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Objective To describe the surgical approach and outcomes in the treatment of adult patients with complications of childhood hypospadias surgery, as such patients present a significant reconstructive challenge due to the combination of anatomical and cosmetic deformity, which often results in major functional and psychosexual sequelae. Patients and methods We analysed prospectively collected data on 79 adults with complications of childhood hypospadias surgery, who were operated on between 2004 and 2016. Of the 79 patients, 48 underwent a two-stage urethroplasty using a buccal mucosa graft, and 31 underwent a one-stage distal urethroplasty. Results Patients were followed up using flexible cystoscopy (every 6-9 months). The mean (range) follow-up was 48 (12-96) months. Of the 48 patients who underwent a two-stage repair, eight (16%) needed a revision of the first-stage graft. In total, nine of the 48 patients (16%) developed fistula requiring closure after the second stage; all but one was closed successfully on the first attempt, whilst one required two attempts before closure. Only two of the 48 patients that underwent a two-stage procedure required a re-do urethroplasty within 3 years. Of the 31 patients who underwent a one-stage repair, six (19%) needed fistula closure, all of which were successful. No patient required a further urethroplasty during follow-up. Conclusions Despite the significant surgical challenges found in this patient group, excellent long-term functional outcomes can be achieved. As expected there is a need for additional intervention, either for revision of the first stage or to close fistulae and less commonly for further reconstruction for stricture recurrence.

The acontractile bladder (AcB) is a urodynamic-based diagnosis wherein the bladder is unable to demonstrate any contraction during a pressure flow study. Although it is often grouped with underactive bladder, it is a unique phenomenon and should be investigated independently. The purpose of the present review was to examine the current literature on AcB regarding its pathology, diagnosis, current management guidelines, and future developments. We performed a review of the PubMed database, classifying the evidence for AcB pathology, diagnosis, treatment, and potential future treatments. Over the 67 years covered in our review period, 42 studies were identified that met our criteria. Studies were largely poor quality and mainly consisted of retrospective review or animal models. The underlying pathology of AcB is variable with both neurological and myogenic aetiologies. Treatment is largely tailored for renal preservation and reduction of infection. Although future developments may allow more functional restorative treatments, current treatments mainly focus on bladder drainage. AcB is a unique and understudied bladder phenomenon. Treatment is largely based on symptoms and presentation. While cellular therapy and neuromodulation may hold promise, further research is needed into the underlying neuro-urological pathophysiology of this disease so that we may better develop future treatments.

What’s known on the subject? and What does the study add? There are no previous studies for urology in the UK but several studies from physician insurance groups in North America. There is anecdotal evidence of common reasons for litigation, e.g. missed testicular torsion. This is the first analysis of the claims data compiled by the NHS litigation authority for the speciality of urology; it provides realistic insight into the areas and procedures of the speciality most commonly affected by litigation. The article identifies areas of high risk, both clinical and medico-legal. OBJECTIVES • To present a summary of the collected data on urological litigation within the UK National Health Service (NHS). • Knowledge of the main areas of litigation is essential for maintaining good clinical practice as well as risk management procedures in any specialty. MATERIALS AND METHODS • Details of all claims closed with indemnity payment pertaining to the specialty of urology as practiced by urologists, general surgeons and paediatric surgeons was obtained from the NHS Litigation Authority (NHSLA) for the years since its creation in 1995 to 2009. • The data was then classified and analysed. RESULTS • In all, 493 cases were closed with indemnity payment with a total of £20 508 686.18 paid. The average payment per claim was £41 599.77. • Most of the claims were related to non-operative events (232), followed by postoperative events (168) and intraoperative events (92). • The most common reason for non-operative-related claims was failure to diagnose/treat cancer (69), perforation/organ injury (38) was the highest intraoperative-related claim and a forgotten ureteric stent (23) was the most frequent postoperative-related claim. • The five most commonly implicated procedures were ureteroscopy/ureteric stenting (45), transurethral resection of the prostate (30), nephrectomy (26), vasectomy (19) and urethral catheterisation (15). CONCLUSIONS • The present study once again emphasizes the importance of thorough clinical assessment, record keeping and follow-up as well as informed consent and good communication with patients. • Recognising the areas of highest risk and improving practice should limit future claims.

• To present a summary of the collected data on urological litigation within the UK National Health Service (NHS). • Knowledge of the main areas of litigation is essential for maintaining good clinical practice as well as risk management procedures in any specialty.• Details of all claims closed with indemnity payment pertaining to the specialty of urology as practiced by urologists, general surgeons and paediatric surgeons was obtained from the NHS Litigation Authority (NHSLA) for the years since its creation in 1995 to 2009. • The data was then classified and analysed.• In all, 493 cases were closed with indemnity payment with a total of £20,508,686.18 paid. The average payment per claim was £41,599.77. • Most of the claims were related to non-operative events (232), followed by postoperative events (168) and intraoperative events (92). • The most common reason for non-operative-related claims was failure to diagnose/treat cancer (69), perforation/organ injury (38) was the highest intraoperative-related claim and a forgotten ureteric stent (23) was the most frequent postoperative-related claim. • The five most commonly implicated procedures were ureteroscopy/ureteric stenting (45), transurethral resection of the prostate (30), nephrectomy (26), vasectomy (19) and urethral catheterisation (15).• The present study once again emphasizes the importance of thorough clinical assessment, record keeping and follow-up as well as informed consent and good communication with patients. • Recognising the areas of highest risk and improving practice should limit future claims.