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Objective: The objective of this study is to evaluate the utility of routine loopogram follow-up three months after cystectomy and urinary diversion in the early detection of benign ureteroileal anastomotic stricture (UAS). Materials and methods: A loopogram was incorporated into our standard follow-up three months after cystectomy and conduit urinary diversion in August 2010–December 2015. Data were maintained prospectively in a database. Results: A total of 250 patients (181 male; 69 female); median age of 70 years (range: 38–83) underwent cystectomy and conduit urinary diversion during this period. Of these, 167 (66.8%) had a routine loopogram at three months. Seven of 167 were confirmed to have a benign UAS. Twenty-three of 250 (9.2%) had an early loopogram prior to the planned three-month study in response to symptoms. Nine of 23 were diagnosed with benign UAS. Sixty of 250 (24%) did not have a routine loopogram for a variety of reasons. Five patients with normal three-month loopograms developed late strictures after a median time of 22 months (range 5–38). In total 21/250 (8.4%) patients developed UAS. Stricture rates for the open, robotic and laparoscopic modalities were 8/129 (6.2%), 12/111 (10.8%) and 1/10 (10%) respectively. Five of seven of patients with early, asymptomatic UAS diagnosed on routine loopogram received treatment; four of five had improvement in renal function. Conclusion: Overall stricture rate in this series was 8.4%. The majority of UAS occur early and are more likely to be symptomatic. A policy of routine loopogram benefitted only 4/250 (1.6%) patients. We advocate the use of loopograms in cases with a high index of suspicion rather than for routine screening. Level of evidence: Not applicable for this multicentre audit.

Objective: To determine the potential for a novel immunohistochemistry panel to accurately distinguish oncocytoma from other renal tumour subtypes. Material and methods: Forty renal tumours removed by surgery between 2000 and 2006 in a single tertiary referral centre in the UK were studied retrospectively. Paraffin blocks from 10 each of oncocytoma, papillary RCC, clear cell RCC and chromophobe RCC were examined. The tumours were tested using a panel of antibodies comprising CK7, CK18, CD15, N-cadherin, E-cadherin and EpCAM. The primary outcome measure was the number of each tumour type staining positively with each marker. The immunohistochemistry marker was considered to be positive if more than 10% of the tumour cells stained positively. No staining or focal staining (Results: CK7, CD15 and EpCAM were able to distinguish between renal oncocytoma and chromophobe RCC: no oncocytoma stained with either CK7 or EpCAM, however 7/10 (70%) stained positive for CD15. Conversely, 8/10 (80%) chromophobe RCC stained positive with CK7 and EpCAM but none stained for CD15. Conclusions: In this preliminary study the immunohistochemistry panel shows promise in differentiating between renal oncocytoma and chromophobe RCC. The panel deserves prospective evaluation on needle biopsy specimens.

Objective: The aim of this study was to determine if patients newly diagnosed with bladder cancer and included in a clinical trial had better outcomes than similar patients treated in the same department before initiation of the trial. Methods: Forty patients presenting with bladder cancer in 2005 and recruited into a randomised trial of photodynamic-assisted tumour resection were compared with a cohort of 40 non-trial patients from 2004. Quality of care was measured by assessing near-miss criteria. Results: There were fewer near-misses in the Trial Group (TG) than in the Control Group (CG) (52 versus 151) ( p< 0.001). There were 15 surgical near-misses in the TG compared with 90 in the CG ( p=0.025). Adjuvant intravesical chemotherapy was given within 6 h of resection in 26/31(84%) of the TG and 1/23(4%) of the CG. There were 37 process near-misses in the TG compared with 61 in the CG ( p=0.002). The times to first outpatient appointment, diagnostic flexible cystoscopy, and outpatient follow-up were shorter in the TG (median 10.5/25/17.5 days) than the CG (median 17/32.5/26 days). Conclusions: Patients in the trial had better outcomes than non-trial patients the previous year. The recruitment of patients into trials is a valuable driver of quality improvement.

Gait disorders in cerebral palsy can be accurately analyzed using the CODA-3 system presenting quantitative data representing movement of the hip, knee, and ankle in the sagittal plane. We describe a technique that classifies abnormal gait automatically on the basis of sagittal kinematic data. Fifty-five hemiplegic and 91 diplegic patients were analyzed using an opto-electronic scanner (CODA-3). The sagittal kinematics of the affected limb in hemiplegics correlated with those of both affected limbs in diplegics. We introduce the concept of the "plegic limb." Sagittal kinematics of 237 affected limbs were studied using cluster statistical analysis. Eight clear groups emerged. The predominant clinical features, typical of each group, were identified and described (eg, stiff leg gait, genu recurvatum, or crouch gait). We propose this classification system as a new technique to use gait analysis data to automatically classify abnormal movements of the lower limb in cerebral palsy. (J Child Neurol 1998;13:101-108).

Three-dimensional techniques are gaining widespread use in a number of disciplines, including medicine, where the visualization of depth information is not only useful but important. Both computer-generated 3-D imaging and 3-D video are set to become increasingly important tools for both diagnosis and teaching. In this paper we will present some of the work that we are currently undertaking using 3-D techniques for remote surgical skills acquisition. This work is based on the use of a small headset with twin miniature video cameras, video codecs, two different 3-D visualization systems and BT's ISDN telecommunications network.

The two-week-wait cancer initiative in the UK was designed to speed referral of patients suspected of having cancer and, by so doing, improve their outcome. We reviewed the case notes of all patients referred under this scheme to a single urology department over twelve months. In the department, nearly one-third of new outpatient appointments came under this scheme. 124 patients were referred and all but 7 were seen within the 14-day deadline. In 62 the reason for referral was haematuria, which was macroscopic in 42. Of those with macroscopic haematuria 6 proved to have cancer, newly diagnosed in 4 (2 bladder, 2 renal); no patient with microscopic haematuria had cancer. Of 35 referred with a raised prostate-specific antigen 11 had prostate cancer, in most cases beyond cure. Cancer was found in 1 of 19 patients referred with a testicular mass. In patients referred under the two-week-wait scheme with macroscopic haematuria, cancer is common. Microscopic haematuria is seldom significant. Carcinoma of the prostate is usually advanced and beyond cure at presentation. Among patients referred with scrotal lumps, cancer of the testis is not common. The scheme as a whole is unlikely to improve cancer outcomes. Patients with macroscopic haematuria might be better served by one-stop clinics. For those with testicular lumps, most of which will be benign, the best answer might be direct general practitioner access to scrotal ultrasonography.

Since its inception, the Internet has created many new opportunities for the dissemination of knowledge. We have developed an Internet-based orthopaedic discussion group. There are 93 members from Ireland and elsewhere in the world. Precautions are taken to ensure the confidentiality of all cases submitted to the group. All patient identifiers are removed from images, radiographs and reports before submission. In the first 18 months more than 100 cases were discussed by the group. The use of an Internet-based discussion group in orthopaedics has expanded the educational and communication opportunities for the Irish orthopaedic profession both nationally and internationally.