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.

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

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.

Initial results from the the STAMPEDE trial suggest that Docetaxol can improve survival of hormone naive advanced prostate cancer patients by 10 months. This may change the standard of care.

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.

In an article published in the journal JAMA the authors compared targeted prostate biopsy compared to standard extended sextant biopsies in 1003 men suspected to have prostate cancer. MRI/USS fusion biopsy detected 30% more high risk prostate cancers than standard biopsy. An additional benefit was that the targeted technique picked up17% fewer low risk cancers. When radical prostatectomy specimens from 170 men were examined, targeted biopsies had a higher PPV for intermediate and high risk cancers than standard biopsies.

In article by Pirkorny et al published in Eur Urol (2014) the authors report a study of223 consecutive patients referred with raises PSA. All had an MRI and random biopsies with additional guided biopsies for suspicious lesions. 63.7% were diagnosed with cancer. Random biopsies detected 56.5% including 37.3% with low risk disease. Guided biopsies would have 69.7% with only 6.1% low risk. Estimated NPV for significant cancer was 71.9% for random and 96.9% for guided biopsies. Follow up of this cohort is required.

In an article by Kirby et al published in BJUI (2014), the authors discuss the rationale and efficacy and tadafil treatment for chronic male pelvic pain. Anecdotally, it has been associated with immediate and sustained improvement especially in daily dosing at 5mg strength.

In an editorial in Eur Urol (2014), the concluding statement sums up the advantages of Robotic surgery.

“Robotics is like driving a limousine instead of a compact car. you can go the same distance in both, but the limousine, although more expensive, is safer, smoother, and more comfortable.”