The Benefits and Harms of Pharmacological Treatment for Postradiation Pelvic Pain: A Systematic Review by the European Association of Urology Chronic Pelvic Pain Panel with Recommendations for Clinical Practice.

Context: Radiotherapy of the pelvis is a widely used method for the treatment of malignancies, and local complications including pain following pelvic radiation therapy are acknowledged complications.

Objective: The primary objective is to assess the clinical effectiveness and safety of pharmacological therapies on postradiation pelvic pain.

Evidence Acquisition: A systematic review of the use of different pharmacological treatments in the management of post-radiation pelvic pain was conducted (PROSPERO-ID: CRD42021249026).

Myofascial Pelvic Pain: Best Orientation and Clinical Practice. Position of the European Association of Urology Guidelines Panel on Chronic Pelvic Pain.

Context: Despite the high prevalence of a myofascial pain component in chronic pelvic pain (CPP) syndromes, awareness and management of this component are lacking among health care providers.

Objective: To summarize the current state of the art for the management of myofascial pain in chronic primary pelvic pain syndromes (CPPPS) according to scientific research and input from experts from the European Association of Urology (EAU) guidelines panel on CPP.

Evidence Acquisition: A narrative review was undertaken using three sources: (1) information in the EAU guidelines on CPP; (2) information retrieved from the literature on research published in the past 3 yr on myofascial pelvic pain; and (3) expert opinion from panel members.

Management of chronic primary pelvic pain syndromes.

Management of chronic pelvic pain (CPP) remains a huge challenge for care providers and a major burden for healthcare systems. Treating chronic pain that has no obvious cause warrants an understanding of the difficulties in managing these conditions. Chronic pain has recently been accepted as a disease in its own right by the World Health Organization, with chronic pain without obvious cause being classified as chronic primary pain.

Paratesticular liposarcoma: a rare cause of scrotal lump.

Paratesticular tumours are tumours arising from within the scrotum not of testicular origin. They may originate from the epididymis, spermatic cord, tunica vaginalis and other supporting structures. Preoperative diagnosis can be difficult as benign and malignant cases are often indistinguishable and may be confused with other benign or malignant pathology (testicular tumours or hernias).

The Benefits and Harms of Botulinum Toxin-A in the Treatment of Chronic Pelvic Pain Syndromes: A Systematic Review by the European Association of Urology Chronic Pelvic Pain Panel.

Context: Patients with chronic pelvic pain syndrome (CPPS) may have pain refractory to conventional management strategies. Botulinum toxin A (BTX-A) is a potential therapeutic option.

Objective: To evaluate the benefits and harms of BTX-A injections in the treatment of CPPS.

Recommendations for future development of contractility and obstruction nomograms for women. ICI-RS 2014.

Aims: At present, existing bladder outlet obstruction (BOO) nomograms for women are still not universally accepted. Moreover, only limited information is available regarding bladder contractility in women. The aim is to present the discussions and recommendations from the think tank session "Can we construct and validate contractility and obstruction nomograms for women?" held at the 2014 International Consultation on Incontinence-Research Society (ICI-RS) meeting in Bristol, UK.

Implications for bidirectional signaling between afferent nerves and urothelial cells-ICI-RS 2014.

Aims: To present a synopsis of the presentations and discussions from Think Tank I, "Implications for afferent-urothelial bidirectional communication" of the 2014 International Consultation on Incontinence-Research Society (ICI-RS) meeting in Bristol, UK.

Methods: The participants presented what is new, currently understood or still unknown on afferent-urothelial signaling mechanisms. New avenues of research and experimental methodologies that are or could be employed were presented and discussed.

TRPM8 agonists modulate contraction of the pig urinary bladder.

The transient receptor potential melastin-8 (TRPM8) channel is activated by the "cooling" compounds menthol and icilin. Pathophysiologically, it is implicated in the overactive bladder and bladder cooling reflex, but the activity of TRPM8 in normal bladder physiology is poorly understood. We investigated the distribution of TRPM8 channels and the effect of TRPM8 agonists on the contractile function of pig bladder (n = 35) strips and whole bladders.

The penile tourniquet.

Tourniquets are commonly used in penile surgery to achieve a bloodless operating field or produce artificial erections intraoperatively. Several techniques have been described, but there is a paucity of data and a lack of guidelines to direct their safe use. In penile surgery, it is the local rather than systemic effects of tourniquet use that are the main concern.

The validation of a functional, isolated pig bladder model for physiological experimentation.

Characterizing the integrative physiology of the bladder requires whole organ preparations. The purpose of this study was to validate an isolated large animal (pig) bladder preparation, through arterial and intravesical drug administration, intravesical pressure recording, and filming of surface micromotions. Female pig bladders were obtained from the local abattoir and arterially perfused in vitro.

Sporadic Creutzfeldt-Jakob disease: a description of two cases.

Sporadic Creutzfeldt-Jakob disease (sCJD) is a rare and devastating illness. It is the most frequently encountered form of the spongiform encephalopathies with 50 new cases a year in the UK. It presents with a myriad of symptoms reflecting central nervous system dysfunction and is characterized by a rapidly progressive dementia leading to death.

Success rates for learning intermittent self-catheterisation according to age and gender.

Purpose: Voiding dysfunction becomes increasingly prevalent with ageing. Clean intermittent self-catheterisation (ISC) is associated with a lower morbidity than indwelling transurethral or suprapubic catheterisation. However, doctors and patients sometimes fail to consider ISC as an option because of a perception it will be unmanageable or poorly tolerated.

