Granulomatosis with polyangiitis (GPA) is an autoimmune small to medium vessel inflammatory vasculitis that can affect multiple organ systems, with predominantly pulmonary, renal and musculoskeletal manifestations. Rarely, there have been cases involving the genitourinary system, particularly causing urethritis and prostatitis. In some incidences, this may mimic prostate abscess or malignancy. We present a case of a 36-year-old man with refractory urinary retention secondary to prostate abscess due to GPA. This case necessitated transurethral resection of the prostate (TURP) and supra-pubic catheterisation, later complicated by a peri-anal abscess and severe urethritis. A potential recto-urethral fistula was noted on magnetic resonance imaging (MRI) and cystourethroscopy, which was managed conservatively with long-term catheter drainage until resolution. The patient ultimately displayed many severe clinical manifestations of a systemic vasculitis and this case report emphasises the importance of considering autoimmune vasculitis conditions as a differential diagnosis when managing inflammatory genitourinary conditions. This case report highlights the importance of obtaining sufficient tissue to make a timely diagnosis in order to initiate immunosuppressant therapy and disease-modifying anti-rheumatic drugs (DMARDs).
Objectives: To determine whether Covid19 had a tangible effect on urology training in Wales. There has been no Welsh data available concerning how training has changed during the covid pandemic. This survey evaluated the overall impact on training, with the primary aims to identify changes in clinical and academic activities and evaluate a trainees’ wellbeing during the crisis. Materials and methods: Online questionnaires were sent to all Urology Trainees; n = 20 (83% response) working in the Welsh deanery in the United Kingdom, asking about changes in training particularly within operating list, out-patient clinics, diagnostic activities, educational courses, teaching sessions and examinations. Results: Across Wales trainees experienced a reduction in operating procedures, clinics and teaching courses. Due to a redesign of services, there was only a minimal impact on training for cancer diagnostics and Multi-Disciplinary Team (MDT) meetings. The majority of trainees felt their index procedures and ability to complete training will be affected. Conclusion: Cancer work, including cancer related theatre lists, diagnostics and MDT were maintained. Trainees lacked confidence that they would reach their operative competencies and struggle to successfully complete training. Following BAPIO discussion, we suggest that training programmes readjust to focus on areas where exposure has been lacking.
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