Nigel J. Parr

Immediate dual energy X-ray absorptiometry reveals a high incidence of osteoporosis in patients with advanced prostate cancer before hormonal manipulation

To examine the incidence of osteoporosis in patients with advanced prostate cancer (using forearm densitometry) before commencing androgen deprivation therapy (ADT), as osteoporotic fractures are more frequent in patients with prostate cancer who have undergone either medical or surgical castration, because of rapid loss of bone mass.

The potassium sensitivity test: a predictor of treatment response in interstitial cystitis

To determine whether the potassium sensitivity test (PST) can be used to predict the response to treatment with intravesical sodium hyaluronate in patients with interstitial cystitis.

Referrals into a dedicated British penile cancer centre and sources of possible delay.

Objective: To assess sources of delay in referral to a specialist Urology clinic for penile cancer. Methods: Patients with penile cancer seen during the period December 2002 to December 2007 were identified from the unit’s database. Information regarding presentation, diagnosis and pattern of referral was retrieved from records. Delay was defined as the time between the patient first noticing a penile lesion and date of first seeking medical advice, or additional time before being seen by a Urologist resulting from referral to another speciality. Results: Of 100 patients, with a median age of 54 years (range 2–81 years), 19% were initially referred to other specialities (Genitourinary Medicine—13%, Dermatology—4%, Plastics 2%). Initial referrals to Genito-urinary Medicine and Dermatology resulted in mean delays of 6 and 3.5 months respectively, whereas the mean duration for patients to present to any medical practitioner from onset of symptoms was 5.8 months. Overall, 47% presented with locally advanced disease. Conclusion: Approximately one-fifth of patients with penile cancer are first referred to specialities other than Urology. This sometimes delays diagnosis, potentially affecting overall prognosis. The major source of delay, however, results from patient reluctance to seek medical advice. Thus, the greatest impact in this condition is likely to be achieved by increased public awareness and education.

Chemical composition of gases surgeons are exposed to during endoscopic urological resections.

OBJECTIVESnTo identify any potentially harmful chemical constituents of the gaseous plume produced from urological endoscopic diathermy.nnnMETHODSnChemical analysis was performed on the gaseous plume produced from prostatic resections and vaporizations using gas chromatography with mass spectroscopy and high-performance liquid chromatography using ultraviolet and visible light detection. In addition, carbon monoxide levels were analyzed using a portable catalytic flammable gas sensor.nnnRESULTSnThis study identified a cocktail of volatile organic hydrocarbons produced during these procedures, some of which are known carcinogens. The most significant finding being high levels of carbon monoxide.nnnCONCLUSIONSnFrom this preliminary study, we advocate the use of smoke evacuator systems for all urologists regularly performing these procedures, and suggest that further research is required to investigate potential long-term complications to the urologist.

Testosterone recovery and changes in bone mineral density after stopping long‐term luteinizing hormone‐releasing hormone analogue therapy in osteoporotic patients with prostate cancer

To investigate the rate of testosterone recovery and changes in bone mineral density in patients found to be osteoporotic while receiving luteinizing hormone‐releasing hormone (LHRH) analogues after changing to antiandrogen monotherapy in an attempt to reduce further demineralization.

Should centralized histopathological review in penile cancer be the global standard

To assess the role of centralized pathological review in penile cancer management.

Penile metastases treated with partial glansectomy and adjuvant radiotherapy 5 years after an initial diagnosis of rectal cancer.

A 61-year-old man with recurrent rectal carcinoma was referred to the urology clinic with two penile lesions. These had negatively affected his quality of life and he underwent a radical circumcision and proximal glansectomy with reconstruction. This case report examines the clinical presentation and surgical treatment of rectal carcinoma metastasising to the penis.

Epithelioid haemangioma: a rare cause of painful erections and sleep deprivation

Epithelioid haemangioma of the penis is a rare condition which usually presents a solid single nodule. We report a case in a 43-year-old man who presented with painful erections and sleep disturbance with two palpable penile nodules. Magnetic resonance imaging with an artificially induced erection revealed these as individual lesions, and local excision was successfully undertaken. Pathological diagnosis of epithelioid haemangioma was confirmed with positive staining for CD31. Although rare, penile epithelioid haemangioma should be considered as a differential in an atypical penile mass. Induction in of an artificial erection prior to MRI can aid diagnosis and treatment is typically with surgical excision.

MRI use with artificial erection in cases of painful erections

They highlight the use of penile magnetic resonance imaging (MRI) with artificially induced erection in aiding diagnosis of a penile lesion that was unapparent on clinical examination. Just prior to their article publication, we described a similar case of epithe-lioid hemangioma with painful erec -tions and sleep deprivation.

The twisted diversion: a paralyzing complication

Ileal conduit remains a widely used urinary diversion performed after radical cystectomy. However, complications of ileal conduits remain an important concern in urological surgery. We report a rare case of an ileal conduit stricture, which can have grim complications if unobserved during the operation. Following an initial operation of radical cystectomy and ileal conduit formation in France in 2011, an 80-year-old male travelled back to the UK after 4 months of general weakness and limb paralysis. Initial blood test shows life-threatening hyperkalemia and worsened renal function. Subsequent ultrasound KUB scan and loopogram revealed obstructive uropathy. The initial management includes intravenous antibiotics and bilateral nephrostomies were inserted to aid diversion of urine. A thorough surgical exploration revealed a twisted, fibrous mesenteric band adhered to the proximal part of the ileal conduit. Only one case report of ileal conduit stenosis was described many years after the procedure.