Cricoid pressure has been used for over 200 years. During that time, training in the technique has not changed greatly, despite the well-documented potential for complications if performed improperly. Typically, training relies on quantitative or qualitative descriptions such as "firm" pressure, a number of Newtons of force or equivalent force to that causing pain while pressing on the nose. This study tests the value of these descriptive methods in training to apply cricoid pressure. Fifty subjects were asked to apply cricoid pressure after receiving a description of the force required and again after having tested how much finger pressure on the bridge of their nose was required to cause discomfort. Initial force, force at 45 seconds, minimum force, and maximum force was recorded. The results were analysed using the Wilcoxon signed ranks test, which showed no significant difference in performance between the two types of training. One subject maintained pressure in the range of 25 to 35 Newtons for the entire 45 seconds of the first attempt but no subject performed this well on the second attempt. The use of qualitative and quantitative descriptors of the appropriate pressure does not appear useful in the training of the technique of cricoid pressure. Training incorporating force feedback is recommended.

ObjectiveTo assess changes in lower urinary tract symptoms (LUTS) and quality of life (QoL) after robot-assisted radical prostatectomy (RARP). Patients and MethodsA prospectively curated database of 1917 consecutive RARPs undertaken over an 8-year period from January 2009 to January 2017 was assessed. Preoperative information including age, prostate-specific antigen (PSA) level, body mass index (BMI), International Prostate Symptom Score (IPSS) and QoL score was collected, with IPSS and QoL score compared between baseline (preoperatively) and 12 months post-surgery. ResultsOf the 1917 patients who underwent RARP, 1470 with complete data were included in the analysis. Their mean AE SD age, prostate weight and BMI were 62 (AE6.7) years, 51 (AE17.6) g, and 28 kg/m 2 , respectively. Overall, 57% of patients reported an improved IPSS score, whilst 76% reported an IPSS of ≤7 postoperatively. A total of 41% of patients reported an improved QoL and 90.3% of patients with severe preoperative LUTS (IPSS 20-35) demonstrated clinically improved LUTS at 1 year post RARP. The post-RARP mean IPSS in the present study was lower than those reported in the existing post-radiotherapy literature, especially in patients with moderate to severe baseline LUTS (IPSSs ≥ 8). ConclusionsAt 12 months post RARP, most patients reported improved overall LUTS and QoL, with the greatest benefit seen in those patients with a high pre-RARP IPSS. This has implications for treatment selection and preoperative counselling in men being offered active treatment for their prostate cancer. Further analyses of specific IPSS domains and longer followup are needed. KeywordsInternational Prostate Symptom Score, lower urinary tract symptoms, prostate cancer, quality of life, robot-assisted radical prostatectomy, survivorship Abbreviations: QoL, quality of life; RARP, robot-assisted radical prostatectomy; PCa, prostate cancer.

Retroperitoneal angiomyolipoma is a rare tumour that is difficult to diagnose preoperatively. We present a case of retroperitoneal angiomyolipoma that highlights its diagnostic dilemma. We also performed a literature review and present a review of retroperitoneal angiomyolipoma.

Penile metastases from prostate cancer (PC) are rarely reported in the literature. Most commonly diagnosed due to presentation with malignant priapism and other urinary symptoms or from findings on clinical examination, prognosis has been reported to be poor. The authors outline a case of penile metastasis from advanced PC. Initially treated with neoadjuvant androgen deprivation therapy for locally advanced PC, this patient displayed upfront castrate resistance, and subsequent prostate-specific membrane antigen positron emission tomography revealed penile metastatic deposits. The patient was treated with external beam radiotherapy, and worsening urethral stricture disease resulted in the placement of a suprapubic catheter.