BackgroundCurrently there is limited research documenting the changes in blood parameters, following Flexible Ureterorenoscopy. This study aims to determine whether there are any changes in haematology and biochemistry parameters, following Flexible Ureterorenoscopy for the treatment of kidney stones.Methods40 consecutive patients aged between 27–87 years (median 49 years) undergoing Flexible Ureterorenoscopy for the treatment of kidney stones were recruited (26 male, 14 female). Blood samples were collected from each patient at four time points: baseline (pre-operatively) followed by 30 minutes, 120 minutes and 240 minutes post-operatively. On these samples, routine haematological and biochemistry tests were carried out. In addition to the assessment of clinical parameters prospectively from the medical notes.ResultsThere was a significant decrease observed following Flexible Ureterorenoscopy in the following parameters: lymphocytes (p = 0.007), eosinophils (p = 0.001), basophils (p = 0.001), haemoglobin (p = 0.002), red blood cells (p = 0.001), platelet count (p = 0.001), fibrinogen concentration (p = 0.001), von Willebrand factor (p = 0.046), C reactive protein (p = 0.01), total protein (p = 0.001), albumin (p = 0.001), globulin (p = 0.001) and alkaline phosphatase (p = 0.001). In addition, there was a significant increase observed in the following parameters: white blood cells (p = 0.001), neutrophils (p = 0.001), activated partial thromboplastin time (p = 0.001), total bilirubin (p = 0.012), creatinine (p = 0.008), sodium (p = 0.002) and potassium (p = 0.001). Limiting factors for this study were the sample size, and restriction on the recruitment time points.ConclusionsSignificant changes were noted to occur in haematology and biochemistry parameters following Flexible Ureterorenoscopy. Some of the data presented in this study may represent the ‘normal’ post-operative response following FURS, as no major complications occurred, in the majority of our patients. This data on the ‘normal response’ will need to be validated but may ultimately aid clinicians in distinguishing patients at risk of complications, if reproduced in larger multi-centre studies.

An ideal treatment option for symptomatic Benign Prostatic Hyperplasia (BPH) should relieve lower urinary tract symptoms (LUTS) and restore Quality of Life (QoL). Currently available medical therapies and surgical options for symptomatic BPH have side effects that adversely affects quality of life. Prostatic urethral lift (PUL) is a novel endourology procedure that promises to relieve LUTS without the aforementioned side effects. Areas covered: We diligently reviewed all the published literature on PUL, till July 2016 using standard search criteria. Expert commentary: There is good quality evidence to establish the efficiency of PUL in treating symptomatic BPH without adversely affecting the QoL. Based on the current literature, PUL can be considered as an option for those symptomatic BPH patients with small or medium size prostates (< 80 ml) without median lobe enlargement, who failed on medical therapy or are intolerant to it and wish to preserve their sexual function.

INTRODUCTION AND OBJECTIVE: Adopting an MRI first approach in prostate cancer diagnostic pathway has helped in decreasing the number of unnecessary prostate biopsies. Guidelines still recommend performing both targeted biopsy (TBx) and systematic biopsies (SBx) even when a lesion is detected in MRI. The prospect of doing only TBx if a definite lesion is seen in MRI is desirable as this decreases the morbidity of the procedure. However this has to be balanced against the risk of missing clinically significant prostate cancer (csPCa). We examined the data of our local anaesthetic transperineal (LATP) prostate biopsies, with MRI scan scores of PIRADS 4 & 5 and targetable lesion, and analysed the percentage of csPCa that would have been missed if only TBx were performed.METHODS: We retrospectively collected the data of 650 patients who underwent LATP biopsies in our institute from February 2019 to July 2022. 329 patients had MRI score of PIRADS 4 or 5. All these patients had SBx and TBx according to the Ginsburg TP protocol. For MRI targetable lesions a four core cognitive guidance TBx was done per target. csPCa was defined as ISUP grade group 2 or more.RESULTS: 329 patients had MRI score of PIRADS 4 or 5. 245 (74.5%) had targetable lesion and underwent both TBx and SBx. Both TBx and SBx were positive for csPCa in 39.6% (97/245). Both TBx and SBx didn't show csPCa in 46.1% (113/245). In 5.7% (14/245), TBx showed csPCa when SBx was negative. In 8.6% (21/245), csPCa detected by SBx was missed by TBx. 15.9% (21/132) csPCa would have been missed if only TBx was performed for PIRADS 4 & 5 with an MRI targetable lesion. The sensitivity of TBx in this study was 82.2%, with specificity of 89.0% and a negative predictive value of 84.3%.CONCLUSIONS: his study from a high-volume centre suggests that adopting the TBx-only approach for MRI targetable lesions continues to miss a significant level of csPCa. Therefore adopting this strategy remains debatable