Cavernosal abscess is a rare diagnosis. Disparity exists in the literature but the most common colonising agents appear to be Neisseira gonorrhoea and Staphylococcus aureus. We describe a 75-year-old man who presented with sepsis and was found to have Escherichia coli positive blood and urinary cultures. Following initial treatment for sepsis of unknown origin, computed tomography demonstrated a bilateral cavernosal abscess. The patient was successfully treated with incision and drainage, multiple re-looks and a delayed closure, alongside a course of appropriate antibiotics. A defect in the bulbar urethra was identified and repaired with bladder drainage via both suprapubic and urethral catheters. Following discharge, a urethrogram showed no urethral leak or stricture and the patient is now catheter free.
Emphysematous pyelonephritis (EPN) is a rare condition which is potentially life threatening. It is characterised by gas formation within the collecting system, renal parenchyma and/or perirenal tissues. Diabetes is the single most common risk factor for the development of EPN. Other risk factors include urinary tract obstruction and immunocompromise. Escherichia Coli is the most common pathogen. EPN is characterised by fever, loin pain and systemic upset. Gold standard diagnosis and classification of EPN is made with contrast CT. Classification can be used as a prognostic indicator for mortality and to guide management. EPN may be managed conservatively or surgically. Patients managed conservatively are resuscitated and administered with intravenous antibiotics. Intravenous fluid, glucose control for diabetics and acid base balance are vital components for primary management. For those in whom conservative management is unsuccessful, a parenchymal drain may be considered to drain gas or a collection of pus. Patients with hydronephrosis will benefit from a nephrostomy or JJ stent insertion. Patients who have failed minimally invasive surgical intervention or who have a number of risk factors predisposing them to EPN should undergo either immediate or delayed nephrectomy. With treatment for EPN now moving away from nephrectomy towards less invasive interventions, mortality rates for EPN are improving but remaining high.
Introduction: The coronavirus disease 2019 (COVID-19) pandemic is having significant effects on health services globally, including on urological surgery for which the British Association of Urological Surgeons (BAUS) has provided national guidance. Kent, Surrey and Sussex (KSS) is one of the regions most affected by COVID-19 in the UK to date. Methods: An anonymous online survey of all KSS urology trainees was conducted. The primary outcome was to assess the effects on urology services, both malignant and benign, across the region in the acceleration phase and at the peak of the pandemic compared to standard care. The second was to quantify the effects on urology training, especially regarding operative exposure. Results: There were significant decreases in urological services provided at the peak of the pandemic across KSS compared to standard care ( p<0.0001). Only 22% of urology units were able to continue operating for low-risk cancer and to continue cystoscopy for two-week wait non-visible haematuria referrals in line with BAUS escalation guidelines. A third (33%) did not complete any prostate biopsies at the peak. The majority of urology units continued clinics by telephone. Urology trainees reported completing substantially fewer operating procedures and workplace-based assessments. A third (33%) had moved to consultant-only operating by the peak. Conclusions: The COVID-19 pandemic has caused significant changes to urological surgery services and training in KSS, with heterogeneity across the region. We suggest further work to quantify the effects nationally. Level of evidence: 4.
Sentinel lymph node biopsy (SLNB) is now an established technique in penile and pelvic cancers, resulting in a lower mortality and morbidity when compared with the traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fluorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate cancer. Although the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.
Background: Over 4 years urology as a speciality has seen a 49% increase in unfilled consultant posts and long term the British Association of Urological Surgeons is predicting a shortage of up to 149 consultants over a 12-year period. Striving to keep trainees within the NHS workforce is one way of minimising those figures. We aimed to examine the challenges to workforce retention in urology higher speciality training. Methods: A 10-item survey was designed and piloted, examining the attitudes and intentions of higher speciality trainees towards their training. Results: Forty-nine higher speciality trainees completed the survey, 29 men (59%), 20 women (41%). Twenty-two (45%) were ST4 or below; 24 (49%) had considered leaving urology training, with 31 of 49 trainees (63%) citing burnout as the most common reason for this. Concerns about a shortage of colleagues and financial challenges were the second and third most common reasons. Thirty-four (69%) respondents would still apply for urology higher speciality training if they had to make the decision again. Colleagues, operating time and the ability to make an impact were all cited as enjoyable factors. Discussion: The findings of this survey clearly demonstrate mixed feelings towards urology higher training. However, the majority of trainees would still pick the speciality again, and when asked trainees were able to select a number of factors which they enjoyed. Conclusion: A workforce crisis affects everyone. While the situation may be unavoidable, we must take this opportunity to limit its impact.
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