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IntroductionWith rising incidence of urolithiasis, treatment of stones (both symptomatic and asymptomatic) in multiple locations including bilateral stones can be controversial and challenging. We report our experience and treatment outcomes in patients undergoing bilateral, same-session ureterorenoscopy (BS-URS) for bilateral ureteric and/or renal calculi, and discuss the advantages and disadvantages of such procedures.Material and methodsBetween May 2012 and October 2013, 251 patients underwent ureteroscopic surgery for stone disease at our institution. Of these, 21 patients underwent 25 bilateral same-session ureterorenoscopy (BS-URS) procedures during this period. Stone-free status was defined as endoscopically stone-free or radiological fragments <2 mm.ResultsThe mean bilateral stone size was 21mm (range: 4-63 mm) with a mean operating time of 70 minutes (range 35-129 minutes). Fifteen procedures (60%) were done as day case procedures with a mean stay of 0.9 days (range 0-7 days). Of the 42 renal units treated, 80% (34/42) were stone-free after a single bilateral ureteroscopy session. A further 12% (5/42) were cleared after a re-look procedure making the overall stone free rate 92.8% (39/42). There were no major complications and 3 minor complications (2 early stent removals due to stent symptoms and 1 pyelonephritis requiring intravenous antibiotics).ConclusionsBilateral same-session ureteroscopy is a safe and effective treatment option for patients with bilateral ureteric and/or renal calculi, even with stones in multiple locations and increasing stone loads. However, as with all surgery, proper patient and equipment selection is crucial in terms of reducing complication rates and improving treatment outcomes.

Background:Serum total human chorionic gonadotrophin β subunit (hCGβ) level might have prognostic value in urothelial transitional cell carcinoma (TCC) but has not been investigated for independence from other prognostic variables.Methods:We utilised a clinical database of patients receiving chemotherapy between 2005 and 2011 for urothelial TCC and an independent cohort of radical cystectomy patients for validation purposes. Prognostic variables were tested by univariate Kaplan–Meier analyses and log-rank tests. Statistically significant variables were then assessed by multivariate Cox regression. Total hCGβ level was dichotomised at < vs ⩾2 IU l−1.Results:A total of 235 chemotherapy patients were eligible. For neoadjuvant chemotherapy, established prognostic factors including low ECOG performance status, normal haemoglobin, lower T stage and suitability for cisplatin-based chemotherapy were associated with favourable survival in univariate analyses. In addition, low hCGβ level was favourable when assessed either before (median survival not reached vs 1.86 years, P=0.001) or on completion of chemotherapy (4.27 vs 0.42 years, P=0.000002). This was confirmed in multivariate analyses and in patients receiving first- and second-line palliative chemotherapy, and in a radical cystectomy validation set.Conclusions:Serum total hCGβ level is an independent prognostic factor in patients receiving chemotherapy for urothelial TCC in both curative and palliative settings.

The GH-2000 score rises in early adolescence, reaches a peak in athletes aged 13-16 yr, and then falls. We have found no evidence that the proposed GH-2000 score developed in adults would lead to an unacceptable rate of false-positive results in adolescent athletes, but caution may be required around the time of peak growth velocity.

Objectives To externally validate a nomogram recently proposed by Larcher et al. (BJU Int. 2017; 120: 490) and to develop a simplified model with comparable accuracy to guide on the need for staging chest computed tomography (CT) for patients with new renal masses. Patients and Methods We analysed the data of 1082 consecutive patients with unilateral enhancing renal masses referred to urology multidisciplinary team meetings at two centres between 2011 and 2017. All patients underwent a staging chest CT at diagnosis. We fitted multivariable logistic regression models and tested the Larcher model performance using area under the receiver‐operating curve (AUC), calibration and decision curve analysis. Results Forty‐two patients (3.9%) had a positive chest CT. The Larcher nomogram had an AUC of 83.8% (95% confidence interval [CI] 77.1–90.6), but was only moderately well calibrated (calibration‐in‐the‐large = −0.61, slope = 0.82). Specifically, the nomogram overestimated the risk of positive chest CT, and the magnitude of miscalibration increased with increasing predicted risks. Using a stepwise backward approach, a new model was developed including tumour size, nodal stage and systemic symptoms. Compared with the Larcher model, the new model had a similar AUC (82.7% [95% CI 75.5–90.0]), but improved calibration and clinical net benefit. The predicted risk of positive chest CT was <1% in the low‐risk group and 1.9–79.9% in the high‐risk group. Conclusion The Larcher nomogram is an accurate prediction tool that was moderately well calibrated with our dataset. However, our simplified model has similar accuracy and uses more objective variables available from referral, so may be easier to incorporate into clinical practice. The low‐risk group from our model (tumour size ≤4 cm and no systemic symptoms) had a risk of positive chest CT <1%, suggesting these patients may forego chest CT.

