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We reviewed previous publications on post-orgasmic pain with reference to prevalence, epidemiology and treatment options, using the Ovid and PubMed (updated May 2006) databases to comprehensively search MEDLINE for reports on post-orgasmic pain that included peer-reviewed English-language articles. Official proceedings of internationally known scientific societies were also assessed. Because of the heterogeneity of the studies we did not apply meta- analytic techniques to the data. The incidence of post-orgasmic pain is 1-9.7%. The ejaculatory pain is associated with prostatitis, chronic pelvic pain syndrome, benign prostatic hyperplasia, and ejaculatory duct obstruction; it is also described in patients after procedures like radical prostatectomy. Aetiopathogenic theories include those referring to bladder neck closure and pudendal neuropathy. The treatment options vary from self-care, a 'perineal hyperprotection programme' to medication with the alpha-blocker, topiramate, and even surgical procedures like removing a section of the sacrotuberous ligament, neurolysis of the pudendal nerve or removing a section of the sacrospinous ligament. This is the first update of the subject, with reference to prevalence, epidemiology and treatment options. There is a need for adequately powered, prospective randomized trials on aetiology and treatment options.

The Technomed Sonolith Vision is the most recently developed electroconductive lithotripter. Using a case-control study, we compared the treatment outcomes of this machine with those of the Dornier Compact Delta for ureteral calculi.Patients (N = 107) with calculi from the ureteropelvic to the ureterovesical junction undergoing primary lithotripsy using the Technomed Sonolith Vision were identified between September 2004 and February 2005. All patients had 2-week and 3-month follow-up. These patients were compared with 524 patients from our database treated between October 2000 and August 2004 with a Dornier Compact Delta. The two groups were similar at baseline. Outcome variables measured were stone-free rate at 3 months, retreatment rate, and requirement for intravenous analgesia during the procedure.There was a superior stone-free rate for the Technomed, reaching significance for calculi up to 7 mm. The Technomed had a significantly lower re-treatment rate for calculi13 mm. There was no statistical difference in the requirement for intravenous analgesia. The Efficiency Quotient was superior for the Technomed (0.67 v 0.56).This latest-generation electroconductive lithotripter in its first 6 months of use has shown stone-free and re-treatment rates superior to those of the Dornier Compact Delta and approaching that of the Dornier HM-3. Lithotripsy remains our first-line treatment for all radiopaque ureteral calculi.

EDITORIAL COMMENT: This paper provides important data concerning the contribution of the different infertility treatments (clomiphene plus gonadotropin versus GIFT plus IVF) to the community incidence of twin pregnancy. It seems to us that sampling only 0.6% of singleton pregnancies and 50% of twin pregnancies (table 3) may have underestimated the contribution to singleton pregnancy of both CC/GT and GIFT/IVF. Ideally, what we require is documentation on all the perinatal data forms of whether the index pregnancy resulted from treatment with CC/GT or GIFT/IVF -the multiple pregnancies rates (twin and higher order multiples) associated with these different treatment regimens could then be evaluated for the total population. This would give a new dimension to informed decision by the doctor and the infertile couple in selection of the method of treatment of infertility in those women who have patent tubes and are thus suitable candidates for either regimen. Knowledge of the twin and higher order multiple pregnancy rate, not to mention the rate of singleton pregnancy, associated with these 2 different regimens would also indicate if present drug regimens require further refinement to be competitive with GIFT and IVF, if. in terms of the community incidence of twin delivery but exclusive of other cost considerations. Summary: A cross-sectional sample of 150 singleton and 159 twin confinements delivered in Western Australia in 1991 were randomly sampled in 1993; 63% of the women responded to a postal questionnaire. Thirteen percent of respondents with singletons and 26% of those with twins reported having problems conceiving at some stage in their life. Six percent of those who had singleton confinements and 22% of those women who had twin confinements sought fertility advice prior to the conception of the index pregnancy. One percent (95%CI 0.03%, 5.5%) of women with singletons received infertility treatment compared with 17% (95%CI 10.4%, 26.3%) of those with twins. Overall 82.7% (95%CI 75.2%, 90.1%) of twin confinements followed spontaneous conception, 11.2% (95%CI 5.7%, 19.2%) followed ovarian stimulation treatment alone and 6.1% (95%CI 2.3%, 12.9%) followed IVF or GIFT procedures. The probability of a spontaneous twin confinement was 1 in 95. It was concluded that nearly twice as many twin pregnancies were associated with ovarian stimulation treatment given alone than with IVF and GIFT combined. The routinely collected data about assisted twin conceptions provide an incomplete picture with regard to the role of different infertility treatment modalities.

OBJECTIVE To review a 10-year experience of medical treatment for idiopathic retroperitoneal fibrosis (RPF), a rare condition of unknown causes, which may obstruct the ureter and for which treatment includes ureterolysis and relief of obstruction, and medical treatment with steroids with or without immunosuppressive medication. PATIENTS AND METHODS Of 31 patients with RPF treated between 1996 and 2004, 28 had idiopathic disease. Ureteric stents were used to relieve the obstruction in all patients, 12 had previous nephrostomies, 16 were given steroids and only one was treated with ureterolysis. RESULTS In all, 28 patients were followed for a mean of 51.17 months; the symptoms were relieved in all cases. Renal function, where impaired, improved dramatically in all patients. Fifteen patients (54%) are free of stents and medication after a mean (range) follow-up of 60.9 (24–110) months. CONCLUSION Idiopathic RPF responds well to conservative management consisting of relief of urinary tract obstruction and steroids.

Objectives To review complications associated with urological laparoscopic port-site placement and outline techniques for their prevention and management. Methods Review of the literature using Medline. Results Laparoscopy now plays a key role in urological surgery. Its applications are expanding with experience and evolving data confirming equivalent long-term outcome. Although significant port-site complications are uncommon, their occurrence impacts significantly on perioperative morbidity and rate of recovery. The incidence of such complications is inversely related to surgeon experience. Ports now utilise bladeless tips to reduce the incidence of vascular and visceral injuries, and subsequently port-site herniation. Metastases occurring at the port site are preventable by adhering to certain measures. Conclusions Whether performing standard or robot-assisted laparoscopy, port-site creation and maintenance is critical in ensuring minimal invasiveness in laparoscopic urological surgery. Although patient factors can be optimised perioperatively and port design continues to improve, it is clear that adequate training is central in the prevention, early recognition, and treatment of complications related to laparoscopic access.

Sir,Renal oncocytomas are considered benign neoplasms originating from the distal renal tubules. Before modern imaging techniques were widely available, they were thought to be responsible for appr...