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The PROMIS trial – time for multi-parametric MRI before a first prostate biopsy

Whilst the relatively random process of 12 core transrectal ultrasound guided (TRUS) prostate biopsy remains by far the most widely employed approach to prostate cancer diagnosis in the UK, its flaws as a standalone diagnostic strategy are increasingly apparent. TRUS-biopsy...

An overview of daytime wetting in children

It is estimated that daytime wetting affects one in seventy-five children over the age of five years [1]. Daytime wetting is commoner in younger children (1 in 7 aged 4.5 years, 1 in 20 aged 9.5 years) [1]. Many younger...

ICS updates in continence care: the role of the nurse continence specialist in continence services

The nurse who specialises in continence care is recognised as a key member of interdisciplinary teams seeking to deliver high quality integrated continence services. The recently published international service specifications for continence care [1] supports the use of specialist continence...

HIV / AIDS – implications for the urologist

“It’s no fun to have HIV even though it’s viewed as a chronic, controllable disease. It means being wedded to the health system.” - Philip Berger, Associate Professor in the Department of Family and Community Medicine, Toronto, Canada; and leading...

Metastatic spinal cord compression – a review

Introduction Metastatic spinal cord compression (MSCC) is an oncological emergency that, unless diagnosed early and treated appropriately, can lead to significant morbidity and mortality, including paralysis and bladder and bowel dysfunction. MSCC can be defined as spinal cord or cauda...

Use of Clavien-Dindo classification in urology part 2 – upper tract

A classification system of surgical complications was proposed by Clavien in 1992 [1] and further modified by Dindo in 2004 [2]. Clavien-Dindo classification has since then been validated through many retrospective case series as well as in comparative studies to...

Training to be a urologist: how risky is it?

The NHS and urology face challenging times in trying to provide quality patient care efficiently and economically. Urology trainees are experiencing conflicting pressures with a new contract, a challenging on-call system and changing training requirements in an overstretched, centralised service...

History of prostate biopsy – part 1

Part 2 of this topic is available here. Prostate biopsy (PBx) to exclude cancer has been part of clinical practice since the beginning of the 20th Century. PBx techniques have evolved over time to optimally address some of the unique...

Consent: your obligations in the modern, post-Montgomery era

There has been so much recent discussion and so much emphasis placed on the fundamental right that we all have to determine what is or is not done to us, the right to self-determination, that it would be either a...

Inguino-scrotal sarcomas

A sarcoma is a malignant tumour that originates from mesenchymal cells such as adipose tissue, bone, cartilage and smooth muscle. Although these tumours histologically do not originate from the urogenital tract, urologists are often involved in their diagnosis and management...

Hard flaccid syndrome

Chronic pelvic pain is defined as pain present below the level of the umbilicus with a duration of more than six months [1,2]. Chronic pelvic pain syndromes (CPPS) are highly prevalent in Western society, affecting both males and females. Studies...