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Objective: Many district general hospitals in the UK do not have 24-hour urology cover and the junior doctors admit almost all patients with acute urinary retention (AUR) unnecessarily. A small retrospective audit involving a random selection of 17 patients who initially presented with AUR to accident and emergency (A&E) and eventually underwent transurethral resection of the prostate (TURP) between January 2002 and May 2002 showed that four (23%) were admitted unnecessarily and only a few patients had digital rectal examination and antibiotic prophylaxis. Guidelines were prepared to assist the junior doctors in managing patients with AUR. The guidelines were audited to assess how they worked. Methods: A total of 32 patients with AUR were managed using the guideline from June 2002 to December 2002 and the details were collected prospectively from A&E referral letters; three patients were excluded. Results: After implementation of the guideline, the majority of patients went home with a catheter (86%), and the number of digital rectal examinations had not increased but antibiotic prophylaxis had improved from 11 to 38%. The number of records of residual urine remained unchanged and residual urine was not documented in seven patients. Therefore, it was not known whether they had very high residual urine needing admission. More patients received alpha-blockers (27%). There were no inappropriate admissions. Conclusion: Patients with uncomplicated urinary retention can be managed without admission. Development of guidelines avoids inappropriate admissions and improves efficiency. Education and training of junior doctors in the management of AUR is an absolute necessity to implement these guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Flexible ureteroscopes are expensive and delicate instruments that are integral in the offering of a minimally invasive technique of diagnosis and treatment of urolithiasis. Published literature has identified the importance of early damage recognition in preventing frequent use of the scope that would lead to further damage and high repair and replacement costs. Our study was designed to examine the outcome of the pressure leak test on the condition of flexible ureteroscopes after every use and analysing the damage and costs of maintenance., Patients and Methods: A prospective study was designed with two treatment groups. Group 1, 95 consecutive procedures (n = 95) of flexible ureterorenoscopy and laser fragmentation of renal calculi were performed with ACMI DUR 8, (a scope with no in-built leak test facility). This was compared against group 2, where 98 procedures of laser fragmentation of renal calculi (n = 98) were performed using Storz Flex X(2) Ureteroscopes (with a in-built leak test facility). All scopes in Group 2 were tested for pressure leak after every procedure and the outcome of the tests recorded., Results: Both groups were comparable for grade of surgeon; stone location, size & number; access sheath usage and duration of lasering. In Group 1, there were seven scope damages resulting in repairs/replacement amounting to costs $46264.40 (7.1% damage). In Group 2, three scopes revealed a positive pressure leak test, implying damage with repair costs of $9952.80 (3.1% damage) (p < 0.05). Significant cost savings and reduction in downtime were made in Group 2., Conclusions: Pressure leak testing following flexible ureterorenoscopy helped to significantly control costs of maintenance and repair. Newer scopes should have a leak testing mechanism as it prevents further detrimental damage to the scope, build-up of repair costs are avoided and there is an increase in the longevity of these delicate instruments., (© 2013 John Wiley & Sons Ltd.)

Introduction: Cocaine abuse is associated with a number of medical complications, most notably arrhythmias, myocardial infarction, and cerebral hemorrhages. The injection of cocaine in the penis has been predominantly recorded into the corpus cavernosae and is associated with priapism., Aim: Here we describe the injection of subcutaneous cocaine within the penile shaft skin producing ischemic necrosis and Fournier's gangrene., Main Outcome Measures: We sought to highlight the effects of cocaine use within the penis and emphasize the different effects that may ensue., Methods: We reviewed a recent clinical case and conducted a literature review on the use of cocaine within the penis., Results: The use of cocaine has been reported previously within the literature and is mainly limited to case reports. Cocaine use within the corpora and the subcutaneous tissues produces significantly different consequences ranging from priapism to Fournier's gangrene., Conclusions: The case illustrates the growing use of cocaine and other illicit drugs and emphasizes the importance of this issue to all clinicians., (© 2013 International Society for Sexual Medicine.)

