Urinary tract infection (UTI) is defined as the inflammatory response of the urothelium to bacterial invasion. UTI in adults is one of the most prevalent infectious diseases worldwide with a substantial financial burden on society. There is mounting concern surrounding the ongoing development of microbial resistance. In addition, the increasing resistance of organisms to broad-spectrum antibiotics is worrying. There is a continuing drive for antibiotic stewardship and more prudent prescribing of antimicrobial agents. There is currently no national UK guideline on the management of UTI in adults but the EAU, AUA and SIGN all have their separate recommendations. In this review, we discuss the existing guideline recommendations particularly relating to lower UTIs (cystitis and epididymo-orchitis), upper UTIs (pyelonephritis) and catheter-associated infections (due to their large healthcare burden). The aims are to identify common recommendations and assess how they may apply for the UK setting. This review has highlighted considerable differences in practice recommendations between the major UK, European and American guidelines. Discrepancy exists in the choice of antibiotics and for some types of infection, whether or not any guidance for treatment is offered. Antibiotic avoidance and prudent antibiotic prescribing will be key components of future strategies in reducing antimicrobial resistance.

Upper urinary tract urothelial carcinomas (UUT-UCs) are relatively rare tumours that present a challenge to urologists, both in terms of diagnosis and treatment. The diagnostic pathway is often complex and the surgical options continue to generate controversy. The outcomes of treatment are mixed, with invasive tumours having a particularly poor prognosis. In this article we compare UK practice with the most recent European Association of Urology (EAU) guidelines for the management of UUT-UCs.

The patient is a 33-year-old woman with polycystic ovaries and a complex surgical history secondary to Crohn’s disease, including previous restorative proctocolectomy and J pouch defunctioning ileostomy. She presented with infertility issues and underwent two unsuccessful cycles of in vitro fertilisation (IVF). Following her third cycle of IVF and subsequent embryo implantation, the patient was admitted unwell with abdominal pain. Ultrasound scan (USS) demonstrated two viable pregnancies, enlarged ovaries secondary to ovarian hyperstimulation syndrome (OHSS) and a grade I hydronephrotic1 left kidney with normal right kidney. Initial blood tests showed a creatinine of 62, normal C-reactive protein (CRP) and negative urine cultures. The next day, the patient’s white cell count had risen to 24 and a repeat urine culture had grown a Group B streptococcus. The patient was commenced on intravenous antibiotics. Three days later, her bloods demonstrated acute kidney injury (AKI) and her creatinine had risen from 62 to 120. It was presumed that her AKI was secondary to urosepsis; however, her creatinine continued to rise to a maximum of 234. Clinically the patient was responding to antibiotics and her inflammatory markers were improving. Despite catheterisation and a good urine output, the patient’s renal function failed to improve and a repeat USS of her urinary tract was requested (three days following her initial scan). Her USS demonstrated enlarged multicystic ovaries in keeping with OHSS – right ovary 10 × 8 × 14 cm, left ovary 16 × 15 × 14 cm (Figure 1). The scan also demonstrated bilateral grade II hydronephrosis1 (Figures 2 and 3). This combined with her refractory AKI resulted in the decision to insert bilateral percutaneous nephrostomies (PCN) to treat her obstructive uropathy, which was undertaken under local anaesthetic using ultrasound guidance without fluoroscopy. Immediately following PCN insertion there was a brisk post-obstructive diuresis with a rapid fall in the creatinine from 239 to 87. The patient was discharged home without further complication. Her case was discussed at the MDT and the decision was made to continue her care with bilateral PCN throughout the pregnancy or until there was good evidence of the resolution of the obstruction.