Increased patient information does not reduce patient anxiety regarding urodynamic studies.

Objective: To establish if patient anxiety pre-urodynamic investigation can be reduced by providing more information within the patient information sheet (PIS).

Patients And Methods: Two prospective cohorts of consecutive patients (round 1, n = 98 and round 2, n = 94) were asked to complete a visual analogue scale (VAS) quantifying their anxiety prior to urodynamics (UDS) and again after UDS quantifying their anxiety of potentially repeating UDS. Patients in round 1 received the standard hospital PIS.

Emerging treatment options for benign prostatic obstruction.

Benign prostatic obstruction (BPO) affects an increasing number of men with age. It can cause troublesome lower urinary tract symptoms, can have a negative impact on quality of life, and may be associated with significant morbidity. Currently available medication and surgical treatments are limited by adverse events, invasiveness, and patient compliance.

Surgical training: the impact of changes in curriculum and experience.

Introduction: Craft specialties, such as surgery, rely on practice to acquire skill. Yet recent changes in training in the United Kingdom have decreased experience and altered the balance of curriculum content. Most recently, the European Working Time Directive has led to a reduction in working hours and expansion in the number of trainees.

Animal models in overactive bladder research.

Overactive bladder syndrome (OAB) is a symptom-based diagnosis characterised by the presence of urinary urgency. It is highly prevalent and overlaps with the presence of bladder contractions during urine storage, which characterises the urodynamic diagnosis of detrusor overactivity. Animal models are needed to understand the pathophysiology of OAB, but the subjective nature of the symptom complex means that interpretation of the findings in animals requires caution.

Clinical tests for carpal tunnel syndrome in contemporary practice.

Introduction: A study conducted to establish the most accurate combination of questionnaire and physical signs for the diagnosis of carpal tunnel syndrome.

Method: Nerve conduction studies confirmed 70 patients with having carpal tunnel syndrome who were enrolled along with 70 age- and sex-matched controls. Patients were assessed using a symptom questionnaire, Phalen's test, Hoffmann-Tinel's sign, hand elevation test, carpal compression test, tourniquet test, pressure aesthesiometry and two-point discrimination.

The role of invasive and non-invasive urodynamics in male voiding lower urinary tract symptoms.

Introduction: Troublesome voiding lower urinary tract symptoms (LUTS) are a common problem in men, particularly with ageing. Implicitly, management of voiding LUTS can be guided by accurate determination of underlying mechanisms, distinguishing men with voiding symptoms caused by outlet obstruction from those with reduced bladder contractility.

Methods: A PubMed search of the published literature on invasive and non-invasive methods used to assess lower urinary tract function was carried out.

Prostate cancer and urinary incontinence.

Prostate cancer is the third most common cancer worldwide and an increasing proportion of men are being diagnosed with localised disease. Urinary incontinence is uncommon in healthy men, but may develop as a result of curative treatment for prostate cancer. The optimal therapy remains undefined so the treatment associated morbidity is an important determinant in patient choice.

The clinical impact of magnetic resonance imaging in diagnosing focal hepatic lesions and suspected cancer.

Aims: To compare the clinical utility of contrast enhanced magnetic resonance imaging (MRI) to ultrasound (USS) and computed tomography (CT) in focal hepatic lesions (FHLs)

Methods: This retrospective study analysed 125 consecutive iron oxide enhanced (SPIO) MRI.

Results: MRI made a difference in 74% of patients who had USS and in 42% of patients who had a CT scan. In suspected cancer, MRI changed diagnosis in 58% and 37% (13/35), respectively.

Analysis of referral letters to a department of old age psychiatry.

Objective: There is a paucity of literature on the content of referral letters to psychiatric services and few relating specifically to referrals to a department of old age psychiatry. There has been a significant increase in referrals over the last five years to this service, which may reflect the ageing population and a greater awareness of the service. Our objective was to evaluate the quality and legibility of information received, clarity of reason for referral and details of pre-referral management.

A review of recorded information given to patients starting to take clozapine and the development of guidelines on disclosure, a key component of informed consent.

Clozapine is a very effective drug with both significant benefits and significant risks in treatment-resistant schizophrenia. Informed consent is generally accepted as both desirable and necessary in order to ensure that the patient's human rights and dignity are respected. Disclosure is a key element of informed consent.

A needs analysis for the provision of a speech and language therapy service to adults with mental health disorders.

Objectives: To examine a sample of adults with mental health disorders attending at an area psychiatric service, for the presence of impairments in language, communication and swallowing, using a test battery administered by speech and language therapists.

Method: The study surveyed a randomly selected sample (n = 60) of patients from an acute psychiatric inpatient unit and associated community services, using several standardised measures of language, communication and swallowing.

Results: On this test battery, over 80% (50/60) of subjects studied demonstrated impairment in language; while over 60% (37/60) presented with impairment in communication and discourse.

Oedipism: Auto-enucleation in a schizophrenic patient.

We report the rare occurrence of subarachnoid haemorrhage secondary to probable auto-enucleation of the orbit (oedipism) and we document management of these co-incident pathologies in a schizophrenic patient. A 67 year old schizophrenic woman suffered a subarachnoid haemorrhage and presented with seizures following enucleation of her right eye. Initial efforts should focus on investigation and management of the subarachnoid haemorrhage.