Journal watch

Vasectomy and risk of prostate cancer

In an article by Hamilton et al published in BMJ 2016, the authors study the link between vasectomy and prostate cancer. 326607 men who had vasectomy between 1994 and 2012 and equal matched number of men who did not, were studied. After a median of 10 year follow up there was no difference in prostate cancer risk.

Incidence of lymphocoele following lymph node dissection after robot assisted radical prostatectomy

In an article by Keskin et al published in BJUI (2016) the authors Analyse 521 patients. At 1 month 9% had USS detected lymphocoeles, 76%regressed by 3 months. Overall 2.5% developed symptomatic lymphocoeles but if a lymphocoele persisted until 3 months 64% became symptomatic. The authors suggested USS at 3 months and percutaneous drainage if a lymphocoele was detected.

Precision in risk stratification for early prostate cancer

In an editorial in BJUI (2016) Emberton comments that combined MRI and perineal intensive biopsy conferred a sensitivity of 97% and NPV of 91% for clinically significant disease.

Retroperitoneal fibrosis reviewed

In an article by O’Brien et al published in BJUI (2016) the authors review the current state of knowledge on RPF.

They identify 7 types:-

1) IgG4 related

2) Systemic autoimmune eg SLE, Wegemer’s, APS, PMR/GCA

3) degenerative aorto-iliac arterial disease (either aneurysmal or non-dilated (may also be IgG4 positive)

4) idiopathic peri-aortitis

5) drug related

6) paraneoplastic

7) radiation induced

The authors suggest that initial tests should include FBC, CrP, renal profile, ESR and screen for SLE, Wegemer’s, APS, PMR/GCA. CT is normal imaging although PET CT may be a useful investigational marker of inflammation. Biopsy should be attempted

The aim of treatment is preserve renal function, and make stent free. Prednisone with 20md bd is used if there is evidence of inflammation. Azothiprine or methotrexate are useful if steroids are successful but relapse occurs after reducing. Rituximab can control where steroids fail. Ureterolysis should be used early.

Medical management of kidney stones

In a recent article in BMJ 2016 the authors discuss the investigation and medical treatment of urolithiasis. They include a useful algorithm.

  

Daily Calis for the treatment of prostatitis.

In an article by Kirby et al published in Trends in Urology and men’s health (2015), the authors propose that 5mg Cialis daily may improve the symptoms of prostatitis. This is a hypothesis driven case report of several cases, which is an interesting observation more than scientific evidence.it is proposed that the effect is a consequence of increased pelvic blood flow/anti inflammatory effect.

Follow-up of Testicular microlithiasis

The implications and follow up of testicular microlithiasis have been widely debated since a possible link with testicular germ cell tumour was reported. In 2015 the European Society of Urogenital Radiology (ESUR) have published the first guidelines on follow up of this condition. As a general rule it does not need follow up, unless there is a seperate risk factor for germ call cancer. Testicular maldescent/orchidopexy, previous germ cell tumour and atrophic testis require annual testicular ultrasound (USS) follow up. Genetic disease requires an USS at 6 and 12 months then discharge. Family history of germ cell tumour requires advice of self examination.