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Urothelial carcinoma is the most common histologic subtype of bladder cancer, accounting for approximately 90%. We herein report a case of a 78-year-old man with an unusual association of bladder stones with an aggressive plasmacytoid variant of urothelial cancer. Initially he presented in 2009 with a very large bladder stone and was treated by an open cystolithotomy. Histology from a bladder biopsy at that time was benign. He failed to attend follow-up appointments but subsequently he attended in 2016 with a recurrent urinary tract infection and an acute kidney injury. A CT scan showed multiple bladder stones. The cause of our patients' multiple bladder stones is unclear and unusual. He then underwent a further open cystolithotomy according to our multidisciplinary team recommendation. Post-operatively he unfortunately developed a non-healing vesicocutaneous fistula for which he was performed cystoscopy and biopsy but ended with transurethral resection due to the extent of abnormal/necrotic tissue. Histology confirmed a plasmacytoid variant of urothelial cancer. To our knowledge, this is the first case of an association of bladder stones with a plasmacytoid variant of urothelial cancer.

Introduction: Benign prostatic hyperplasia (BPH) and cataract formation are common in older people. Medical management of symptomatic BPH is often preferred to surgical treatment as surgery increases the risk of morbidities, whereas, surgery is the main form of treatment to restore sight in patient with cataract. The clinical treatment of BPH is either alpha-1 adrenergic antagonist alone or combination of alpha reductase inhibitor and alpha adrenergic receptor (AR) antagonist. There are four alpha-AR antagonists currently available to treat BPH. The uroselective alpha-blocker tamsulosin is the most commonly used drug among all. Studies showed that the majority of the patients who develop intraoperative floppy iris syndrome (IFIS) were on tamsulosin. Women are more likely to develop cataract than men and some recent studies showed that tamsulosin is effective in treating female lower urinary tract symptoms and thereby can cause IFIS during cataract surgery. Evidence Acquisition: We performed a critical review of the published articles and abstracts on association of IFIS with alpha-blockers and other medications as well as other medical conditions. Evidence Synthesis: Tamsulosin is the most common cause of formation of IFIS. However, not all patients given tamsulosin develop IFIS and cases have been reported without any tamsulosin treatment. Conclusion: Tamsulosin is a recognized cause to impede mydriasis and lead to IFIS during cataract surgery. Urologist should collaborate with their ophthalmology colleagues and general practitioner during prescribing tamsulosin in patients with history of cataract or waiting for planned cataract surgery. The increasing life expectancy and growth of older people will increase the number of men and women who suffer from lower urinary tract symptoms as well as cataract. Therefore, further research and studies are required to properly understand the relation of alpha blockers and IFIS.

The use of percutaneous renal surgery has been recently revolutionised with novel endourological instruments and techniques. However, the incidence, prevention and management of severe complications such as colon perforation still lack consensus. By presenting our 10-year experience, we would like to highlight the diagnosis and management of the rare complication of colon perforation.

Tumors metastasizing to the glans penis are uncommon and a rare occurrence. The majority of the primary tumors are located in the pelvis and they arise from the genitourinary tract and rectum (>75%). We report a 61-year-old man with known metastatic (lymph nodes and maxilla) esophageal cancer who was treated with chemotherapy and referred to urology with phimosis for circumcision. He did not have any other urological or penile complaints. During circumcision the glans penis looked nodular and a biopsy was taken. The histological examination of the biopsy showed metastasis from esophageal primary adenocarcinoma. The case was discussed in a multi-disciplinary meeting and palliative radiotherapy was recommended and commenced.

