Emphysematous cystitis is an uncommon condition characterised by the presence of gas in the bladder. It is an infection caused by gas forming organisms, usually in elderly women with a background of diabetes mellitus. The presentation is variable, however with increasing use of imaging more cases are being diagnosed in asymptomatic patients. Routine cross-sectional imaging is not advocated for specific diagnosis but its role in accurate assessment of the severity of the condition cannot be overlooked. As the mode and duration of follow-up in incidentally detected cases has not been addressed in the literature, follow-up should be tailored individually depending upon the severity and response to treatment. We describe two such incidentally detected cases of emphysematous cystitis in elderly diabetic patients and present a review of the literature. The triad of treatment is adequate control of diabetes, antibiotics and bladder drainage. One patient died in the hospital, while the other underwent a flexible cystoscopy 6 weeks later which was normal.

A 69 year old male who presented with painful, swollen and infl amed scrotum is presented as a unique case report. He was initially treated as a case of infection and was subject to further investigation due to poor response to antibiotics. CT scan showed thickened scrotal wall and an incision biopsy revealed metastatic 'carcinoma en cuirasse' of the scrotal wall with the primary foci in the lung. There has been one other such case reported in literature, presenting as generalised swelling of scrotum with the whole of the scrotal wall being involved.

Background and ObjectiveThere are no current guidelines to manage female retention patients. We aimed to see if a standardized approach could be used to manage these patients. MethodsBetween October 2014 and September 2016, all female patients with urinary retention admitted under a urology consultant were reviewed. ResultsA total of 46 females had a single episode of urinary retention whilst 19 females had recurrent episodes. The commonest cause for a single episode of retention was attributed to anesthesia (general/spinal) (n=9), constipation (n=9) and medication use (n=4). Most of these women (95%) voided on the first attempt fol-lowing catheter removal. In the absence of any neurological symptoms, pelvic ultrasound was the only investigation that revealed any underlying pathology in female retention patients. A pelvic mass was identi-fied in 3 (4.5%) patients. ConclusionFemales with an isolated episode of retention, with an obvious precipitating cause identified during full history and examination, could proceed directly to a nurse-led trial of catheter removal without the need for any further urology review. Others should undergo a pelvic ultrasound and review by a urologist. In our opinion, females with recurrent unexplained episodes of urinary retention should be referred for a trial of sacral neuromodulation if considered appropriate.

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