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Objective: To reassess the trends in upper urinary tract (UUT) stone disease burden and management in the UK during the last 5 years. Methods: The present paper is our third quinquennial analysis of trends in the management of renal stones in England. Data were collected using the Hospital Episode Statistics database for the years 2015–2020 inclusive. These were then analysed, summarized and presented. Results: The number of UUT stone episodes increased by 2.2% from 86 742 in 2014–2015 to 88 632 in 2019–2020 but annual prevalence remained static at 0.14%. The number of UUT stone episodes in those of working age has remained static but increased by 9% for patients aged > 60 years (from 27 329 to 29 842). The number of shockwave lithotripsy (SWL) treatments decreased by 6.8%. There was a further increase in the use of ureteroscopy (URS) between 2015 and 2020 of 18.9%. Within this subgroup, flexible URS had the most rapid increase in use, with a rise of 20.4% from 7108 to 8558 recorded cases. Over the 20‐year period from 2000 to 2020 there was a remarkable 257% increase in URS cases. There was a further decline in open surgery for UUT stone disease by 40%. Stone surgery day‐case numbers have increased by 14.7% (from 31 014 to 35 566), with a corresponding decline in the number of bed days of 14.3%. Emergency cases increased by 40%, while elective cases saw a slight increase of 1.9%. Conclusion: The present study shows a plateauing in the prevalence of UUT stone disease in England in the last 5 years, with a move towards day‐case procedures and an increase in the proportion of emergency work. For the first time in England, URS has overtaken SWL as the most common procedure for treating UUT stone disease, which might reflect patients' or physicians' preference for a more effective definitive treatment. [ABSTRACT FROM AUTHOR]

Objective: To report the 5‐year failure‐free survival (FFS) following high‐intensity focused ultrasound (HIFU). Patients and Methods: This observational cohort study used linked National Cancer Registry data, radiotherapy data, administrative hospital data and mortality records of 1381 men treated with HIFU for clinically localised prostate cancer in England. The primary outcome, FFS, was defined as freedom from local salvage treatment and cancer‐specific mortality. Secondary outcomes were freedom from repeat HIFU, prostate cancer‐specific survival (CSS) and overall survival (OS). Cox regression was used to determine whether baseline characteristics, including age, treatment year, T stage and International Society of Urological Pathology (ISUP) Grade Group were associated with FFS. Results: The median (interquartile range [IQR]) follow‐up was 37 (20–62) months. The median (IQR) age was 65 (59–70) years and 81% had an ISUP Grade Group of 1–2. The FFS was 96.5% (95% confidence interval [CI] 95.4%–97.4%) at 1 year, 86.0% (95% CI 83.7%–87.9%) at 3 years and 77.5% (95% CI 74.4%–80.3%) at 5 years. The 5‐year FFS for ISUP Grade Groups 1–5 was 82.9%, 76.6%, 72.2%, 52.3% and 30.8%, respectively (P < 0.001). Freedom from repeat HIFU was 79.1% (95% CI 75.7%–82.1%), CSS was 98.8% (95% CI 97.7%–99.4%) and OS was 95.9% (95% CI 94.2%–97.1%) at 5 years. Conclusion: Four in five men were free from local salvage treatment at 5 years but treatment failure varied significantly according to ISUP Grade Group. Patients should be appropriately informed with respect to salvage radical treatment following HIFU. [ABSTRACT FROM AUTHOR]

The article offers information about paper sessions on urology to be discussed at the BAUS Annual Meeting to be held in Manchester, England from June 23-27, 2008.

Our updated review of over 93 000 biopsies complements the previous decade-long evaluation of nearly half-a-million biopsies and illustrates the impact COVID-19 has had on prostate cancer diagnostics. The reduced sepsis and emergency readmission rates associated with the transperineal approach were alluded to in our paper reviewing the clinical and financial implications of a decade of NHS prostate biopsies from 2008 to 2019 [[1]]. Abbreviations AUR acute urinary retention GA general anaesthetic HES Hospital Episode Statistics LA local anaesthetic NEL non-elective The move towards transperineal biopsy and retreat from the traditional transrectal approach termed "TREXIT" is in vogue. [Extracted from the article]

Information of the annual meeting of the British Association of Urological Surgeons (BAUS) on June 22-25, 2009 in London, England is presented. The event featured papers on the systemic inflammatory response in patients for renal cancer in an interactive session. In addition, the event featured distinguished speakers including Sara Ramsey, who received the John Blandy Prize, and Daniel Canter, recipient of the Robert Krane Prize for the best clinical paper.