Introduction:Computed tomography kidneys, ureter and bladder (CTKUB) is the accepted gold standard investigation for suspected renal colic. Dose considerations are particularly pertinent in the context of detecting urolithiasis given the high risk of disease recurrence, which can necessitate multiple radiological examinations over the lifetime of a stone-former. We performed a systematic review of the literature to see whether there was any evidence that reducing the effective radiation dose of a CTKUB compromised the diagnostic accuracy of the scan.Materials and Methods:Relevant databases including MedLine, EMBASE, DARE and the Cochrane Library were searched from inception to October 2012. All English language articles reporting on prospective studies where non-contrast, low-dose CT (LDCT) was used to investigate adults (males and non-pregnant females) presenting with flank pain or suspected urolithiasis were included. LDCT was defined as an effective radiation dose <3 mSv per examination.Results:Our initial search identified 497 records. After removing duplicates, 390 abstracts were screened, of which 375 were excluded, principally because outcomes of interest were not presented. Six papers remained for the final analysis, reporting on a total of 903 patients. Individual studies showed a prevalence of urolithiasis ranging between 36% and 88%, with additional pathologies found in 5-16%. The effective radiation dose of the LDCT techniques used ranged from 0.5 to 2.8 mSv. The sensitivity of LDCT for diagnosing stone disease was 90-97% with a specificity of 86-100%.Conclusions:The sensitivity and specificity of CTKUB for diagnosing urolithiasis remains high, even when the effective radiation dose is lowered. LDCT may miss some small stones (<3 mm), especially in obese patients (>30 kg/m2), but in this group LDCT still identifies most alternative diagnoses. With at least one level 1A and two level 1B studies supporting the use of LDCT, there is Grade A recommendation for its use as the first-line investigation in suspected renal colic in non-obese patients.

A 40 year old man complains of two episodes when he noticed blood in his ejaculate. He is otherwise well and has no comorbidities.Visible blood in ejaculate-haematospermia or haemospermia-is usually an isolated symptom, and its incidence is unknown. In most cases, it is benign and self limiting, often caused by inflammation or infection of the prostate, urethra, or seminal tract. 1 Possible causes are outlined in Box 1. Patients may describe haematuria, urinary frequency, dysuria, and scrotal, pelvic, or perineal pain, particularly at the time of orgasm. 2 What you should cover HistoryAsk about:• Timing, frequency, and duration of haematospermia, and colour of the semen: bright red with or without clots (that is, fresh bleeding), or brown (old blood).• Associated urinary symptoms suggestive of infection-for example, dysuria, frequency, or urgency of urination, visible haematuria, pain in the abdomen, scrotum, pelvis, or perineum.• Sexual history, including presence of urethral discharge, which could point to a sexually transmitted infection. • Recent urological investigation or intervention.• History of prolonged or excessive bleeding or easy bruising from minor injuries or surgical procedures suggestive of bleeding disorders or a history of coagulopathy.• Travel history, particularly to areas where tuberculosis and schistosomiasis are endemic, as these can cause genitourinary tract infections.• Family history of prostate cancer, particularly in first degree relatives and relatives diagnosed under the age of 60, and coagulopathies. Examination• Ask the patient to expose the external genitalia. Palpate for any lumps, scrotal tenderness, or swelling, which could indicate underlying testicular or epididymal pathology• Perform a digital rectal examination to detect prostatic enlargement, tenderness, fluctuance, firmness, or nodules• Look for signs of easy bruising or bleeding tendencies, such as large bruises (>5 cm in diameter) in the absence of trauma, and petechiae• Examine the abdomen for hepatosplenomegaly, which could indicate an underlying haematological, liver, or infectious disease• Measure blood pressure to identify uncontrolled hypertension What you should doHaematospermia can cause alarm. Reassure patients that a single episode is likely to be benign and self limiting, and ask them to return if the problem continues (Box 2).The initial approach is to rule out infectious causes (Box 1). We suggest that these results are interpreted based on the age of the patient. However, onward referral criteria are based on expert opinion, supported by limited evidence. 3-6 The algorithm ( fig 1⇓) showing the initial assessment and management of haematospermia is based on authors' clinical experience and practice.In patients aged under 40, the most common cause is infection, and management can be guided by non-specialists. Urologists tend to recommend a prolonged course of antibiotics, usually six weeks in duration. Consider referral to a genitourinary medicine clinic if you suspect a sexually transmitted infection to ...