PURPOSE OF REVIEW:Anterior urethral stricture disease (USD) affects 1% of at-risk men. While urethroplasty remains the gold standard, novel adjuncts, including drug-coated balloon (DCB) dilation and intralesional treatments have re-energized the field. This review summarizes the evidence base for DVIU/dilation versus urethroplasty, outlines the efficacy, safety and cost-effectiveness of DCB and intralesional treatments, and outlines where novel endoscopic treatments should sit in the current treatment pathway. RECENT FINDINGS:The OPEN trial clarified the limitations of DVIU in recurrent USD, with patients who underwent urethroplasty having greater improvements in objective urinary function with less risk of reintervention. However, urethroplasty was associated with greater adverse events and higher costs; as a result, DVIU remains a cost-effective option. The ROBUST trials have established the efficacy and safety of DCB dilation in recurrent anterior USD, with durable improvements in IPSS and QMax. At 3 years, freedom from repeat intervention was 71.7% with DCB dilation, compared with 24% with DVIU. Economic evaluations suggest DCB dilation is likely cost-advantageous in settings where recurrent treatments are required. Intralesional mitomycin C and steroid injections have shown promising short-term results in small series but further data are required. SUMMARY:Endoscopic therapy remains an essential component of USD management. Future research should explore DCB dilation use in primary anterior USD treatment, long-segment disease, recurrence, and posterior urethral strictures.

BACKGROUND:Transurethral resection of bladder tumour (TURBT) is the gold standard for diagnosing and risk-stratifying bladder cancer. Accurate and comprehensive operative documentation is critical for ensuring effective patient management. The European Association of Urology (EAU) guidelines provide a framework for TURBT documentation, including tumour characteristics, procedural details, and complications. However, adherence to these guidelines varies, necessitating quality improvement initiatives. AIMS:This study aimed to assess the quality of TURBT operative notes at a single institution before and after implementing a standardised electronic TURBT template based on EAU guidelines. METHODS:A closed-loop audit was conducted at an academic teaching hospital. Operative notes for 40 consecutive TURBT cases from December 2021 to September 2022 were evaluated against EAU documentation criteria. Following the introduction of a standardised electronic TURBT template, a second audit cycle of 40 cases from September 2022 to March 2023 was conducted. Key documentation elements, including tumour location, appearance, size, multifocality, procedural steps, resection completeness, and complications, were compared. RESULTS:The introduction of the electronic template significantly improved documentation adherence, increasing overall compliance from 69 to 93%. Notable improvements were observed in tumour appearance (65 to 97.5%), tumour size (67.5 to 90%), completeness of resection (55 to 95%), and complication recording (2.5 to 75%). CONCLUSIONS:A structured electronic TURBT template enhances the quality and completeness of operative documentation, aligning with EAU guidelines. Standardised templates facilitate better communication, continuity of care, and quality improvement in TURBT procedures, ultimately contributing to improved patient management and outcomes.

Objective To provide an update on the association between preoperative membranous urethral length (MUL) and postoperative urinary incontinence (UI) in men who undergo robot‐assisted radical prostatectomy (RARP)/robot‐assisted laparoscopic prostatectomy (RALP). Materials and Methods Urinary incontinence is common after RARP/RALP, and early recovery of continence is one of the most important functional outcomes following surgery. MUL has been identified as a factor associated with continence recovery after RARP/RALP. A systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, using PubMed, Embase, and Scopus databases. Inclusion criteria were English language full journal articles authored within the last 5 years that assessed continence using the Expanded Prostate Cancer Index Composite. The Critical Appraisal Skills Programme tool for retrospective cohort studies was used to evaluate study quality. A random‐effects meta‐analysis was performed to pool odds ratios (ORs) from available studies relating to continence as a function of MUL. The Grading of Recommendations, Assessment, Development and Evaluations framework was used to synthesise evidence. Results Six studies including 970 patients reported an association between MUL and continence at 12 months. Longer MUL was associated with reduced UI odds at 12 months after surgery (pooled OR 0.74, 95% confidence interval 0.68–0.87, P < 0.001). Significant methodological and statistical heterogeneity was encountered. Conclusions Preoperative MUL measured on magnetic resonance imaging (MRI) is significantly associated with postoperative continence in men undergoing RARP/RALP. We recommend consideration of MRI measurement of MUL prior to RARP/RALP to guide treatment decisions in this population.

