What's known on the subject? and What does the study add? The suppressor effect of probiotics on superficial bladder cancer is an observed phenomenon but the specific mechanism is poorly understood. The evidence strongly suggests natural killer (NK) cells are the anti‐tumour effector cells involved and NK cell activity correlates with the observed anti‐tumour effect in mice. It is also known that dendritic cells (DC) cells are responsible for the recruitment and mobilization of NK cells so therefore it may be inferred that DC cells are most likely to be the interphase point at which probiotics act. In support of this, purification of NK cells was associated with a decrease in NK cells activity. The current use of intravesical bacille Calmette‐Guérin in the management of superficial bladder cancer is based on the effect of a localised immune response. In the same way, understanding the mechanism of action of probiotics and the role of DC may potentially offer another avenue via which the immune system may be manipulated to resist bladder cancer. Probiotic foods have been available in the UK since 1996 with the arrival of the fermented milk drink (Yakult) from Japan. The presence of live bacterial ingredients (usually lactobacilli species) may confer health benefits when present in sufficient numbers. The role of probiotics in colo‐rectal cancer may be related in part to the suppression of harmful colonic bacteria but other immune mechanisms are involved. Anti‐cancer effects outside the colon were suggested by a Japanese report of altered rates of bladder tumour recurrence after ingestion of a particular probiotic. Dendritic cells play a central role to the general regulation of the immune response that may be modified by probiotics. The addition of probiotics to the diet may confer benefit by altering rates of bladder tumour recurrence and also alter the response to immune mechanisms involved with the application of intravesical treatments (bacille Calmette‐Guérin).

Results from PVP with an HPS(®) laser are durable. Complications are low and compare favourably with TURP. Lasing energy, PSA, Qmax, patient age and length of stay are not associated with development of complications. However, a longer postoperative catheterisation after PVP is associated with development of complications.

No abstract

We read with interest the recent case by Bhatt et al. 1 A case is presented of a 70-year-old multiparous female who presented with dysuria, dribbling and strangury. Physical examination revealed a palpable bladder and a stone in the distal urethra. Subsequent management consisted of a voiding cystourethrogram (VCUG), open stone excision and closure of the diverticular sac. The authors then discuss the incidence and aetiology of urethral diverticulae. This case again illustrates the heterogeneity of presentations that can occur with urethral diverticulae in female patients, and emphasises the difficulty in reaching the correct diagnosis as stone-related pathologies may be treated initially as interstitial cystitis or vulvodynia. Specific to our institution, we have reported a case of a 56-year-old female who presented with recurrent infections and vaginal examination revealed an indurated anterior wall. 2 This was thought to be a diverticulum and subsequent MRI revealed a tumour at the bladder neck. Transurethral resection confirmed adenocarcinoma. Following a voiding trial the patient developed urinary retention. A repeat MRI was performed due to the aggressive histology and concerns over urethral involvement. This revealed a stone in a urethral diverticulum which was treated with lasertripsy. The patient finally proceeded to undergo a pelvic clearance for adenocarcinoma. Reports exist of lasertripsy and diverticulum repair. 3 All those working in the field of female urology should be aware of the complexity of presentations that may potentially occur with urethral diverticulae, 4,5 and additionally should acknowledge that MRI has limitations when used as an assessment tool. 6

Objectives: To determine whether administration of single dose prophylactic intravenous gentamicin prior to intravesical injection of botulinum toxin type A (BoNT-A) is associated with adverse extravesical neuromuscular effects in idiopathic overactive bladder syndrome. Patients and methods: A retrospective analysis of 220 consecutive idiopathic overactive bladder patients following sedation-free flexible cystoscopic injection of intravesical BoNT-A. All patients received a single dose of intravenous gentamicin (160 mg) followed by 100-200 IU of BoNT-A. They were followed up at intervals to determine whether they had experienced any adverse extravesical neuromuscular side effects. Results: None of our patients developed adverse extravesical neuromuscular side effects from intravesical botulinum injections with concomitant administration of intravenous gentamicin. Conclusion: Single dose intravenous gentamicin is safe to use as a prophylaxis for intravesical BoNT-A injections of 200 IU or below in idiopathic overactive bladder patients. Level of evidence: Not applicable.