We present the unusual case of a spontaneous intraperitoneal bladder rupture as a first presentation of chronic bladder outflow obstruction secondary to benign prostatic hyperplasia. A contributing factor to diagnostic delay was unfamiliarity with the classical presentation of abdominal pain, abdominal distension and urinary ascites leading to autodialysis represented by an unusually high serum creatinine. A cystogram was performed after a non-contrast computed tomography (CT) scan originally performed to determine the cause of abdominal pain, failed to confirm the diagnosis. The patient's initial acute presentation was successfully managed conservatively with prolonged urinary catheterization.

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There is a wealth of evidence which can be traced back to the African transatlantic slave trade indicating that black men have a higher risk of prostate cancer compared to other ethnic groups. Migration to Westernised countries may have had little effect on the incidence of prostate cancer in this ethnic group; however, current evidence indicates that there are several complex factors that may contribute to this risk.Studies in the UK quote that black men are at 2–3 times the risk of prostate cancer in comparison to their Caucasian counterparts, with a 30% higher mortality rate. Caution should be taken prior to the interpretation of these results due to a paucity of research in this area, limited accurate ethnicity data, and lack of age-specific standardisation for comparison. Cultural attitudes towards prostate cancer and health care in general may have a significant impact on these figures, combined with other clinico-pathological associations.This update summarises new contributory research on this subject, highlighting the need to increase awareness and understanding of prostate cancer amongst high-risk communities and to support further robust research in this area by nominating a lead in cancer and ethnicity studies within the National Health Service.

Objectives: Acute urinary retention (AUR) is a common urological emergency; however, when approaching a difficult catheterization, this is an evidence-free zone. Our objective is to investigate current practice with the intent to reach a workable consensus for the management of patients in AUR who cannot be easily catheterized urethrally. Subjects: We performed a hypothetical scenario-based, multideanery survey with urology consultants and ST3+ trainees. Participants were asked how they would manage three patients who prove difficult to catheterize using standard methods: benign prostatic obstruction (BPO), urethral stricture, and meatal stenosis. Results: Of respondents, 38% (n=23) indicated that a 16F curved-tip silicone catheter would be their first choice in managing a patient with BPO, followed by a suprapubic catheter (SPC) (20%, n=12) if this failed. SPC would be the firstline option for patients with a urethral stricture for 67% (n=40) consultants, and for those with meatal stenosis, 60% would use a meatal dilator followed by SPC (22%, n=13) if this failed. Conclusion:Although there are general trends in preference towards managing a patient who is difficult to catheterize with AUR, there still remains considerable variation in practice due to lack of evidence in this area. We would recommend further multicentre data determining guidelines for best practice.