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BackgroundBotulinum toxin was first described in 1895. It is a potent neurotoxin released by clostridium, a gram-negative, anaerobic, rod-shaped bacterium. Initially, it was considered to be the cause of life-threatening disease. However, research demonstrated it to be a novel and effective therapy in managing a range of diseases, including some that affect the urinary bladder. It was approved by the Food and Drug Administration (FDA) in 1898. ObjectivesThis study aimed to evaluate the long-term effects of intravesical botulinum toxin A (BTA) injections in patients with an indwelling long-term catheter for detrusor overactivity. The patients selected for this study were experiencing significant catheter-associated symptoms such as bypassing, bladder spasms, intractable pain, blockages, and recurrent infections. MethodA retrospective cohort study was conducted in patients that received intravesical BTA after the failure of symptom management using oral anticholinergic and beta 3-adrenocepter agonist. A group of 12 patients was identified, and they were followed up in the clinic after receiving treatment. ResultsAll of the patients included in this study had relief of their symptoms following administration of intravesical BTA. Almost 58% (n = 7) of patients required 3 or fewer treatments with BTA to gain symptom control, with the remaining patients gaining control after 4 treatments. There were no significant adverse events reports with only mild and temporary side effects, such as haematuria, experienced. ConclusionThis study demonstrated that intravesical BTA can significantly improve symptoms associated with long-term indwelling catheters and may help avoid more complex and invasive interventions.

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We report a 79-year-old gentleman with an asymptomatic intra-ureteric encrusted suture thread. He was found to have calcification in the left renal pelvis and thickening of the upper ureteric wall on a follow-up computerised tomography (CT) scan ten years after a radical cystoprostatectomy and ileal conduit formation for bladder and prostate cancer. These incidental CT scan findings raised the possibility of either ureteric stone or tumour. Subsequently, the patient underwent a ureterorenoscopy, which revealed a calcified 6cm length thread thought to be a suture that slipped intraoperative during his initial radical surgery ten years earlier.

BackgroundThoracic ureteric herniation is an uncommon finding with a varying presentation. Since its first documen-tation in 1958, few case reports have been published, and there is no consensus on its management. This condition is typically asymptomatic, with most cases identified incidentally from cross-sectional imaging or discovered intra-operatively.As a result of differing presentations and a lack of consensus or evidence of best practice, this rare finding’s management is not defined. This can range from adopting a conservative approach to more invasive measures such as ureteric stenting or pyeloplasty to repair the thoracic hernia.The authors present a case of thoracic ureteric herniation in a 74-year-old male presenting with right-sided abdominal pain. This patient was known to have a diaphragmatic hernia following pulmonary fibrosis investigations and chronic obstructive pulmonary disease (COPD). At presentation, there was acute kidney injury (AKI), and subsequent computed topography (CT) demonstrated right-sided hydronephrosis and perinephric fat stranding. This was caused by ureteric obstruction with a transition point at the site of thoracic herniation. The patient was successfully managed with retrograde ureteric stent insertion.This case report aims to highlight variance in the presentation of ureteric thoracic herniation and discuss management options. There is no consensus on management for this condition and choices dependant on specific symptoms and patient factors to the best of our knowledge.