What ' s known on the subject? and What does the study add? Suprasacral spinal cord injuries can result in intractable detrusor overactivity adversely effecting patients ' quality of life. It can lead to high pressure bladder resulting in urinary incontinence and deterioration of upper tract function. Augmentation cystoplasty is an accepted procedure in treating refractory neurogenic detrusor overactivity.Several publications have reported on the short-to intermediate-term outcomes with augmentation cystoplasty in patients with spinal cord injury. However, it is not known how these outcomes alter over a longer period. This study has a follow-up of at least 10 years. It evaluates the durability of this procedure over the longer term. It also assesses the patients reported outcome over this period. This data can help counsel patients better when considering augmentation cystoplasty as a treatment option for the management of refractory neurogenic detrusor overactivity secondary to spinal cord injury. OBJECTIVE• To report the long-term outcomes of augmentation ileocystoplasty (AIC) in patients with spinal cord injury (SCI), with a minimum follow-up period of 10 years. PATIENTS AND METHODS• We retrospectively analysed all operations performed by a single surgeon at a specialist spinal unit.• Outcomes were measured by comparing preoperative and follow-up videocystometrograms (VCMGs).• Complications were identifi ed from case notes and the surgery database.• Subjective assessment was through a previously validated questionnaire. RESULTS• The mean (range) follow-up was 14.7 (10.5 -20.3) years. There were 19 patients (12 males) with a mean (range) age at time of surgery of 28.9 (12 -52) years. The mean (range) period from injury to surgery was 4.5 (0.3 -22) years. All had suprasacral injuries.• The VCMGs showed a signifi cant improvement in bladder capacity and a decrease in intravesical pressures ( P < 0.001).• Long-term complications included bladder stones ( n = 4); urosepsis ( n = 2); vesico-ureteric refl ux ( [ VUR ] n = 2), VUR requiring ureteric re-implantation ( n = 1); neurogenic detrusor overactivity ( [ NDO ] n = 1); and laparatomy for bowel obstruction ( n = 1). Surveillance cystoscopies did not detect any bladder neoplasms.• The response rate for the questionnaire survey was 14/17; 13/14 patients were satisfi ed with the operation such that they would consider it again or recommend it to a friend. No patient reported any signifi cant changes in either bowel habit or sexual function. CONCLUSIONS• We found that AIC has excellent long-term outcomes in the defi nitive management of refractory NDO in patients with SCI.• The complications of AIC appear to be more than counterbalanced by a high level of patient satisfaction with the procedure and by the achievement of the primary aim of ensuring continence and upper tract safety in these patients. KEYWORDSspinal cord injury , ileocystoplasty , augmentation cystoplasty Study Type -Therapy (case series) Level of Evidence 4

Actinomyces species are commensal flora usually found in the oropharynx, gastrointestinal tract, and female genital tract. Primary actinomycosis of the breast is an unusual condition, where the most commonly isolated pathogen has been Actinomyces israelii. In recent years, other Actinomyces strains have been found associated with breast disease. We present the first reported cases of breast infection caused by the rare species, Actinomyces turicensis and Actinomyces radingae. Both infections displayed chronicity and abscess formation. In the first case, the infection was refractory to recurrent aspirations and initial antibiotic therapy. In the second case, aspiration and prolonged antibiotic therapy was required to overcome the chronic infection.

TRUS-guided needle biopsy of the prostate is the standard technique in the diagnosis of prostate cancer. Our survey highlights nationwide diversity in practice in the UK with respect of the number of cores taken, antibiotic prophylaxis and local anaesthesia utilisation. This raised the issue of standardising the practice. More urologists are also actively taking part in this procedure, making the structured training increasingly important.

questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTSThe mean (range) follow-up was 10 (8.5-12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/ day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONSIn women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good longterm outcomes. KEYWORDSneuropathic bladder, stress incontinence, tension free vaginal tape Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVETo evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODSTwelve women (mean age 53.3 years, range 41-80) with neuropathic bladder dysfunction and SUI confirmed by videocystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-

OBJECTIVE To evaluate patients’ perspective on whether they would consider botulinum toxin‐A (BTX‐A) injections as a long‐term treatment option for managing their neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI). PATIENTS AND METHODS In all, 72 patients with SCI and urodynamically confirmed NDO refractory to anticholinergics, who have had at least one or more injections with BTX‐A were invited to participate in a 5‐min telephone questionnaire covering various aspects of their treatment. Questions about patient satisfaction were rated on a scale from 1 to 10 (1, not satisfied; to 10, very satisfied). RESULTS Of the 72 patients surveyed, 48 (67%) were still actively undergoing repeat BTX‐A injections. The mean patient satisfaction score was 6.2. Of the 48 patients, 43 (90%) replied that they would consider continuing with BTX‐A injections as a long‐term treatment option. Only seven (15%) of patients still having BTX‐A injections would consider an alternative permanent surgical option in the next 5 years. Of those patients considering a one‐off permanent surgical solution, younger patients were likely to consider this at a later interval than those in an older group (Spearman’s correlation coefficient, −0.52, 95% confidence interval −0.78 to −0.10, P = 0.02). The annual new patient recruitment rate was high (mean 14.4) and the annual withdrawal rate was low (mean 4.8). CONCLUSION With high satisfaction and low annual withdrawal rates, there are increasingly many patients on BTX‐A. Most consider continuing BTX‐A injections in the long term, increasing the future demand for this service. There is an urgent need for further research into optimizing the current delivery of an intradetrusor BTX‐A injection service for patients with NDO.

Transrectal ultrasound guided biopsy of the prostate is generally well tolerated with minor pain and morbidity in our urologist-led service. Our data will assist counselling of patients prior to the procedure.

Unilateral renal cystic disease (URCD) is a rare condition, with pathological features indistinguishable from autosomal dominant polycystic kidney disease (ADPKD). In contrast to this condition, however, URCD is not inherited, is not associated with progressive deterioration in renal function, and is unilateral. We present a case of URCD associated with polycythaemia, which showed resolution following nephrectomy. Secondary polycythaemia has not previously been reported in cases of URCD, but may be hypothesised to be a result of excess erythropoietin production.

We describe a technique in which the breast implant capsule is used to fill localized depressions in the breast, including those under the nipple-areola complex. Capsules have been reported to persist long-term and their high vascularity renders them suitable for use as flaps.