Introduction: Acceptance of abstracts at the BAUS Annual Meeting is sought after by trainees and encouraged by trainers; however, it is the publication of this research in a peer-reviewed journal that validates the significance of the work. We aimed to compare current publication rates with those detailed in a previous study 10 years ago to examine for changes on the rate and time to peer-reviewed publications of abstracts presented. We also assessed whether there was a difference in the presentation and publication rates between UK deaneries. Methods: All abstracts accepted for presentation at the annual BAUS 2012 and 2013 meetings were identified from the published supplements in the BJU International journal. Listed abstracts were searched for in October 2015 using the Medline Plus (PubMed) database to assess for successful conversion to a peer-reviewed paper listed on the Medline database. Results: In total 281 abstracts were presented; of these, 265 (94.3%) were from the UK. A total of 24.2% of the abstracts presented over the two-year period resulted in a successful conversion to a peer-reviewed publication. Mean time to publication was 11.59 months and mean impact factor of the publishing journal was 3.854. There appeared to be no correlation between the number of abstracts presented per deanery and the subsequent successful conversion to peer-reviewed publication. Conclusions: There has been a decline over the past decade in the number of BAUS abstracts being successfully converted into peer-reviewed publications, from 42% to 24.2%. The quality of any scientific meeting can be quantified by the number of peer-reviewed publications arising from its abstracts. Possible reasons for this observed reduction include a lack of time to prepare manuscripts, the actual quality and relevance of work being presented and data that may be of questionable validity. In addition, indicative numbers set for publications to enable successful awarding of Certificate of Completion of Training are low.

Renal plasmacytomas are extremely rare manifestations of multiple myeloma. Histologically, a plasmacytoma is described as a tumour of plasma cells. Clinically it can mimic a renal or transitional cell carcinoma of the kidney. A lack of published evidence makes management of these cases challenging. We present this case due to its rarity and to educate clinicians with regards to the consideration of plasmacytic tumours during the investigation of renal masses in patients with multiple myeloma. A plasmacytoma is described as a tumour of plasma cells.1 Cells are identical to those seen in multiple myeloma. They present as a discrete, solitary mass of neoplastic monoclonal plasma cells in either bone or soft tissue (extramedullary).2,3 Typically, extramedullary plasmacytomas are more common in males and those aged 55–60 years.4 Developmental risk factors are unclear but previous radiation exposure has been suggested.5

Cancer that has invaded the detrusor muscle can be associated with a high degree of morbidity and mortality. Radical treatments are required, including cystectomy, radiotherapy and chemotherapy. These treatments can cause short-term and long-term consequences for patients. In this article the authors describe the current treatment approaches to muscle-invasive bladder cancer.

BACKGROUND:The risk of the development of renal cell cancer (RCC) in renal transplant recipients is several times higher than the general population. There can often be a delay between initial radiological imaging and patients undergoing renal transplantation. We present and evaluate the prevalence and clinical characteristics of RCC in renal transplant recipients at a single UK transplant center, with particular focus on tumors diagnosed in the immediate post-operative period, that is, likely present before transplantation.METHODS:This is a retrospective cohort study examining all renal transplant recipients with the diagnosis of RCC of native and/or graft kidneys followed up in a single UK transplant center.RESULTS:Between January 2002 and April 2014, 1386 patients underwent renal transplantation. 19 of 1386 patients had development of RCC (1.4%): 17 native and 2 graft tumors. The mean interval between pre-operative native renal imaging and transplantation was 3.5 years in 13 of 19 patients (range, 1-10 years). Six patients had no documented renal imaging before their renal transplant. The median time from transplantation to diagnosis of RCC was 5 years (range, 1 month to 30 years). In 5 patients (26.3%), RSS developed within 6 months of undergoing renal transplantation.CONCLUSIONS:In our study, we identified several patients with RCC diagnosed shortly after surgery, which raised the possibility that this was present before transplantation. With transplant recipients at increased risk of development of RCC and early detection key in the management of RCC, there appears to be a role for native renal radiological screening for patients undergoing renal transplantation.

We present a review on the current options for continent urinary diversion and their different indications on the basis of patient selection. In current clinical practice continent urinary diversion is being used world-wide in patients undergoing radical cystectomy and in severe cases of benign bladder pathologies. We also discuss the specific complications of continent urinary diversion and highlight the need to rigorously monitor these patients in the long- term specifically in terms of their renal function and cancer recurrence.

