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A retrospective analysis of the outcome of radical prostatectomy (RP) for prostate cancer in a single centre and assessment of the role of salvage radiotherapy (RT) for patients with biochemical relapse. Hundred and thirty-seven patients underwent RP for adenocarcinoma of the prostate in our centre between December 1994 and June 2003. Fifty-four of these patients developed a biochemical relapse prostate-specific antigen (PSA > or = 0.2 ng/ml). Thirty-two patients including five from elsewhere (one with a palpable local recurrence) received salvage RT. Twenty-five of these had positive margins at resection and four had involvement of seminal vesicles. Nine had Gleason score > or = 8. Median PSA before RT was 0.55 ng/ml (range 0.2-5.0). Median age at surgery was 63.5 years (range 52-71). Median age at RT was 65 years (range 53-73). Median time from surgery to biochemical relapse was 11 months (range 0-37) and median interval from surgery to RT was 22 months (range 3-71). Twenty-seven patients received 64 Gy in 32 fractions, three patients received 55 Gy in 20 fractions and two patients received 50 Gy in 20 fractions. Twenty-seven patients were managed by observation or hormone therapy. Twenty-seven patients (84%) achieved complete biochemical remission following RT. Eighteen (56%) remain in complete remission with a median follow-up since RT for the whole group of 30 months (range 8-85). Fourteen patients have relapsed, eight of whom had either clear margins or PSA >1.0 ng/ml at the time of RT (PSA > or = 0.2 ng/ml). Salvage RT is an effective treatment for achieving biochemical remission in selected patients who relapse following RP.

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OBJECTIVE: To determine the effect of the anatomical site of sperm recovery on intracytoplasmic sperm injection (ICSI) embryo implantation, pregnancy and live birth rates in couples with isolated obstructive azoospermia as the sole cause of infertility. DESIGN: Controlled, single centre, retrospective clinical study. SETTING: University Hospital, Centre for Reproductive Medicine. SAMPLE: One hundred and fifty-one cycles of ICSI were performed, using surgically recovered sperm, between August 1996 and March 2002. METHODS: The outcome of ICSI, with surgically recovered sperm, was compared between epididymal (Group E) and testicular (Group T) derived sperm. Inclusion was limited to couples undergoing their first treatment cycle, where female age was < or =39 years and a minimum of five oocytes were available for injection. Women with a history of ovarian surgery, ultrasonic evidence of polycystic ovaries, uterine anomalies or hydrosalpinx were excluded. MAIN OUTCOME MEASURES: Clinical pregnancy, implantation and live birth rate. RESULTS: Forty-two of 151 cycles met the strict inclusion criteria. Groups E and T were comparable with respect to age, basal serum FSH, ovarian response; number of oocytes injected and number of embryos available and transferred. No difference existed between Groups E and T in implantation, clinical pregnancy or live birth rate (28.8% vs 25.8%, 42.9% vs 42.9% and 39.3% vs 42.9%, respectively). CONCLUSIONS: Cryopreserved epididymal and testicular sperm, from men with obstructive azoospermia, appear equally effective in ICSI. Epididymal recovery should remain the method of first choice for obstructive azoospermic men but further study of sperm DNA damage rates in different testicular sites is required.

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Various factors such as age have been shown to be related to the successful outcome of transurethral resection of the prostate (TURP). Age may not necessarily correlate with the general health and fitness of the patient. A more accurate way to predict outcome of TURP is the pre-operative American Society of Anaesthesiologists Physical Status (ASA-PS) score. This study showed better urological performance, improved QOL and LOS with lower ASA-PS score. It indicates therefore, that ASA-PS is a possible predictor of treatment outcome for TURP. This study indicates a positive correlation between ASA-PS and treatment outcome of TURP.