Condoms have been a subject of curiosity throughout history. The idea of safer sex has been explored in ancient and modern history, and has been used to prevent venereal diseases. We conducted a historical and medical review of condoms using primary and secondary sources as well as using the RSM library and the internet. These resources show that the first use of a condom was that of King Minos of Crete. Pasiphae, his wife, employed a goat's bladder in the vagina so that King Minos would not be able to harm her as his semen was said to contain "scorpions and serpents" that killed his mistresses. To Egyptians, condom-like glans caps were dyed in different colours to distinguish between different classes of people and to protect themselves against bilharzia. The Ancient Romans used the bladders of animals to protect the woman; they were worn not to prevent pregnancy but to prevent contraction of venereal diseases. Charles Goodyear, the inventor, utilized vulcanization, the process of transforming rubber into malleable structures, to produce latex condoms. The greater use of condoms all over the world in the 20(th) and 21(st) centuries has been related to HIV. This account of the use of condoms demonstrates how a primitive idea turned into an object that is used globally with a forecast estimated at 18 billion condoms to be used in 2015 alone.

Aims: It is common knowledge that proteus bacteria are associated with urinary tract infections and urinary stones. Far more interesting however, is the derivation of the word proteus. This study examines the origin of the word proteus, its mythological, historical and literary connections and evolution to present-day usage., Materials and Methods: A detailed search for primary and secondary sources was undertaken using the library and internet., Results: Greek mythology describes Proteus as an early sea-god, noted for being versatile and capable of assuming many different forms. In the 8(th) century BC, the ancient Greek poet, Homer, famous for his epic poems the Iliad and Odyssey, describes Proteus as a prophetic old sea-god, and herdsman of the seals of Poseidon, God of the Sea. Shakespeare re-introduced Proteus into English literature, in the 15(th) century AD, in the comedy The Two Gentleman of Verona, as one of his main characters who is inconstant with his affections. The 'elephant man' was afflicted by a severely disfiguring disease, described as 'Proteus syndrome'. It is particularly difficult to distinguish from neurofibromatosis, due to its various forms in different individuals. The Oxford English Dictionary defines the word 'protean' as to mean changeable, variable, and existing in multiple forms. Proteus bacteria directly derive their name from the Sea God, due to their rapid swarming growth and motility on agar plates. They demonstrate versatility by secreting enzymes, which allow them to evade the host's defense systems., Conclusions: Thus proteus, true to its name, has had a myriad of connotations over the centuries.

Introduction: Pyeloplasty is a standard and highly successful treatment for ureteropelvic junction obstruction. However, stenosis is a late complication causing symptom recurrence. The purpose of this study was to evaluate the use of holmium laser stenosis incision-"laser endopyelotomy"-to manage this., Patients and Methods: Fifteen adult patients were referred for loin pain recurrence after pyeloplasty. Subsequent to ureteropelvic junction stenosis confirmation with intravenous urogram and dynamic isotope renogram investigations, the patients underwent ureteroscopic laser endopyelotomy. Eleven patients had stents in situ before endopyelotomy. Ureteric stents (7F) were placed for 6 weeks postprocedure when ureteroscopy was repeated and stents removed. All patients had repeat intravenous urogram and renograms at 3 months postprocedure., Results: Patients presented at a median of 3.2 years (range, 9 months to 8 years) after pyeloplasty (nine open dismembered, three Culp, and three laparoscopic). Three patients (all nonstented) required a second incision. All patients were discharged from hospital within 23 hours with no complications. Symptomatic improvement was documented in all of the patients, and improved drainage was recorded in the 3-month nuclear scans., Conclusion: Laser endopyelotomy is an appropriate minimally invasive procedure for postpyeloplasty stenosis. Results are better in patients with ureteric stents in situ before the procedure.

Background: Herniorrhaphy is one of the most commonly performed operations in the UK. Approximately 1 per 1,000 of the population has a groin hernia., Method and Result: We report on a rare complication following laparoscopic inguinal herniorrhaphy of bladder stone formation and its management., Conclusion: To our knowledge a combined laparoscopic repair of the urinary bladder wall, following iatrogenic injury by a mesh fixation clip and retrieval of bladder stone (induced through the misplacement of the clip) has not been described previously.

