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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...

Defining adjuvant, consolidative, and salvage treatment after RP

The most common oncologic outcome following radical prostatectomy (RP) for localised prostate cancer is achieving undetectable prostate-specific antigen (PSA) levels (<0.1 ng/ml), indicating an absence of detectable disease. However, the landscape of RP is shifting as active surveillance becomes the...

Clinical Trials 2 – key papers

Clinical Trials 1 is available here. Case 1 This British study on haematuria clinic diagnostic yield was published in the British Journal of Urology International in 2006. The results are often asked in examinations! Edwards TJ, et al. A prospective...

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,...

Prostate cancer management 1 – non-metastatic disease

You are referred a 68-year-old gentleman to the rapid access prostate clinic with a serum prostate specific antigen (PSA) of 12ug/L. He is otherwise fit and well with mild voiding lower urinary tract symptoms (LUTS). He undergoes a multi parametric...

Artificial penile pearls: what every Urologist should know!

Penile implants are inert objects placed beneath the skin of the penis through an incision. These are variously referred to as Yakuza beads, pearls, ball bearings, speed bumps, penile marbles, inserts, etc. The term ‘penile implant’ described here should not...

A Core Trainee’s Guide to Preparing for a Career in Urology

National Selection pits the best of the UK’s core surgical trainees (sorry – that includes EEC countries as well) against each other in a process that determines who is allowed to proceed into higher surgical training. For the successful, it...

Seminal vesicle calculi

Epidemiology Seminal vesicle calculi are uncommon with just over 100 cases being reported in the literature, although the true incidence is likely to be higher [1-9]. Patients usually present aged between 30 and 45 years old and although the pathogenesis...

Kidney stones in pregnancy

Case 1 A 28-year-old female, 19 weeks pregnant, presents with severe left loin pain. There is no past medical history of note. Blood tests show a white cell count of 14.1x109/L and creatinine of 56umol/L. An ultrasound scan (USS) reports...

The Underactive Bladder

For many, a diagnosis of an underactive or atonic bladder represents the end of the line in terms of management options. It remains a poorly understood and even more poorly appreciated condition, both in terms of underlying pathophysiology and alternatives...

Textbook of Penile Cancer

This is already a firm favourite amongst that cohort of trainees who sit the FRCS(Urol) – an exam, which does not discriminate between those wishing a career in andrology and those who do not. Everyone will need to learn and...

Prostate biopsy and survival

Talk to many urologists and the axiom is “you are more likely to die with prostate cancer than from it”. This study was conducted on Danish men between 1995 and 2011. The observations are: 1) Cumulative prostate cancer – specific...