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OBJECTIVE: To investigate the usefulness of serum testosterone levels as a relevant or useful indicator of sexual potency in men attending an erectile dysfunction clinic. PATIENTS AND METHODS: Ninety consecutive men attending the erectile dysfunction clinic completed a sexual-activity questionnaire, and underwent a focused physical examination and questioning about their medical history. The serum testosterone level was measured in all patients and the results analysed in relation to the patient's age. Patients with low serum testosterone levels commenced replacement therapy comprising three intramuscular injections of testosterone (Sustanontrade mark, Organon, The Netherlands) 250 mg every third week. Potency status and serum testosterone were reassessed after 3 months' treatment. RESULTS: Of the 90 men, 28 (31%) were aged < 50 years whilst 62 (69%) were >/=50 years old. Nineteen (21%) patients overall had low testosterone levels; four of these were < 50 and 15 were >/=50 years old. Five of 90 patients had a decreased libido; two of these also had low testosterone levels and all were < 50 years old. Testosterone levels returned to normal in all patients who received replacement therapy but potency returned in only two (10%); both were in the older group. CONCLUSION: Measuring testosterone was not helpful in assessing potency or libido and low serum levels were not related to age. Correcting low testosterone did not improve either impotence or libido.

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A case report of a 23 year old man is described who was diagnosed with loin pain/haematuria syndrome. Despite auto-transplantation with interposed polytetrafluoroethylene (PTFE)-prosthesis in the arterial anastomosis the symptoms recurred. A possible mechanism for the recurrent pain is proposed.

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Twenty-four patients undergoing aortic surgery for aneurysmal or occlusive aortic disease were studied prospectively to assess the effect on bladder function. Thirteen patients completed the study with post-operative follow-up at 3 months. Aortic surgery was found to be unlikely to cause damage to the parasympathetic nerves. There was no change in the detrusor stability/instability status in five of seven patients undergoing surgery for occlusive disease. Fifty-seven per cent of patients undergoing surgery for aneurysmal disease and 83% of those undergoing surgery for occlusive disease noted improved urinary flow with decreased maximal urethral pressure following surgery, suggesting damage to the sympathetic nerve supply to the lower urinary tract. The improvement in urinary flow did not relate either to the assessed extent of damage to the sympathetic nerves at operation or to the type of operation or vascular anastomosis. It is concluded that aortic surgery damages the sympathetic rather than the parasympathetic nerves and that any effect on bladder function is of no serious significance.

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The influence of 12 clinical and social factors on the length of post-operative stay in hospital after transurethral resection of the prostate was investigated in 100 patients. Using a multiple binary regression analysis, the factors significantly associated with a post-operative stay exceeding 6 days were: patient's age greater than 70 years (P less than 0.005), the presence of existing cardiovascular disease (P less than 0.005) and the weight of the prostate gland resected greater than 10 g (P less than 0.005). The first two factors are useful in providing a prediction of prolonged post-operative stay. The results indicate that those factors associated with a prolonged post-operative stay are beyond the control of the clinician.

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The patient with an acute scrotal swelling may be misdiagnosed and either have unnecessary surgery or not have necessary surgery. Radionuclide imaging has been used on 33 patients with scrotal swellings and has been found to be an easy, cheap and painless investigation with a high degree of accuracy of diagnosis. It is recommended as a useful diagnostic tool in cases of scrotal swelling of doubtful aetiology, particularly when emergency surgery is being considered.

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Mucinous and squamous cell metaplasia of the transitional cell epithelium occurs in response to chronic irritation and is predominantly found in the bladder. When the 2 forms of metaplasia occur simultaneously they usually are associated with malignancy. We report 2 cases of mucinous and squamous metaplasia of the epithelium of the renal pelvis that were not associated with malignancy. This is believed to be the fourth report of this divergent metaplasia. The mechanism for these changes is discussed.

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Thirty-eight cases of large bladder diverticula treated surgically between 1970 and 1979 were reviewed. Twenty-two underwent diverticulectomy alone and 19 of these had no further trouble during a follow-up period averaging 4.5 years. Three other patients who had undergone resection of a small prostate gland prior to diverticulectomy might also have been cured by diverticulectomy alone. In at least half of the patients presenting with large bladder diverticula no obstructive factor was present and it is concluded that primary diverticula are more common than was previously thought. Clinically, primary diverticula may be distinguished from secondary on the basis of symptoms, cystoscopic findings of trabeculation and urodynamic studies. A more extensive application of the transperitoneal approach in performing diverticulectomy is recommended.

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Primary urinary incontinence is a recognised symptom of ectopic ureter but it is unusual for incontinence in this condition to occur for the first time in adult life. Three cases are described of ectopic ureter presenting in adult life with incontinence; 2 were secondary to ectopic ureterovaginal fistula resulting from gynaecological procedures and one followed prolonged labour.

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