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Is TRUS and biopsy obsolete as a diagnostic test for prostate cancer: refining the perineal biopsy technique?

Whilst there has been a dramatic shift in how patients are investigated for potential prostate cancer, transrectal ultrasound (TRUS) and biopsy remains the most commonly used technique for tissue sampling. In this single centre, retrospective analysis, 634 men, over a...

The role of transperineal template biopsies in the diagnosis of prostate cancer

The case In 2002, Mr A, a 64-year-old software engineer, was referred by his GP for further investigation of a raised prostate specific antigen (PSA) of 6.2. His prostate felt benign. He underwent transrectal ultrasound guided (TRUS) prostate biopsies. This...

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...

COVID-19: the impact on a junior registrar

Prior to the coronavirus pandemic I was a trust grade junior registrar, using this year at a district general hospital to gain experience, skills and portfolio points for round two of National Selection. My urology registrar on-call duties would consist...

Students for Urology: a new national society aimed at improving undergraduate exposure

As medical students, we were surprised at just how little urological content was taught at medical school. We received a basic education on how to manage urological infections, renal stones and urinary retention but nothing particularly inspiring was shared, nothing...

Role of emergency ureteroscopy in the management of ureteric stones

Emergency ureteroscopy for all acute stone patients is not widespread in the UK but this is not the case elsewhere. In Auckland, New Zealand, it is commonly carried out in the emergency setting to reduce pressure on elective lists and...

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,...

ICS updates on continence care: making sense of detrusor underactivity and the underactive bladder

Countless epidemiological studies have established the frequent occurrence of lower urinary tract symptoms (LUTS) and the significant burden these symptoms incur. For the most part of the past three decades, there has been an overwhelming focus on detrusor overactivity (DO)...

Novel therapy for SUI

This is a joint study from Iran and University College London. Stress urinary incontinence (SUI) is a difficult condition to treat for patients and clinicians alike. Various surgical procedures have their benefits and pitfalls. Cell therapy is a new modality;...

Solifenacin for children and adolescents with overactive bladders

Solifenacin (VESIcare®) is the second-line anti-muscarinic medication of choice for my patients with overactive bladder (oxybutynin being my initial choice). However, currently, it remains unlicensed for use in children. Newgreen et al. have evaluated the long-term safety and efficacy of...

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...

History of prostate biopsy – part 2

For Part 1 of this topic is available here. The major limitations of the transrectal ultrasound (TRUS) guided prostate biopsy (PBx) protocols are the risk of profound sepsis and the risk of persistently significant false negative rates, related to the...