Testicular metastasis from carcinoma of the prostate is rare. We report a case of carcinoma of the prostate with bilateral testicular metastases 7 years after the initial diagnosis. The exact prognosis is not known but it usually indicates advanced disease. Although testicular metastasis is uncommon, it should be considered when a patient presents with a lump in the testis, particularly in a patient known to have another primary malignancy.

This is the largest series of L2(nd)FSO to date. A successful outcome is recorded in 85 out of 102 (83.3%) testicles. Atrophy occurred in 8.8% and ascent in 8.8%.

Our study indicates that in patients with no prior cardiac history TURP does not cause myocardial damage indicated by nonincrease of Trop T. There are slight increases in pro-BNP after TURP in some patients although the exact clinical significance is uncertain.

INTRODUCTION The impact of Modernising Medical Careers on the differential need for consultant urologists and urological surgeons is as yet unknown. This study's aim was to determine what changes there had been in operative urological activity so as to predict the need for urological surgeons in the future.MATERIALS AND METHODS A retrospective study of all elective operative urological surgery over a 15-year period was performed. The absolute numbers of patients presenting for different grades of surgery were aggregated and analysed using the Spearman's rank correlation test.RESULTS Aggregated data from 27,839 procedures demonstrated no change in the number of operations ( r 0.01; NS) or the number of diagnostic endoscopic procedures ( r 0.21; NS) carried out over the study period. There was a decrease in endoscopic surgery related to a 70% reduction in trans-urethral resection of the prostate (TURP) ( r -0.89; P = <0.0001) and an increase in ureteroscopic interventions ( r 0.82; P = 0.0002) for stone disease. There was no change in the amount of major surgery carried out ( r -0.43; NS) over the 15 years.CONCLUSIONS There have been changes to the pattern of surgery urologists have provided over the last 15 years but the need for complex surgical interventions has not altered. This suggests there will be as great a need for operating surgeons in the future, as currently exists.

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Objective: To compare clinical course and outcomes in patients admitted for Chronic Obstructive Pulmonary Disease (COPD) who smoke tobacco plus marijuana versus tobacco only. Methods: A retrospective chart review was conducted for patients admitted to the Victoria and St Jude Hospitals from January 2014 to June 2016 with a primary discharge diagnosis of Chronic Obstructive Pulmonary Disease (COPD). Select biographic data, self-reported substance use, clinical course and adverse outcomes related to COPD were reviewed. The study was reviewed by the St Lucia Medical and Dental Council Ethics Committee and ethical approval granted. Results: A total of 100 patient charts were reviewed; 70 patients in the tobacco plus marijuana group and 30 in the tobacco only group. There were significant differences in clinical course and outcomes between the two groups with poorer outcomes noted in tobacco plus marijuana smokers (p < .001). Tobacco plus marijuana smokers required admission for COPD at a younger age (M = 45.4 years, SD = 9.4) compared to tobacco only smokers (M = 72.6 years, SD = 11.6). Tobacco plus marijuana smokers were more likely to be diagnosed with cor pulmonale (OR 15.7, 95% CI 3.47-71.01), which was associated with increased mortality (OR 8.2, 96% CI 3.2-20.8). Lastly, tobacco plus marijuana smokers died at an earlier age, mean age at death 47.6 years (SD = 7.2) versus 73.6 years (SD = 12.8) in tobacco only smokers. Worse clinical outcomes in tobacco plus marijuana smokers were seen despite lower cumulative tobacco consumption; mean of 11.8 pack years (SD = 14.3) versus 34.3 pack years (SD = 29.1) in tobacco only smokers. Conclusion: Worse clinical outcomes were seen in tobacco smokers who also smoke marijuana. There was an increased risk of admission for COPD at a younger age and more frequent progression to cor pulmonale and death in tobacco plus marijuana smokers despite lower cumulative tobacco consumption compared with tobacco only smokers.

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