Transanal minimally invasive surgery (TAMIS) is a surgical alternative to transanal endoscopic microsurgery (TEM), transanal excision and proctectomy in the management of benign rectal polyps and early rectal cancers. Low anterior resection syndrome (LARS) describes the constellation of symptoms which result from and are common after distal colorectal resection. Symptoms include incontinence, frequency, urgency and evacuatory dysfunction. The aim of the current study was to prospectively evaluate pre- and post-operative LARS in patients who undergo TAMIS. We conducted a prospective analysis of a consecutive series of patients who underwent TAMIS at our institution between January 2021 and February 2022. A LARS questionnaire was undertaken preoperatively, at 1 month and at 6 months post-operatively. Twenty patients were recruited to this pilot study. The mean age was 63 ± 12 years, 11 of the patients were male, mean pre-operative BMI was 29 ± 6 kg/m2, and 30

Activity-based funding (ABF) is a reimbursement model for public hospitals in Ireland. Little data exist regarding cost estimates for acute surgical admissions in Ireland. This study presents a novel method of direct cost estimation for testicular torsion (TT) care in Ireland. Hospital Inpatient Enquiry (HIPE) data, covering all public hospital admissions in Ireland, were analysed to derive annual incidence rates for TT between 2009 and 2018. The monetary cost of each case was calculated by cross-referencing the diagnosis-related group (DRG) with reference prices for inpatients and day-cases in public hospitals in 2019. Annual cost was adjusted using the Consumer Price Index for Health (Ireland). One thousand seven hundred forty-six patients under 25 years underwent orchidectomy or orchidopexy for TT between 2009 and 2018. The direct cost of TT care in public hospitals between 2009 and 2018 was €6,331,402. Costs increased 54% over 10 years, from €513,232 in 2009 to €788,700 in 2018 (2019 Euros). Just over two-thirds of cases (70%, n = 1230) were reimbursed with public funding. This novel cost estimation model may serve as a template for future direct cost estimates for surgical interventions in Ireland. This will improve the accuracy of future economic evaluation for healthcare interventions in Ireland.

A 58-year-old woman with a prior radical cystectomy and ileal conduit underwent a living-related donor renal transplant for end-stage renal disease secondary to autoimmune glomerulonephritis. She subsequently developed an ischaemic stricture of the transplant ureter. A successful ureteropyelostomy was performed with the native right ureter anastomosed to the pelvis of the renal transplant. She presented to the emergency department 18 months later feeling unwell and with raised inflammatory markers. Imaging demonstrated a large soft tissue mass over the right psoas muscle and hydronephrosis of the native right kidney. A nephrostomy and nephrostogram of the native right kidney diagnosed a urine leak from the native right kidney and she underwent an open right native nephrectomy. She recovered well postoperatively and continues to have excellent graft function. Renal transplantation in an abnormal urinary tract carries a high risk of complications. A multidisciplinary team approach is essential in offering the most appropriate treatment and ensuring good graft function is preserved.

Abstract Introduction Activity-Based Funding (ABF) is a new reimbursement model for public hospitals in Ireland. Little data exists regarding cost estimates for acute surgical admissions in Ireland. This study presents a novel method of direct-cost estimation for Testicular Torsion (TT) care in Ireland. Method Hospital In-Patient Enquiry (HIPE) data, covering all public hospital admissions in Ireland, were analysed to derive annual incidence rates for TT between 2009-2018. The monetary cost of each case was calculated by cross-referencing the Diagnosis-Related Group (DRG) with reference prices for inpatients and day-cases in public hospitals in 2019. Annual cost was adjusted using the Consumer Price Index for Health (Ireland) Results N = 1,746 patients under 25 years underwent orchidectomy or orchidopexy for TT between 2009 and 2018. The direct cost of TT care in public hospitals between 2009 and 2018 was €6,331,402. Costs increased 54% over 10 years, from €513,232 in 2009 to €788,700 in 2018 (2019 Euros). Just over two-thirds of cases (70%, n = 1,230) were reimbursed with public funding Conclusions This novel cost-estimation model may serve as a template for future direct-cost estimates for surgical interventions in Ireland. This will improve the accuracy of future economic evaluation for healthcare interventions in Ireland.

A 29-year-old male patient presented to the emergency department with haematuria and flank pain. Ten months agopreviously, he had undergone orchidectomy and adjuvant chemotherapy for a testicular mixed germ cell tumour. Cystoscopy revealed a large bladder wall mass. The final diagnosis of yolk sac tumour was established after transurethral resection of the lesion. The patient was treated with salvage chemotherapy and placed on short-interval biochemical and radiological surveillance to assess treatment response.