Patients with a urinary bladder malignancy or severe anatomical/functional bladder abnormalities may be candidates for urinary diversion at the time of cystectomy. Most urinary diversions are constructed from intestinal segments. Urological surgeons who perform urinary diversion surgery should be aware of the physiological and metabolic changes that can occur when intestinal segments are in direct contact with urine. The complications associated with urinary diversion are both acute and chronic. The most important factor associated with the development of metabolic complications following urinary diversion is the length of time that the urine is in contact with the bowel and the type of bowel segment used for urinary diversion. In this review, we describe the metabolic complications associated with urinary diversion, their characteristic clinical presentation, follow-up, and specific treatment.

Testicular germ cell tumours (TGCT) account for between 1% and 1.5% of male neoplasms and 5% of urological tumours in general. They are classified broadly into Seminoma, which resemble primordial germ cells (PGCs), and Non-Seminoma, which are either undifferentiated (embryonal carcinoma) or differentiated (exhibiting a degree of embryonic (teratoma) or extra-embryonic (yolk sac choriocarcinoma) patterning). We present the current details of the latest classification, epidemiology and treatment aspects of TGCT in the UK in our review.

Background and purpose Laparoscopic radical prostatectomy (LRP) is an established treatment option for patients with prostate cancer in selected centres with appropriate expertise. The goal of LRP is to achieve excellent cancer control whilst attempting to preserve normal urinary continence and erectile function. We studied our single-centre experience evaluating the oncological outcomes in patients undergoing LRP. Patients and methods Three hundred and six patients underwent LRP between 2005 and 2011. Patients were divided into D'Amico low-, intermediate- and high-risk groups. Results The mean age was 61.9 years (range 46-74 years). The two most important factors predictive of positive surgical margins (PSMs) at LRP were the initial prostate-specific antigen (PSA) level and tumour stage at diagnosis. The overall PSM rate was 26.7%. For low D'Amico-risk patients, the PSM was 24.5%, intermediate-risk patients had a PSM of 32.4%, while high-risk patients had a PSM of 13.6%; 6.4% (nine of 139) of patients sampled had evidence of lymph node-positive disease. Five-year PSA progression-free survival rates were 83% in low-risk patients, 57% in intermediate-risk and 41% in high-risk patients. Conclusion LRP offers good oncological outcomes in the low- and intermediate-risk groups with low incidence of biochemical recurrence for patients with localised disease. Our high-risk group has a low incidence of PSM and a five-year PSA progression-free survival rate of 41%. Patients with high-risk, but non-metastatic, prostate cancer can be offered a minimally invasive prostatectomy in an experienced centre.

Aims: To determine whether cardiac arrest calls, the proportion of adult patients admitted to intensive care after CPR and their associated mortalities were reduced, in a four year period after the introduction of a 24/7 Critical Care Outreach Service and MEWS (Modified Early Warning System) Charts.Methods: A retrospective analysis of prospectively collected data during two four-year periods, (2002-05 and 2006-09) in a UK University Teaching Hospital Comparisons were via chi(2) test. A p value of <= 0.05 was regarded as being significant.Results: In the second audit period, compared to the first one, the number of cardiac arrest calls relative to adult hospital admissions decreased significantly (0.2% vs. 0.4%; p<0.0001), the proportion of patients admitted to intensive care having undergone in-hospital CPR fell significantly (2% vs. 3%; p=0.004) as did the in-hospital mortality of these patients (42% vs. 52%; p=0.05).Conclusion: The four years following the introduction of a 24/7 Critical Care Outreach Service and MEWS Charts were associated with significant reductions in the incidence of cardiac arrest calls, the proportion of patients admitted to intensive care having undergone in-hospital CPR and their in-hospital mortality. (C) 2010 Elsevier Ireland Ltd. All rights reserved.