The incidence of ureteric obstruction after kidney transplantation is 3-12.4%, and the most common cause is ureteric stenosis. The standard treatment remains open surgical revision, but this is associated with significant morbidity and potential complications. By contrast, endourological approaches such as balloon dilatation of the ureter, ureterotomy or long-term ureteric stenting are minimally invasive treatment alternatives. Here we discuss the available minimally invasive treatment options to treat transplant ureteric strictures, with an emphasis on long-term stenting. Using an example patient, we describe the use of a long-term new-generation ureteric metal stent to treat a transplant ureter where a mesh wire stent had been placed 5 years previously. The mesh wire stent was heavily encrusted throughout, overgrown by urothelium and impossible to remove. Because the patient had several previous surgeries, we first considered endourological solutions. After re-canalising the ureter and mesh wire stent by a minimally invasive procedure, we inserted a Memokath® (PNN Medical, Kvistgaard, Denmark) through the embedded mesh wire stent. This illustrates a novel method for resolving the currently rare but existing problem of ureteric mesh wire stents becoming dysfunctional over time, and for treating complex transplant ureteric strictures.

Introduction: The Memokath 051™ is a semipermanent inert metal alloy ureteric stent which can bridge strictures and, compared to double J stents, causes less bladder irritation and pain, is more resistant to external compression forces and may be more effective in patients with malignant ureteric obstruction. We present our experience with this novel stent in such cases. Methods: All suitable patients referred to us with malignancy-associated ureteric strictures over a 4-year period had ureteric Memokath 051™ stents inserted. Data on aetiology and position of the strictures as well as length of the Memokath stents used and their efficacy and complications were recorded prospectively. Results: 42 ureteric Memokath 051™ stents were inserted in 37 patients (mean age 64 years). 40.5% of strictures were related to gynaecological cancer, 21% to bowel cancer, 14% were post radiation, 14% occurred in prostate cancer patients and 9.5% were found in other cancers. The mean follow-up was 22 months (range 5–60 months). The main complications were stent migrations in 5, urinary tract infections in 3 and blockage of stent due to progressive transitional cell carcinoma of the ureter in 2 cases. Conclusion: Memokath 051™ ureteric stents are safe, effective and durable in the long-term treatment of malignant strictures.

The standard management for pelviureteral junction (PUJ) obstruction is a laparoscopic dismembered pyeloplasty. We present the initial results of our experience of laparoscopic cranial transposition of lower-pole crossing vessels in the management of adult PUJ obstruction where crossing vessels were identified.All patients during the last 2 years who presented with PUJ obstruction caused by crossing lower-pole vessels underwent a laparoscopic transposition of the artery to a more cranial position and, in fact, plicated within the renal pelvis well above the PUJ to reduce the size of the baggy renal pelvis. Patients were followed up postoperatively with mercaptoacetyl triglycine renography as well as clinical symptom review at 3 months, 6 months, and then yearly.Seven patients have undergone this procedure so far. The mean follow-up period at present is 14 months (range 8-22 months). All patients had a nonobstructive renogram curve at 3 months and 6 months. One patient has had renography at 22 months, which still shows a nonobstructive drainage pattern. All patients have had a resolution of their pain and urinary tract infections. The mean operative time, including the retrograde study and Double-J stent insertion was 121 minutes (range 110-131 min) with a mean blood loss of 30 mL. The mean hospital stay was 2 days. There were no complications.Although currently the number of patients is small and follow-up is short, this procedure appears to be effective in relieving both symptoms and obstruction in patients with lower-pole crossing vessels. Other benefits include shorter operative time, less blood loss, as well as no risk of anastomotic stricture and urine leak when compared with a dismembered pyeloplasty. The Double-J stent can be removed within a few days (typically 5 in our hands) or even shorter where logistically feasible. This reduces stent-related complications.

Uretero-ileal anastomotic stricture is a potentially serious late complication after ileal conduit formation, with a reported incidence of 3-9%. The standard management technique is open surgical revision of the anastomosis with reimplantation of the affected ureter. This is technically challenging and has potential significant morbidity for the patient. Advances in endourological techniques now offer a variety of less-invasive treatment options, like balloon dilatation or laser ureterotomy followed by stent insertion. What happens when such open and minimally invasive techniques fail? Recently, using a combined antegrade and retrograde approach, we inserted a novel, semi-permanent, dual-expansion thermo-expandable metallic alloy stent across a recurrent ileal-ureteric stricture. We describe the technique and potential advantages of this minimally invasive method. This minimally invasive treatment option is of interest, as in contrast to other stents, it does not require routine change, and is resistant to corrosion and urothelial ingrowth, hence ensuring ease of exchange or removal if required.

