This is the largest, contemporary cohort of ORCs in England, encompassing >80% of all performed operations. We now know the current standard for ORC in England. This provides the basis for individual surgeons and units to compare their outcomes and a standard with which future techniques and modifications can be compared.

Objective To ascertain current trends in the incidence and mortality rates for upper tract urothelial cancer (UTUC) and identify any relationship with age, stage at presentation, social deprivation and treatment method. Patients and Methods We used national databases to collect the data: incidence, stage and survival data from the National Cancer Data Repository (NCDR) and British Association of Urological Surgeons (BAUS) audit database; mortality data from the Office for National Statistics (ONS); and treatment method data from the Hospital Episodes Statistics (HES). Results The incidence of UTUC is increasing (from 1985 to 2009 it increased by 38% in men and 77% in women). It affects mainly those aged >60 years, and diagnoses are increasingly made in those aged >80 years. Diagnoses at advanced stage have increased from 45 to 80%. Mortality has risen faster than incidence; the overall 5‐year survival rate has dropped from 60 to 48%. Survival is worst in stage IV disease and in patients aged ≥80 years; when analysed by age or stage group, survival rates are unchanged. Nephroureterectomy has increased by 75%, but endoscopic treatment, which only became available part way through the study period, now accounts for 11% of surgical interventions for UTUC, mainly in stage I disease and in the elderly. Conclusions Despite sharing its risk factors with bladder cancer, current incidence and mortality trends for UTUC contrast with those in bladder cancer. Increasing use of cross‐sectional imaging may explain some of the identified increased incidence. Higher incidence specifically in people >80 years, together with stage migration to more advanced cancers, are likely to have caused at least some of the observed increased mortality. Further study is required to answer the questions of whether there are other hitherto unidentified aetiological or prognostic factors; whether less aggressive treatment of UTUCs in the elderly is always justified; and whether the rising frequency of minimally invasive treatment means suboptimum oncological management.

Male lower urinary tract symptoms (LUTS) are common, causing significant bother and impair quality of life. LUTS are a spectrum of symptoms that may or may not be due to benign prostatic obstruction (BPO). LUTS are divided into storage, voiding or post micturition symptoms, which each need to be considered in terms of impact, mechanism and treatment options. In most patients, a mixture of symptoms is present. In order to have a better insight about which symptoms are affecting quality of life, a thorough evaluation should include medical history, examination, validated symptom questionnaires, bladder diary, and flow rate (with post void residual measurement). Other tests, particularly urodynamic tests may be needed to guide treatment selection, particularly for surgery. Management of male LUTS is tailored according to the underlying mechanisms. Different treatment modalities are available according to individual patient preference. These range from watchful waiting, behavioral and dietary modifications, and/or medications - either as monotherapy or in combination. Surgery to relieve BPO may be needed where patients have significant bothersome voiding LUTS, and are willing to accept risks associated with irreversible treatment. Interventions for storage LUTS are available, but must be selected judiciously, using particular caution if nocturia is prominent. In order to achieve better outcomes, a rational stepwise approach to decision making is needed.

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