Ann R Coll Surg Engl 2008; 90: 153-155 153The value of urine cytology in the investigation of haematuria is debatable. 1,2As a small minority of cases of transitional cell carcinoma may only be detected by urine cytology, it has been suggested that one can justify the cost of performing routine cytology on all new patients with haematuria. 3The American Urological Association (AUA) best-practice policy for urine cytology recommends the test only in patients with risk factors for transitional cell carcinoma. 4 Urine cytology may be a useful adjunct in the diagnosis of urothelial carcinoma. Overall sensitivity is, however, dependent on the degree of differentiation. Interpretation of cytology is observer-dependent and lacks a simple reproducible consensus for diagnostic criteria and terminology. Interpretation may be compromised by atypia, low cellular yield, inflammation, degenerative changes and therapeutic interventions. A fresh, uncontaminated specimen is required in order to optimise evaluation.Performing urine cytology on all patients has significant financial and man-power implications. This study evaluates the clinical value and cost-effectiveness of urine cytology in a one-stop haematuria clinic. Patients and MethodsA total of 1000 consecutive patients who attended the onestop haematuria clinic, with either microscopic or macroscopic haematuria, between June 2003 and November 2004 were studied prospectively. The patients were evaluated according to a standard protocol. All patients were seen and examined by a member of the urology team and investigated on the same day. Investigations included urine cytology, blood tests as appropriate, upper tract imaging (IVU for macroscopic haematuria or ultrasound scan for microscopic haematuria) and flexible cystoscopy.Urine samples were obtained at the time of examination before flexible cystoscopy and prepared according to a standard protocol. All abnormal results including malignant cells, suspicious cells and atypical cells were considered positive. The objective of this study was to determine the value of routine urine cytology in the initial evaluation of patients presenting to a one-stop haematuria clinic. Ann R Coll Surg Engl

ObjectiveTo summarize the practice of UK urologists with regard to nephrectomy for benign disease, documenting the indications, procedural techniques and outcomes. MethodsAll patients undergoing nephrectomy for a benign condition in 2012 were identified from the British Association of Urological Surgeons (BAUS) nephrectomy database. Recorded variables included the technique of surgery, the type of minimally invasive procedure, operating time, blood loss, transfusion rate, conversion rate, intra-and postoperative complications and mortality rate. Cases were also subanalysed according to their pathologies to determine the differences in complication rate between stone disease, pyelonephritis, non-functioning kidney and other benign lesions. To contextualize procedural complexity, the simple nephrectomy data were compared with those obtained from the BAUS stage T1 radical nephrectomy audit. ResultsA total of 1 093 nephrectomies were performed (537 nonfunctioning kidneys, 142 stone disease, 129 nephrectomies secondary to pyelonephritis and 285 cases with other benign conditions). Of these, 76% were performed laparoscopically. Blood loss >500 mL was noted in 74 cases with a 4.8% blood transfusion rate. The intra-and postoperative complication rates were 5.2 and 11.9%, respectively. Of the 847 minimally invasive procedures, the conversion rate was 5.9%. Patients with stone disease have the highest intra-and postoperative complications (9.9 and 23.9%, respectively) compared with other benign pathologies. The total number of T1 radical nephrectomies performed was 1 095. In comparison with T1 radical nephrectomy, simple nephrectomy carries an increased risk of conversion to an open procedure (1.8 times), a higher rate of blood transfusion (4.8 vs 2.8%), and a higher risk of intra-and postoperative complications (5.2 vs 3.7% and 11.9 vs 10%, respectively). ConclusionThe present study reports the largest series of nephrectomies performed for benign disease and the resultant data now support the bespoke preoperative counselling of patients. Furthermore, it confirms the commonly held view that simple nephrectomy can be more difficult than its radical counterpart. The authors suggest that the term 'simple nephrectomy' is changed to 'benign nephrectomy'.

The efficacy of laparoscopic pyeloplasty is equivalent to that of open pyeloplasty, with less wound pain at 6 months. The outcome for secondary procedures is inferior. There was a trend toward a reduction in complications and the conversion rates with time, suggesting that there may be a learning curve of approximately 30 laparoscopic pyeloplasty cases. Preoperative stent insertion did not seem to affect any objective measures of outcome for laparoscopic pyeloplasty.

Retrograde ureteroscopy in patients with ileal conduits can be technically challenging due to distorted anatomy. This procedure can be safely performed in experienced hands with standard endourological equipment. An antegrade approach can be carried out simultaneously, which may be required in a small number of patients.

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