Objective To evaluate the accuracy and use of ®ne-needle aspiration (FNA) cytology for the diagnosis of renal masses because with the improved quality and increasing use of ultrasonography and computed tomography (CT), asymptomatic renal masses, particularly small (<5 cm) tumours, are being discovered more frequently. Patients and methods Between 1995 and 1997, 49 patients (mean age 67.5 years, range 42±88, 34 men and 14 women) underwent FNA of a solid or complex cystic mass under radiological guidance. All masses were further evaluated and staged by CT. Solid masses were divided according to size (<5 cm and o5 cm).Patients were followed up to the determination of a ®nal diagnosis on tissue histology, after nephrectomy where possible. Results Thirty-six patients had histologically con®rmed carcinoma at nephrectomy, and nine had presumed carcinoma (four un®t for surgery, ®ve with advanced malignancy). The remaining four patients had benign diagnoses. FNA produced insuf®cient sample in eight cases (16%). The sensitivity was 89% for large (o5 cm) solid masses, 64% for small (<5 cm) solid masses and 50% for complex cysts. Conclusion FNA does not contribute to the diagnosis of malignancy in large (>5 cm) masses, as good radiological imaging is nearly always diagnostic. For smaller (<5 cm) masses and complex cysts, FNA can occasionally con®rm malignancy, but lack of diagnostic yield and low sensitivity means that FNA is unreliable as a diagnostic tool and will rarely help in the routine management of these patients.

The cause of haemospermia was determined in 70 (86%) of 81 patients. Inflammatory lesions accounted for the bleeding in most men under 30 years of age. Neoplasia (6), trauma (3) and amyloidosis (2) of the seminal vesicle were diagnosed in the other patients. Persistent haemospermia should always be investigated since clinically unsuspected tumours may be the source of bleeding in the older age groups. Analysis of the semen, prostatic fluid and urine should be performed initially. Cystourethroscopy should then be carried out if the initial investigations are negative and, if this too is negative, vasography is indicated.

OBJECTIVE To review the role of transarterial renal embolization in our unit, assessing the indications, tolerability and efficacy of this technique for treating renal cell carcinoma (RCC). PATIENTS AND METHODS Thirty patients undergoing transarterial embolization between 1991 and 1999 were identified and 25 case notes analysed retrospectively. RESULTS Most patients (14 of 25) presented with less advanced (stage I–III) RCC who were unable or unwilling to undergo radical surgery; the remainder (11) presented with advanced (stage IV) disease. The embolizing agent was ethanol, usually combined with stainless steel coils (85% of cases). Procedural pain and fever was controlled successfully. The median hospital stay associated with the procedure was 4 days. At the time of analysis six of 11 stage IV and 11 of 14 stage I–III patients were alive (median follow‐up 27 and 39 months, respectively). Symptoms from the primary tumour were well controlled. Overall, 17 of 25 (68%) of patients reported no problems while three (12%) required brief hospital admission for treatment of persistent haematuria. Fourteen patients were subsequently re‐staged; the primary tumour in two had increased, in seven remained unchanged and in five it decreased. No patients without metastases developed them and metastases in two patients regressed. CONCLUSION Transarterial embolization is associated with minimal morbidity and complications, and subsequent symptom control is good. The effect of palliative embolization on RCC progression is unknown and requires prospective investigation. Presently, there is no role for cytoreductive embolization; it should be included as a treatment option in clinical trials evaluating such options in patients with metastatic RCC.

Extracorporeal shockwave lithotripsy has been shown to be a safe and effective method of treating most upper urinary tract stones. Major complications, although few, include haemorrhage, septicaemia, "Steinstrasse" formation and cardiac arrhythmias. The experience from 600 consecutive cases is reviewed and methods of prevention are discussed.

Eighteen patients with a cholangiocarcinoma involving the hilum of the liver, and one patient with a carcinoma of the gall bladder causing obstruction of the common hepatic duct, have been treated with bile drainage using a U-tube (8 patients) or a percutaneous transhepatic catheter (11 patients) followed by internal radiotherapy with 192iridium wire. The median survival is 11 months, and 9 patients (47 per cent) have survived for 12 months or longer. The addition of internal radiotherapy may be beneficial to patients with hilar cholangiocarcinoma causing biliary obstruction in whom bile drainage can be established.

Superficial lesions of the glans penis can pose diagnostic difficulties. Plasma cell balanitis is such a condition and it may be confused clinically with erythroplasia of Queyrat. It is unresponsive to topical medication and curable only by circumcision.

Ketorolac can be considered a viable alternative to pethidine for the treatment of renal colic.

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