What's known on the subject? and What does the study add? Prior to the First World War, traumatic injuries to the spinal cord rapidly led to death from severe infections of the bladder. During the Second World War, Ludwig Guttmann resurrected the use of intermittent catheterisation at Stoke Mandeville Hospital, by meticulous attention to detail and was so successful, that this method was introduced into general urological practice. Historical review of the management of the bladder in patients with spinal injuries. Spinal injury patients - literature review - personal experience at Stoke Mandeville Hospital. Review of the different methods of catheterisation from the 19th century to today. Methods learned from the management of the bladder of spinal injuries patients were adopted into mainstream urology. [ABSTRACT FROM AUTHOR]

The article offers information on the annual charity benefit bicycle tour Bike for The Urology Foundation (TUF) held on September 6-15, 2009 in Malawi. It cites that the event furthers the objectives of the TUF in patient care, research, medical education, and scholarship. Professor Roger S. Kirby, director of the Prostate Center in London, England imparts that people in Malawi are warm and welcoming individuals. It notes that the contingent donated to Malawi Dream charity to help the children.

The article offers information on the poster sessions on urology to be discussed during the BAUS Annual Meeting to be held in Manchester, England from June 23-27, 2008.

Post-prostatectomy urinary incontinence (UI) is a well-recognised consequence of radical prostatectomy carried out as treatment for organ-confined prostate cancer. It is not clear whether the same centres were involved in implanting both devices; it is however of note that for AUS implantation, 34.7% of the centres performed fewer than six post-prostatectomy AUS implantations over the 8-year period and 18.4% performed> 50 in the same period. Both re-do and removal surgery of AUS had some association with low-volume providers; 7.7% of patients received a second AUS and 0.8% had undergone the procedures three or more times. [Extracted from the article]

OBJECTIVES To examine the safety and use of apomorphine as prescribed in general medical practice in England as a treatment for erectile dysfunction (ED). PATIENTS AND METHODS Apomorphine hydrochloride (marketed as Uprima®, Abbott Laboratories Ltd, UK) is licensed in the UK as a sublingual therapy for ED. It is the first treatment for ED with a central mode of action. This postmarketing observational cohort study was conducted using prescription-event monitoring (PEM) methods. Exposure information was obtained from dispensed prescription data for patients first prescribed apomorphine between October 2001 and December 2002. Outcome data were derived from Green-Form questionnaires posted to prescribing physicians ≥6 months after the date of the first apomorphine prescription for each patient. The study cohort comprised 11 185 patients, 99.3% (11 111) of whom were men, with a median (interquartile range) age of 61 (54–68) years. RESULTS The most frequently reported prescribing indication was ED and the most frequently reported reason for stopping apomorphine was that it was ‘not effective’. In addition, the percentage of patients for whom apomorphine was reported to have been effective was relatively low. Headache was the most commonly reported adverse drug reaction, and the most frequently reported clinical condition occurring in the first month of observation. A small number of events (24) were reported that were not listed in the current Summary of Product Characteristics (SPC) and were considered by the prescribing general practitioner (GP) to be associated with apomorphine use. CONCLUSION The proportion of patients for whom apomorphine was reported to be effective was low. Also, ‘not effective’ was the most frequently reported event and a high percentage of patients stopped apomorphine because it was ‘not effective’. The most frequently reported clinical adverse events (headache and nausea) were those listed in the SPC. A small number of reports for unlabelled events were thought by prescribers to be related to apomorphine use. The confounding factors of patient age and coexisting disease should be considered when assessing data from this study. [ABSTRACT FROM AUTHOR]

Discusses key issues concerning prostate cancer in England and Wales. Natural history and burden of prostate cancer; Outcome of screening; Estimates of ad hoc screening.

Presents abstracts of articles about andrology, to be discussed at the Annual Scientific Meeting of the British Association of Urological Surgeons from June 23-27, 2003 in Manchester, England. `The role of retroperitoneal lymph node dissection in the management of stromal tumors of the testis,' G.L. Smith et al.

