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Intrauterine contraceptive devices (IUCDs) with lost threads are an infrequent but growing problem, and there are several successful first-line methods of retrieving the devices. In the event of retrieval failure, we propose a novel second-line technique using an endovascular snare under direct fluoroscopic guidance. A total of 137 women were referred with 'lost string' IUCDs and underwent removal using a snare device, designed for endovascular foreign body retrieval, inserted transcervically. The snare is manipulated to catch the stem of the IUCD under C-arm fluoroscopy. The successful removal rate was 89.6%. The average screening time was 3 min 29 s, with a median air kerma of 12.33 mGy and DAP of 985 mGy cm(2), which was considered minimal and comparable with similar gynaecological interventional procedures. There were no significant complications, with the procedure being tolerated and pain free in 97.8% of cases. [ABSTRACT FROM AUTHOR]

Haematuria is blood in the urine. This may be microscopic (visible only with a microscope) or macroscopic (visible to the naked eye). Either may be the sole manifestation of serious pathology. Use of investigations must be rationalised to ensure that bleeding due to renal tract tumours, urolithiasis or infections is diagnosed and treated promptly, while avoiding increasing morbidity, anxiety and cost by over-investigating low-risk patients. This article considers a number of strategies to achieve this balance, weighing up the merits of different techniques as first- and second-line tests in investigating haematuria. First, we discuss the detection of haematuria, concentrating in particular on the roles of dipstick testing and microscopy. The emphasis then moves to comparing the relevant radiological investigations. Each imaging modality is considered within a broader clinical context, and the protocol put forward for investigating haematuria is related to other published protocols. Various key pathologies are introduced and addressed throughout the review, and the final section summarises specific conditions and imaging findings. [ABSTRACT FROM AUTHOR]

Objective: Ultrasound surveillance of patients with testicular microlithiasis (TM) has been advocated following the reported association with testicular cancer. The aim of this study was to assess the evidence base supporting such surveillance.Methods: Formal literature review identified cohort studies comprising at least 15 patients followed up for at least 24 months. Combining an institutional audit with the identified studies in a pooled analysis the incidence of new cancers during the surveillance period was evaluated.Results: Literature review identified eight studies. Our institutional audit comprised 2,656 men referred for scrotal ultrasound. Fifty-one men (1.92 %) with TM were identified, none of whom developed testicular cancer (mean follow-up: 33.3 months). In a combined population of 389 men testicular cancer developed in 4. Excluding 3 who had additional risk factors, only 1 of 386 developed testicular cancer during follow-up (95 % CI 0.05-1.45 %).Conclusions: Ultrasound surveillance is unlikely to benefit patients with TM in the absence of other risk factors. In the presence of additional risk factors (previous testicular cancer, a history of maldescent or testicular atrophy) patients are likely to be under surveillance; nonetheless monthly self-examination should be encouraged, and open access to ultrasound and formal annual surveillance should be offered.Key Points: • The literature reports a high association between testicular microlithiasis and testicular cancer. • Our study and meta-analysis suggest no causal link between microlithiasis and cancer. • In the absence of additional risk factors surveillance is not advocated. • In the presence of additional risk factors surveillance is recommended. • Such surveillance is primarily aimed at engaging patients in regular follow-up. [ABSTRACT FROM AUTHOR]

Transrectal ultrasound (TRUS) was first developed in the 1970s. TRUSguided biopsy, under local anaesthetic and prophylactic antibiotics, is now the most widely accepted method to diagnose prostate cancer. However, the sensitivity and specificity of greyscale TRUS in the detection of prostate cancer is low. Prostate cancer most commonly appears as a hypoechoic focal lesion in the peripheral zone on TRUS but the appearances are variable with considerable overlap with benign lesions. Because of the low accuracy of greyscale TRUS, TRUS-guided biopsies have become established in the acquisition of systematic biopsies from standard locations. The number of systematic biopsies has increased over the years, with 10–12 cores currently accepted as the minimum standard. This article describes the technique of TRUS and biopsy and its complications. Novel modalities including contrast-enhanced modes and elastography as well as fusion techniques for increasing the sensitivity of TRUS-guided prostate-targeted biopsies are discussed along with their role in the diagnosis and management of prostate cancer. [ABSTRACT FROM AUTHOR]

Unlabelled: The aim was to develop clinical guidelines for multi-parametric MRI of the prostate by a group of prostate MRI experts from the European Society of Urogenital Radiology (ESUR), based on literature evidence and consensus expert opinion. True evidence-based guidelines could not be formulated, but a compromise, reflected by "minimal" and "optimal" requirements has been made. The scope of these ESUR guidelines is to promulgate high quality MRI in acquisition and evaluation with the correct indications for prostate cancer across the whole of Europe and eventually outside Europe. The guidelines for the optimal technique and three protocols for "detection", "staging" and "node and bone" are presented. The use of endorectal coil vs. pelvic phased array coil and 1.5 vs. 3 T is discussed. Clinical indications and a PI-RADS classification for structured reporting are presented.Key Points: This report provides guidelines for magnetic resonance imaging (MRI) in prostate cancer. Clinical indications, and minimal and optimal imaging acquisition protocols are provided. A structured reporting system (PI-RADS) is described. [ABSTRACT FROM AUTHOR]

A quiz concerning the diagnosis of a 75-year-old male patient who was referred with macroscopic hematuria is presented.

Haematuria can be microscopic or visible to the naked eye (macroscopic): both forms may be the sole manifestation of serious pathology. Clinicians must rationalize investigations to ensure that bleeding due to renal tract tumours, urolithiasis or infections is diagnosed and treated promptly; yet they must also avoid increasing morbidity, anxiety and cost by over-investigating low-risk patients. This article considers a number of strategies to achieve this balance, weighing up the merits of different techniques as first- and second-line tests in investigating haematuria. First, I discuss the detection of haematuria, concentrating in particular on the roles of dipstick testing and microscopy. My emphasis then moves to comparing the relevant radiological investigations. I include an extended section on CT urography, reflecting the increasing utility of this technique in urological practice. Each imaging modality is considered within a broader clinical context, and the protocol put forward for investigating haematuria is related to other published protocols. Various key pathologies are introduced and addressed throughout the review, and the final section summarizes specific conditions and imaging findings. [ABSTRACT FROM AUTHOR]

The article presents the medical cases of two women with major vascular injury during lumbar laminectomy. The article describes the vascular injury as a rare complication of a surgical procedure performed in orthopaedic and neurosurgical units. The patient's medical history is described. Several characteristics of vascular injuries include disc space bleeding and hypotension.