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The emerging role of physician associates in urology

The physician associate (PA) is a new role in the NHS which has expanded across medical and surgical specialties to include urology. In the USA, it has long been an established field of practice where physician assistants work autonomously within...

A negative ureteroscopy for stone disease: is it acceptable and is it avoidable?

Urinary tract stone disease and the consequent demand for endoscopic intervention in the upper urinary tract is an increasing phenomenon [1]. Although ureteroscopy is generally considered to be associated with low morbidity [2], risks do exist. Recognised complications include urothelial...

The process of medical innovation – evolving trends and future perspectives

In 2018 the United Kingdom Government spending on healthcare totalled almost £166 billion. Of this approximately 65% was attributed to providing curative or rehabilitation therapy, with health-related long-term care and provision of goods accounting for 25%. The remaining was accredited...

Retroperitoneal fibrosis

Introduction Retroperitoneal fibrosis (RPF) is a condition that occurs when extensive fibrosis develops in the retroperitoneum, usually centred over the anterior aspect of the fourth and fifth lumbar vertebrae. The fibrotic tissue typically surrounds the infrarenal aorta, inferior vena cava...

The bulbocavernosus reflex

Despite its first discovery predating the early-1940s, clinical application of the bulbocavernosus reflex (BCR) has been limited to date. The BCR traditionally involves contraction of the bulbo- and ischiocavernosus pelvic floor muscles, often referred to as the ‘bulbocavernosus muscle’, in...

Erectile dysfunction part II: treatment

Introduction The identification of specific risk factors associated with erectile dysfunction (ED) allows patients with mild or moderate ED to undergo a series of lifestyle changes, which may provide enough improvement in the erectile function to avoid pharmacotherapies. Cessation of...

Balanitis xerotica obliterans

Balanitis xerotica obliterans (BXO) / lichen sclerosus of the male genitalia is a common cause of acquired phimosis, and was first described by Stuhmer in 1928 [1]. It is described in medical literature as a chronic inflammatory condition of unknown...

ICS updates on continence care: what’s hot in physiotherapy after 80 years?

Origins of pelvic floor physiotherapy Physiotherapy, and in particular pelvic floor muscle training (PFMT) is nowadays first-line management for pelvic floor dysfunction (PFD). PFMT is originally attributed to Dr Arthur Kegel, hence the term Kegel exercises. Indeed, he was the...