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The article presents a case study of a 63-year-old man admitted with suprapubic pain, terminal dribbling and microscopic hematuria. Magnetic resonance imaging was applied for histological examination to the patient who had mucinous adenocarcinoma of the urachal remnant caused by pseudomyxoma peritonei (PMP). Based on medical analysis, the cystoprostatectomy and partial cystectomy were very effective surgical procedures for chronic urinary retention.

The discovery of prostate-specific antigen (PSA) was beset with controversy; as PSA is present in prostatic tissue and semen, it was independently discovered and given different names, thus adding to the controversy. In this review we document the early research in this field to describe the chronology of the discovery of PSA. Using a comprehensive Medline search of the historical aspects of PSA, all relevant papers were reviewed; communication with the scientists involved in the discovery of PSA was an invaluable contribution. In 1960, Flocks was the first to experiment with antigens in the prostate and 10 years later Ablin reported the presence of precipitation antigens in the prostate. In 1971, Hara characterized a unique protein in the semen fluid, gamma-seminoprotein. Li and Beling, in 1973, isolated a protein, E1, from human semen in an attempt to find a novel method to achieve fertility control. In 1978, Sensabaugh identified semen-specific protein p30, but proved that it was similar to E1 protein, and that prostate was the source. In 1979, Wang purified a tissue-specific antigen from the prostate ('prostate antigen'). PSA was first measured quantitatively in the blood by Papsidero in 1980, and Stamey carried out the initial work on the clinical use of PSA as a marker of prostate cancer. Thus the discovery of PSA is interesting and surrounded by controversy. Although the credit for purifying PSA goes to Wang, other eminent scientists published research on this antigen. The initial work on PSA in semen was to asses its properties as a forensic marker for rape victims, but soon its potential as a marker for prostate cancer became evident.

Objectives: To describe our experience of the etiology, presentation, management and outcomes of male urethral diverticula, which are uncommon, with few reports of large series published., Methods: Twenty-one patients with male urethral diverticula were treated at a single institution during a 7-year period. Their case notes were retrospectively reviewed., Results: Of the 21 diverticula, 7 (33.3%) were congenital as determined from the history and histologic analysis. These 7 patients' mean age at presentation was 25 years, and they complained mainly of obstructive symptoms, poor bladder emptying, and a palpable perineal swelling. The 14 patients with acquired diverticula presented later, at a mean age of 35 years, but with almost identical symptoms and signs. The most common aetiolgical factors included trauma in 3, urethral stricture disease in 3, and previous urethroplasty in 3. The anterior urethra and penoscrotal junction were the most commonly affected sites in both groups (18 of 21). Overall, 12 patients underwent open surgical repair, 6 underwent endoscopy, and in 3, the diverticulum was left in situ. Postoperative complications were more frequent in the acquired group (64% versus 27%) and included urethrocutaneous fistula in 5, urethral stricture in 2, and wound infection in 4., Conclusions: Urethral diverticula are uncommon, but should always be considered in young men with lower urinary tract symptoms or in those with a history of urethral trauma. Treatment should be individualized and determined according to the patient's fitness and the site and size of the diverticulum.

Objective: To compare the incidence of acute and/or chronic intraprostatic inflammation (ACI) in men undergoing transurethral resection of the prostate (TURP) for urinary retention and lower urinary tract symptoms (LUTS), as recently a role was suggested for ACI in the pathogenesis and progression of BPH, and urinary retention is considered an endpoint in the natural history of this condition., Patients and Methods: Details of TURPs done between January 2003 and December 2005 at one institution were obtained from the operating theatre database. Patients were divided by indication (retention/LUTS). Clinical data and histology reports were then reviewed and bivariate and logistic regression used to compare the pathological features between these groups., Results: Of 406 patients, 374 had evaluable data; 70% of men with urinary retention had ACI, vs 45% of those with LUTS (P < 0.001). On logistic regression, the pathological factors associated with TURP for acute retention compared to that for LUTS were ACI, old age, and resection weight to a lesser degree., Conclusion: Inflammation appears to be important in the pathogenesis and progression of BPH. In this study, the risk of urinary retention due to BPH was significantly greater in men with ACI than in those without, and the association of TURP for retention with ACI was stronger than that with prostate weight. This finding might offer new avenues for the medical treatment of men with LUTS due to BPH.

Hernia through the suprapubic catheterization (SPC) site is rare. Attention is required for such hernias as they get obstructed due to the narrow neck. We report this rare presentation in an elderly gentleman with obstructed incisional hernia through the SPC site, which was reduced and subsequently had a successful mesh repair.