The deep dorsal penile vein was obtained from seven patients undergoing surgery for erectile dysfunction. The veins were studied histologically and immunohistochemically for serotonin, dopamine beta-hydroxylase, vasoactive intestinal polypeptide, neuropeptide Y, substance P, calcitonin gene-related peptide, somatostatin, and [Leu]- and [Met]enkephalin. Histologically, the deep dorsal vein was found to be a large muscular vein with a thin endothelial lining. The tunica media was composed of an inner longitudinally and an outer circularly arranged smooth muscle layer. Numerous vasa vasorum (up to 30 in a single transverse section) were found in the tunica adventitia. The greatest density of nerves supplying the deep dorsal vein and vasa vasorum were neuropeptide Y-immunoreactive nerves followed (in a decreasing order) by vasoactive intestinal polypeptide- and dopamine beta-hydroxylase-immunoreactive nerves. Substance P-, calcitonin gene-related peptide- and somatostatin-immunoreactive nerves, but not serotonin-, [Leu]- and [Met]enkephalin-immunoreactive nerves, were occasionally found around the deep dorsal vein. All these nerve fibers were confined to the adventitial-medial border except neuropeptide Y-immunoreactive nerves which in addition penetrated the tunica media to the subendothelial layer of the deep dorsal vein. In contrast, neuropeptide Y-immunoreactive nerves supplying the vasa vasorum were always confined to the adventitial-medial border. The possible function of the medial innervation of the deep dorsal vein by neuropeptide Y-immunoreactive nerves is discussed.

Extracorporeal shockwave lithotripsy has been shown to be a safe and effective method of treating most upper urinary tract stones. Major complications, although few, include haemorrhage, septicaemia, "Steinstrasse" formation and cardiac arrhythmias. The experience from 600 consecutive cases is reviewed and methods of prevention are discussed.

Open surgery for large or complex renal calculi may be difficult, particularly in patients with recurrent stones, and may require special operative techniques to preserve renal function. With the advent of percutaneous nephrolithotripsy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) new approaches are now available for the treatment of these difficult cases. A review of 67 patients who presented between November 1984 and May 1986 has shown that it was possible to clear large stones in 71% of patients using a combination of PCNL and ESWL. There was no mortality; the morbidity for both procedures was low and was less than when either procedure was used alone for the treatment of complex stones.

The papaverine test has become established in the investigation of impotence. Although a full response to papaverine excludes a significant vascular lesion, failure to respond may be due to either arterial deficiency or venous leakage. Pharmacocavernometry, which combines the papaverine test and an artificial erection test, was performed in 126 patients. Intracorporeal pressure was monitored following the intracorporeal injection of 80 mg papaverine; 10 min later, saline was infused to determine the presence of a venous leak. Five different responses were observed. Patients with a Type 1 or 2 response were psychogenic or neurogenic. Patients with a Type 3 response were arteriogenic and patients with a Type 4 or 5 response had significant venous leakage. The modified papaverine test permits more information to be gained concerning the aetiology of the impotence.

Many men presenting with impotence can be cured by surgical intervention. Psychosexual counselling is always beneficial but surgery may be indicated when there is irreversible organic erectile impotence or when there is an anatomical abnormality of the penis preventing coitus. The diagnosis and management of such disorders are summarized.

A prospective, randomized, controlled trial was conducted in 116 consecutive patients undergoing colorectal surgery to compare single dose prophylaxis with mezlocillin to cefuroxime plus metronidazole in three doses. Patients were randomized to receive either a single dose of iv mezlocillin (5.0 g) or three doses of iv cefuroxime plus metronidazole at 8-hourly intervals. The first dose was given on the operating table. The overall wound infection rate in the mezlocillin treated patients (n = 54) was 30% and in the patients treated with cefuroxime plus metronidazole (n = 56) 25%. This difference is not statistically significant. When trivial wound infections were disregarded the wound infection rates were 11% and 16% respectively, which again was not statistically significant.