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Objective: To ascertain whether the holmium: YAG laser can be used for transurethral incision of the prostate (TUIP), without the need for post-operative catheterization., Patients and Methods: The study comprised 100 men with symptomatic bladder outlet obstruction and clinically benign glands (< 30 g). The International Prostate Symptom Score (IPSS), flow rates and post-void residual urine volume were measured before and 6 weeks after surgery. The first 22 patients were admitted overnight for observation, but the remaining 78 patients were discharged on the day of the procedure, once they had successfully voided., Results: Ninety-seven men voided successfully on the day of the procedure. The mean IPSS, flow rate and residual urine volume were all significantly improved at the time of review. Six patients developed a urinary tract infection post-operatively and eight men reported retrograde ejaculation., Conclusion: The holmium: YAG laser facilitates a bloodless TUIP thus avoiding catheterization, allowing the procedure to be carried out as a day case.

Objective: To determine the range of surgical techniques, analgesic practice, post-operative care and follow-up procedures used in the circumcision of children by urologists in the United Kingdom, and to suggest changes which would improve patient care and medical training in the relatively simple procedure of circumcision., Materials and Methods: In 1994, all consultant urologists in the United Kingdom were sent detailed questionnaires asking about their practices in the circumcision of children., Results: Of 308 urologists, 61% replied; of these, 55% use the sleeve-resection technique and 39% the free-hand method, and 57% use diathermy, half of which is bipolar. There is wide variation in the type of post-operative analgesia; 95% use an initial dressing but few recommend any subsequent dressing, 70% perform all circumcisions as day cases and 48% review patients in the clinic. There is significant concern that circumcision is not taught adequately to junior surgeons., Conclusion: The sleeve technique of resection should be more widely used. Analgesic practice could be improved with greater use of regional anaesthetics. Most urologists promote no specific care after discharge. There is probably a place for increasing the use of alternative procedures to circumcision.

A series of 287 patients referred by their family doctors with symptoms of bladder outflow obstruction were asked to attend the hospital for "pre-clinic" screening for carcinoma of prostate (CaP). Blood samples were collected from 211 patients and analysed for serum prostate specific antigen (PSA) and prostatic acid phosphatase (PAP). Thirty-six patients had a serum PSA greater than 10 micrograms/l and 7 had PAP levels greater than 5 iu/l. In no instance was the PAP elevated without an associated increase in PSA concentration. Patients with raised markers underwent further investigations which included prostatic biopsy and/or resection; 17 patients were proved to have carcinoma of the prostate, 9 of whom had distant metastases. The specificity of PSA for detecting prostate cancer in this study was 90% with a sensitivity of 89.5%, in contrast to values for PAP of 100% and 36.8%. The routine use of PAP as a marker for prostatic cancer should be abandoned. The use of PSA as a screening test in a group of patients with prostatism appears justified, but with a positive predictive value of only 47%, its use in a mass unselected screening programme is not recommended.