Objective: To determine the number of peer-reviewed publications arising from the abstracts presented at the annual meetings of the British Association of Urological Surgeons (BAUS), and to assess urological trainees' attitudes to research in relationship to the pursuit of Specialist Registrar (SpR) training numbers and their perception of academic urology in the UK., Methods: Publications resulting from presentations at the annual meetings of the BAUS 2001 and 2002 were searched for using the PubMed database. Variables that might influence the subsequent publication of abstracts in peer-reviewed journals were analysed. Whether institutions from other countries had similar publication rates to those in the UK was also assessed. SpRs were interviewed about their motivation to convert presentations to publications before and after their appointment to SpR training., Results: In July 2004, 142 of 449 abstracts presented at BAUS 2001 and 2002 were published, giving a publication rate of approximately 42% on Kaplan-Meier analysis. The rate of publication appeared to continue to the end of the period of searching for publications. The publication rate arising from UK presentations was lower than that from the non-UK presentations (hazard ratio 0.75, 95% confidence interval 0.49-1.15, P = 0.14). Publication rates from podium and poster presentations were similar. Urology journals accounted for 75% of the publications. Of the SpRs evaluated, 83% did research and presented papers to obtain a training number rather than because of an inherent interest to pursue an academic career., Conclusions: The conversion rate from BAUS presentation to peer-reviewed publication at 36 months was similar on Kaplan-Meier analysis to that of the American Urological Association (AUA, 38%). Interestingly, the rate of publication from the AUA seems to be faster than from BAUS. In addition, presentations from outside the UK appeared to be published faster than those from the UK. Delegates attending these conferences need to consider this when deciding whether a particular presentation will influence their practice. British urology requires academics who are interested in pursuing high-quality research, and which is presented at major conferences with an intention to publish it in peer-reviewed journals.

The published literature has focused mainly on the efficacy of tension-free vaginal tape (TVT) in correcting stress incontinence with few reports of complications. We report our experience with the first 52 cases of TVT, specifically assessing voiding dysfunction after the procedure. We carried out a retrospective study of patients undergoing TVT surgery for stress urinary incontinence (SUI) between April 2001 and July 2003. Data were collected on period of catheterization, voiding and storage symptoms, their duration and management. Fifty-two women with a mean age 54 years (36-77) were included. Postoperatively, the urethral catheter was removed routinely within 12 h. Twelve patients (23%) failed to void spontaneously and needed recatheterization. Ten of them (83%) were able to resume spontaneous voiding within 3 months. Twenty patients (38%) complained of storage symptoms postoperatively. Sixteen (80%) responded to conservative treatment. Transient urinary symptoms after TVT sling for SUI are common but can usually be managed conservatively.

A trichobezoar with a calculus in the center was diagnosed in a young woman on long-term urethral catheter drainage. Urologists need to be aware of this potentially preventable complication to save patients from significant morbidity.

Objective: Traditionally, patients presenting with haematuria undergo a series of investigations, including urine cytology, cystoscopy, i.v. urography (IVU) and renal tract ultrasound (US). Studies have suggested that the omission of IVU as a routine investigation for painless haematuria does not dramatically reduce the detection rate of malignant conditions. In this large retrospective study we evaluated the impact of the omission of IVU on the diagnosis of renal tract malignancies and other non-malignant but significant conditions., Material and Methods: A retrospective analysis of all patients attending our haematuria clinic between January 2000 and August 2002 was carried out. The diagnostic yields of IVU and a US scan were compared and the significance of abnormalities missed by either modality was assessed with regard to the overall management of patients. Diagnoses were divided into those that were significant and potentially harmful [e.g. tumour, pelvi-ureteric junction (PUJ) obstruction, hydronephrosis] and those that were insignificant and harmless (e.g. simple cyst, non-obstructing calculus). Liddell's exact test for matched pairs was used to test for statistical significance and to give the relative risk of a positive result., Results: A total of 1211 patients were included in the study. When cytology, cystoscopy and US were normal, IVU did not detect any additional malignant pathology. Performing IVU instead of a US scan would have resulted in 74 non-malignant conditions remaining undiagnosed. Similarly, US alone would have missed 64 non-malignant lesions. Six non-malignant but significant conditions, including PUJ obstruction (n = 5) and benign ureteric stricture with hydronephrosis (n = 1), were missed by US but detected by IVU., Conclusion: In this cohort of retrospectively studied patients attending a haematuria clinic, IVU could safely have been omitted without decreasing the overall detection of malignant pathologies. Nevertheless, significant non-malignant pathologies would have remained undiagnosed. The authors suggest that US combined with a MAG III renogram could be considered as a first-line investigation instead of IVU. This is likely to result in maximum detection of malignant and non-malignant conditions, while reducing the radiation exposure to the patient.