We present a case of a 63-year-old gentleman with intermittent macroscopic hematuria, in whom the only abnormality was an isolated large tortuous varicosity on the posterior wall of the bladder. Vesical varices are very rare and are only reported to be associated with pregnancy, portal hypertension, retroperitoneal fibrosis, schistosomiasis and iliac vein thrombosis. This patient did not have any of these underlying pathologies. We present an up to date review of the current literature and discuss treatment options on this rare but important cause of hematuria.

‘Various studies have found intravesical chemotherapy with mitomycin-C to be an effective treatment in preventing the recurrence rate of superficial bladder cancer.’ The use of intravesical therapy for the treatment of superficial bladder cancer aims to reduce morbidity and mortality by eradicating existing disease, preventing tumor recurrence and attempting to halt tumor progression. Mitomycin-C is a commonly used intravesical treatment option for superficial bladder cancer and was used for the first time by Shida and colleagues in 1967 [1]. It is an antitumor antibiotic with a molecular weight of 334.3 and is soluble in water and organic solvents. Mitomycin-C is usually minimally absorbed on intravesical instillation due to its high molecular weight and hydrophobic nature. The use of an instillate at the lowest achievable osmotic strength appears to be optimal for the intravesical instillation of the drug and, hence, sterile water is preferred over saline. Its dose is typically 40 mg per instillation – this regimen has been shown to exhibit a longer time-torecurrence and less recurrence compared with the standard regimen (20 mg) in patients with Stage Ta and grade 1–2 bladder cancer [2].

Bladder outflow obstruction is a very common age-related clinical entity due to a variety of benign and malignant diseases of the prostate. Surgical treatment under general or regional anesthesia is not suitable for high-risk elderly patients who seek minimally invasive management. Unfortunately, for patients who are not fit for transurethral and/or laser prostatectomy, few treatment options remain, other than long-term catheterization and insertion (under local anesthesia) of a prostatic stent. In this review, we present developments in the use of prostatic stents.

INTRODUCTION AND OBJECTIVES: The incidence of postrenal transplant ureteric stenosis ranges from 2%‐12%. Currently the gold standard treatment is open revision, but minimally invasive endourological procedures may provide an attractive alternative. We present our data on the successful use of a thermo-expandable, metallic alloy ureteric stent, (Memokath® 051) as a long-term treatment for posttransplant ureteric strictures. METHODS: We retrospectively analysed the medical records of patients undergoing Memokath 051® insertion for ureteric strictures following renal transplantation. The records were reviewed for age, site of stricture, duration of stenting and complications. RESULTS: Seven male patients, mean age 48 (23-74) with strictured or otherwise obstructed ureters following kidney transplantation have been treated with ureteric Memokath (MMK) 051® insertion. At a mean follow up of 3 years, 4 stents were patent and patient’s kidney function has been normal. Average indwelling time of these stents was 31 month. In two patients the stricture extended the whole ureter so that full length MMKs (60mm and 150mm) were inserted; one patient had a 4 cm proximal ureteric stricture which was bridged by a 10 cm MMK, one presented with a blocked, previously inserted Wallstent bridging the stricture through which the Memokath (10cm) was placed. Spontaneous resolution of the stricture without the need for further stenting was seen in two patients: an anastomotic stricture between transplant ureter and a Boari flap resolved spontaneously and the MMK was expelled after 5 month indwelling time. The other patient underwent removal of his MMK due to blockage after 13 month indwelling time - intraoperatively, the stricture showed to be resolved so no further treatment was necessary. In one patient MMK treatment had failed: After extra-anatomical implanted kidney he developed a massively torted, obstructive ureter, which was bridged by a full length Memokath. Due to migration, this was removed after 1 month and replaced with a JJ stent. The overall success rate of Memokath placement was 85% (4 stents patent in situ and 2 spontaneous resolutions of stricture, 1 failure). No other morbidities were recorded and all other patients tolerated the stents well. CONCLUSIONS: Permanent ureteric stenting with the Memokath® 051 is a safe and effective minimally invasive treatment alternative for ureteral strictures after kidney transplantation. It provides an attractive alternative to open surgery and is well tolerated by patients.