OBJECTIVE To describe recent trends in the use of radical prostatectomy (RP) in England, as there is currently no consensus on the most effective treatment for localized prostate cancer, although RP is the treatment of choice among urological surgeons for men aged < 70 years. METHODS Routine data were assessed to establish the number of RPs performed in England in 1991–99. Age-standardized operation rates were compared by region and socio-economic group, and the geographical spread of use mapped. RESULTS The number of RPs performed annually increased nearly 20-fold between 1991 and 1999. Rates of surgery were greatest in the London National Health Service (NHS) regions and lowest in the Trent region. Outside London, the risk of surgery in a NHS hospital was significantly greater for men living in the least deprived areas; in London this trend was reversed. CONCLUSION Rapid increases in the use of RP showed marked regional variations, most likely related to access to prostate-specific antigen testing and the location of surgeons able to carry out radical surgery. By 1999, a third of procedures were still being undertaken in ‘low-volume’ hospitals, with implications for the quality of care and outcomes. Crucially, these developments occurred in the absence of robust information about the effectiveness of RP. Recent funding of a randomized trial of treatment options in this area is welcome, but wider questions remain about the timing of the evaluation of surgical technologies. [ABSTRACT FROM AUTHOR]

Objective To review the results of non-interventional observational cohort studies of 14 772 patients treated with finasteride and 12 484 patients treated with tamsulosin, both studies being of national proportions and undertaken in general medical practice in England. Methods Both studies were undertaken by prescription-event monitoring (PEM), whereby the exposure data are derived from information provided in strict confidence by the Prescription Pricing Authority of the National Health Service. The outcome data are derived from ‘green form’ questionnaires completed by the prescribing general practitioners (GPs). Additional data are obtained by medical follow-up with the attending practitioners. Adverse experience was measured in three ways; as reports of events which the doctors considered to represent adverse drug reactions; as reports of reasons for stopping the drug; and by studying the incidence density of each reported event. For these purposes a computerized dictionary containing 1430 higher level terms was used. The duration of exposure in the finasteride study was ≈ 1 year and was ≈ 6 months in the tamsulosin study. Results The outcome data on the 14 772 and 12 484 patients treated in the finasteride and tamsulosin studies were derived from the 63% and 57.4% of the green forms sent out and returned, respectively. The finasteride cohort included two women and the tamsulosin cohort 70 women. The mean (sd) age of the men in the two cohorts was, respectively, 69.0 (9.2) and 66.2 (11.7) years. Both drugs were well tolerated on long-term therapy and 69.6% (10 274 patients) of the total finasteride and 62.0% (7739 patients) of the total tamsulosin cohort were still receiving the drug at the end of 6 months. In the finasteride study, impotence or ejaculatory failure was reported in 2.0% of the patients still receiving the drug; there were reports of decreased libido in 1.0% and gynaecomastia was reported whilst the drug was still being prescribed in 39 patients (0.3% of the cohort). With tamsulosin, uncommon cases of dizziness, headache, malaise and hypotension (89 reports in 12 484 patients, i.e. 0.7% of the cohort) were common to the findings of reported adverse reactions, reasons for stopping the drug and events of highest incidence density. None of the deaths which occurred in either of these large cohorts was attributed by either the reporting GPs or the PEM medical staff to the drugs examined. Conclusion The GPs rated the drugs effective in most patients; tolerance and adverse experience was consistent with the known pharmacology of the two drugs. No serious, unexpected adverse effects were identified. [ABSTRACT FROM AUTHOR]

A calendar of events related to various congresses and conventions is presented which include one titled "RSM Clinicopathology Papers Prize Meeting and Stater of the Art Lecture" by the Royal Society of Medicine on March 18, 2010 in London, England, one titled "25th Annual EAU Congress" on April 16-20, 2010 in Barcelona, Spain, and one titled "1st World Congress of Pediatric Urology" on May 28-30, 2010 in San Francisco, California.

An introduction is presented in which the editor discusses various reports within the issue on topics including the longitudinal comparison of a large number of patients undergoing urinary diversion after radical cystectomy and the percutaneous nephrolithotomy (PCNL) outcomes in England.

Objective To evaluate the natural history of a group of patients who underwent contact laser prostatectomy or transurethral resection of the prostate (TURP). Patients and methods Patients were followed up at 5 years after enrolling in a prospective double-blind randomized controlled trial of TURP vs contact laser prostatectomy. Results Of the initial trial patients, 11.5% had died (seven in the laser and 10 in the TURP arm) and eight (5.4%) were too incapacitated by coexistent medical disease to respond to the questionnaires. Thirty-eight patients were not available for follow-up, despite numerous invitations. Thirteen of the laser patients (18%) and 11 of the TURP patients (14.5%) had undergone re-operation. Two patients from each arm had received α-blockers for worsening symptoms. Conclusions Five years after prostatic surgery, a significant number of patients were dead or disabled by coexistent medical disease. The re-operation rate after TURP and contact laser prostatectomy were similar. [ABSTRACT FROM AUTHOR]