mg once...

Clinical trials 1

Clinical Trials 2 is available here. Case 1 1. What are the levels of clinical evidence based on the 2009 definitions from the ‘Oxford CEBM’? 2. What is the null hypothesis? 3. What are type 1 and type 2 errors?...

The transition from surgeon to manager during the COVID-19 response

Writing this article on the first Sunday in May, when in any other year, I would be wearing my bowler hat in Hyde Park for the annual Cavalry Memorial Parade, a time ‘pre-COVID’ does seem a very distant memory. Having...