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BACKGROUND: Overactive bladder (OAB) is a common syndrome in the community characterised by unstable bladder contractions, resulting in urinary urgency, frequency and nocturia in the absence of detectable disease. Large studies suggest that >10% of the general population is symptomatic. OBJECTIVE: The aim of this article is to summarise the stepwise treatment for OAB that seeks to improve patient quality of life and reduce patient and health system costs. DISCUSSION: OAB is a diagnosis of exclusion that begins with a targeted history and examination of the urogenital system with the aim of assessing the burden of disease on the patient. First-line treatment comprises conservative measures including weight reduction, a decrease in exposure to bladder stimulants, fluid optimisation and pelvic floor exercises. Pharmacological treatments for OAB include anticholinergic medications such as oxybutynin. If the patient is unresponsive to pharmacological treatment, a review by a urology specialist is appropriate. Recommendations may include minimally invasive procedures such as intravesical botulinum toxin A injections, reserving the invasive procedures for patients in specific circumstances.

Ureteral stents are an essential tool in modern day adult and paediatric urology. They are usually placed with the intention of removal or replacement after a specific time but may occasionally be forgotten or unintentionally retained. We present the case of a young man who presented with symptoms caused by a retained ureteric stent placed 26 years earlier during reconstructive ureteric surgery as an infant.

Skeletal metastases present a major clinical challenge for prostate cancer patient care, inflicting distinctive mixed osteoblastic and osteolytic lesions that cause morbidity and refractory skeletal complications. Macrophages are abundant in bone and bone marrow and can influence both osteoblast and osteoclast function in physiology and pathology. Herein, we examined the role of macrophages in prostate cancer bone lesions, particularly the osteoblastic response. First, macrophage and lymphocyte distributions were qualitatively assessed in patient's prostate cancer skeletal lesions by immunohistochemistry. Second, macrophage functional contributions to prostate tumour growth in bone were explored using an immune-competent mouse model combined with two independent approaches to achieve in vivo macrophage depletion: liposome encapsulated clodronate that depletes phagocytic cells (including macrophages and osteoclasts); and targeted depletion of CD169(+) macrophages using a suicide gene knock-in model. Immunohistochemistry and histomorphometric analysis were performed to quantitatively assess cancer-induced bone changes. In human bone metastasis specimens, CD68(+) macrophages were consistently located within the tumour mass. Osteal macrophages (osteomacs) were associated with pathological woven bone within the metastatic lesions. In contrast, lymphocytes were inconsistently present in prostate cancer skeletal lesions and when detected, had varied distributions. In the immune-competent mouse model, CD169(+) macrophage ablation significantly inhibited prostate cancer-induced woven bone formation, suggesting that CD169(+) macrophages within pathological woven bone are integral to tumour-induced bone formation. In contrast, pan-phagocytic cell, but not targeted CD169(+) macrophage depletion resulted in increased tumour mass, indicating that CD169(-) macrophage subset(s) and/or osteoclasts influenced tumour growth. In summary, these observations indicate a prominent role for macrophages in prostate cancer bone metastasis that may be therapeutically targetable to reduce the negative skeletal impacts of this malignancy, including tumour-induced bone modelling. Copyright © 2016 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Gregory Verhoest*, Rennes, France; Thomas Bessede, Geraldine Pignot, Rachid Bahi, Paris, France; Jean Christophe Bernhard, Bordeaux, France; Fabien Bouliere, Paris, France; Jean De La Rosette, Alex Bex, Amsterdam, Netherlands; Jerome Rigaud, Nantes, France; Morgan Roupret, Guillaume Coffin, Paris, France; Jean Marie Ferriere, Bordeaux, France; Jean Alexandre Long, Jean Louis Descotes, Grenoble, France; Alexander Zisman, Tel Aviv, Israel; Philippe Paparel, Lyon, France; Charlotte Maurin, Eric Lechevallier, Marseille, France; Roberto Bertini, Francesco Montorsi, Milan, Italy; Laurent Salomon, Paris, France; Roy Farfara, Haifa, Israel; Bjorn Ljungberg, Umean, Sweden; Alexandro Rodriguez, Tampa, FL; Karim Bensalah, Rennes, France; Jean Jacques Patard, Paris, France