Objective. With this review, we provide a comprehensive overview of the main aspects and currently used drugs for analgesia in shockwave lithotripsy. Evidence Acquisition. We reviewed current literature, concentrating on newer articles and high-quality reviews in international journals. Results. No standardized protocols for pain control in SWL exist, although it is crucial for treatment outcome. General and spinal anaesthesia show excellent pain control but are only recommended for selected cases. The newer opioids and nonsteroidal anti-inflammatory drugs are able to deliver good analgesia. Interest in inhalation anaesthesia with nitrous oxide, local anaesthesia with deep infiltration of the tissue, and dermal anaesthesia with EMLA or DMSO has recently rekindled, showing good results in terms of pain control and a favourable side effect profile. Tamsulosin and paracetamol are further well-known drugs being currently investigated. Conclusion. Apart from classically used drugs like opioids and NSARs, medicaments like nitrous oxide, paracetamol, DMSA, or refined administration techniques for infiltration anaesthesia show a good effectiveness in pain control for SWL.

Introduction We report the case of a true hermaphrodite with testicular seminoma with resulting metastases to the inguinal lymph nodes eight months after radical orchidectomy. This is an unusual presentation of testicular cancer and, to the best of our knowledge, the first report of this kind in the literature. Case presentation A 45-year-old Caucasian true hermaphrodite, raised as a male, developed a testicular seminoma. He had undergone a left orchidopexy at the age of 10 for undescended testes. Metastases from testicular tumors to inguinal lymph nodes are a rare occurrence. It has been suggested that previous inguinal or scrotal surgery may alter the pattern of nodal metastasis of testicular cancer. We review the literature to evaluate the incidence of inguinal lymph node involvement in early stage testicular cancer and discuss possible routes of metastases to this unusual site. We also discuss the management of the inguinal lymph nodes in patients with testicular tumors and a previous history of inguinal or scrotal surgery, as this remains controversial. Conclusion Inguinal lymph node metastases from testicular cancer are rare. A history of inguinal or scrotal surgery may predispose involvement of the inguinal nodes. During radical inguinal orchidectomy, the surgeon should be careful to minimize the handling of the testis and ensure high ligation of the spermatic cord up to the internal inguinal ring to reduce the risk of inguinal lymph node metastasis.

The fundamental aspect of cell culturing is to understand the type of cells that the investigator wishes to grow. There are many differences between the cell types; however, the easiest method of categorizing them is into primary cells and cell lines. Two types of cultured cell types: Primary cells Cell lines

Perineal radical prostatectomy (PRP) is one of the oldest surgical procedures for prostate cancer, but its use has declined over the past 30 years. New studies show that PRP is not only minimally invasive but beneficial from an economic perspective and should not yet be abandoned in the treatment of early prostate cancer.

There are a number of graspers and baskets to snare and remove stones during percutaneous nephrolithotomy (PCNL). These instrumental techniques can, however, cause inadvertent trauma to the renal mucosa and can be time consuming. Increasingly, these graspers and baskets are disposable, which also has financial implications. We use a simple technique to flush out fragments from the kidney during PCNL. Once fragments have been identified as a size that can pass through the Amplatz sheath, a cut nasogastric tube is inserted through the sheath--if possible next to or behind the fragments. It is repeatedly moved forward and backward in a jerking motion while saline is instilled under some pressure to create some turbulence. This results in the mechanical flushing out of stone fragments. We have found this to be a safe, effective, and reliable technique of stone extraction during PCNL.