Rectal administration of diclofenac 1 hour prior to TRUS and prostate biopsy is a simple procedure that significantly relieves the pain experienced with no increase in morbidity. With the trend toward more core samples, screening for prostate cancer and the younger age of patients undergoing biopsy we urge urologists to provide analgesia for this painful procedure.

Two series of patients with histologically proven interstitial cystitis that was unresponsive to hydrostatic bladder distension and intravesical chemotherapy with dimethyl sulfoxide have been studied. In the first series 24 patients were treated by subtotal cystectomy and substitution cystoplasty without further consideration; 8 of these 24 patients had persistent frequency due to active disease in the remaining trigone and/or urethra and in 2 cases this was severe. Because of this experience the second group of patients had routine biopsy of the trigone and assessment of urethral sensation as part of the initial assessment. In those in whom the trigone was unaffected, treatment was unchanged. If the trigone was affected, total cystourethrectomy was performed with substitution cystourethroplasty unless the patient chose or was advised to avoid surgery altogether or to have a simpler option such as conduit or continent urinary diversion. Trigonal biopsies should be part of the routine assessment of all patients being considered for surgery, since residual active disease is a major cause of dissatisfaction after subtotal cystectomy and substitution cystoplasty.

Ann RC oll Surg Engl 2008; 90:5 65-570 565Prior to August 2004, general practitioners (GPs) in East Suffolk were able to investigate patients with scrotal disorders in several ways. Direct referral to the diagnostic imaging department for testicular ultrasound scan followed by ar eport by fax or mail involved several delays for the patient in the diagnostic pathway. Following this, referral to the urologydepartment may then have ensued, resulting in further diagnostic delay.A lternatively,i maging was arranged after consultationw ith as enior urologist, resulting in two separate department visits on three occasions in addition to their initial GP consultation. In 2003, the diagnostic imaging department received 560 requests for scrotal ultrasonography,a nd the waiting time for such ascan, if routine, was in excess of 20 weeks. It was possible, however,ifthe index of suspicion was high, for the investigation to be performed on the same day as the consultation.It was believed that the varied systems for patient evaluation provided neither the best quality service nor utilised resources with maximum efficiency.A ss uch, the patient pathway was redesigned to provide aone-stop service in an attempt to provide rapid and simpler diagnosis and instigation of definitive treatment. Funding was provided by the NHS Modernisation Agency'sA ction On Urology project. Men who were referred by their GP with at esticular or scrotal condition would be reviewed in aj oint sonographer and urology nurse specialist clinic provided entirely within the urology department with rapid open access. This service was to be provided in parallel with established urology general out-patient sessions where consultant urologists , the waitingt ime for routine scrotal assessment approached 6m onths in our hospital. The patients' diagnostic pathway was not uniform and involved several delays between general practitioner,r adiologist and urologist. If malignancy was suspected, patients were seen and assessed within 2w eeks. However,i tw as possible for patients with unsuspected malignancy to have their diagnosis delayed.

Pelvic actinomycosis is a rare cause of ureteric obstruction. The diagnosis is usually difficult and often only apparent after histological examination of an operative specimen. The following case led us to consider the aetiology, clinical findings and to review the management of reported cases.