OBJECTIVE To report the short‐ to intermediate‐term experience of using salvage targeted cryoablation of the prostate (TCAP) for the recurrence of localized prostate cancer after radiotherapy. PATIENTS AND METHODS Between May 2000 and November 2005, 100 patients had salvage TCAP for recurrent prostate cancer after radiotherapy; the mean follow‐up was 33.5 months. All patients had biopsy‐confirmed recurrent prostate cancer. Biochemical recurrence‐free survival (BRFS) was defined using a prostate specific antigen (PSA) level of <0.5 ng/mL and by applying the American Society for Therapeutic Radiology and Oncology (ASTRO) definition for biochemical failure. Patients were stratified into three risk groups, i.e. high‐risk (68 men), intermediate‐risk (20) and low‐risk (12). RESULTS There were no operative or cancer‐related deaths; the 5‐year actuarial BRFS was 73%, 45% and 11% for the low‐, intermediate‐ and high‐risk groups, respectively. Complications included incontinence (13%), erectile dysfunction (86%), lower urinary tract symptoms (16%), prolonged perineal pain (4%), urinary retention (2%), and recto‐urethral fistula (1%). CONCLUSION Salvage TCAP is a safe and effective treatment for localized prostate cancer recurrence after radiotherapy.

OBJECTIVE To present the UK experience to date with laparoendoscopic single‐site surgery (LESS) simple nephrectomy. PATIENTS AND METHODS Five female patients underwent LESS nephrectomy; three procedures were carried out with the umbilicus as the port of entry (U‐LESS). RESULTS All cases were completed uneventfully. The operative duration was 45–150 min and blood loss was negligible. There were no conversions to conventional multi‐port laparoscopy or open surgery. Recovery was uneventful with only minor complications in two patients; convalescence was rapid. CONCLUSION LESS nephrectomy offers a safe, cosmetic alternative to conventional multi‐port laparoscopy, with younger female patients being especially happier with the ‘scarless’ outcome of U‐LESS. LESS certainly appears to be more in these situations.

OBJECTIVE To evaluate medium‐term outcome data from patients with distal urethral cancers treated with penile‐preserving surgery. PATIENTS AND METHODS We analysed prospectively 18 consecutive men referred for the management of urethral carcinoma. All had a specialist review in a supra‐regional multidisciplinary team meeting, where the histology findings were reviewed by one pathology consultant. Tumours were staged according to the Tumour‐Node‐Metastasis classification and the patients offered penile‐preserving surgery when tumours were limited to the glanular or penile urethra. RESULTS All 18 patients were suitable for penile‐preserving surgery; the procedures were: three hypospadias formation with or without topical chemotherapy; four buccal mucosa urethroplasty; three glansectomy and reconstruction; six glansectomy, distal corporectomy, reconstruction and hypospadias formation; two urethrectomy with or with no excision of adjacent tunica albuginea. The mean (median, range) follow‐up was 26 (20.5, 9–58) months. There were no local recurrences; four patients with regional nodal disease progressed and of these, two died from metastatic disease, and one died from an unrelated condition. CONCLUSION Medium‐term data show that penile‐preserving surgery is a feasible treatment for men with distal urethral carcinoma, providing excellent local control without prejudicing survival; a longer follow‐up is needed.

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Background: Complications of suprapubic catheter insertion are rare but can be significant. We describe an unusual complication of a delayed bowel perforation following suprapubic catheter insertion.

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Objectives Limited data exist on the risks of complications associated with a suprapubic catheter (SPC) insertion. Bowel injury (BI) is a well‐recognized albeit uncommon complication. Guidelines on the insertion of SPC have been developed by the British Association of Urological Surgeons, but there remains little evidence regarding the incidence of this complication. This study uses contemporary UK data to assess the incidence of SPC insertion and the rate of BI and compares to a meta‐analysis of available papers. Methods National Hospital Episodes Statistics data were searched on all SPC insertions over an 18‐month period for operating procedure codes, Code M38.2 (cystostomy and insertion of a suprapubic tube into bladder). Patients age, 30‐day readmission rates, 30‐day mortality rate, and catheter specific complication rate were collected. To estimate the BI rate, we searched patients who had undergone any laparotomy or bowel operation within 30 days of SPC insertion. Trusts were contacted directly and directed to ascertain whether there was SPC‐related BI. PubMed search to identify papers reporting on SPC related BI was performed for meta‐analysis Results 11 473 SPC insertions took place in the UK in this time period. One hundred forty‐one cases had laparotomy within 30 days. Responses from 114 of these cases reported one BI related to SPC insertion. Meta‐analysis showed an overall BI rate of 11/1490 (0.7%). Conclusions This is the largest dataset reported on SPC insertions showing a lower than previously reported rate of BI. We recommend clinicians use a risk of BI of less than 0.25% when counseling low‐risk patients.

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