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were studied further. Two urology registrars examined the films independently. Location, size and length of stone were recorded. Where there was discordance, the films were examined by an independent radiologist. RESULTSIn all, 108 of 163 patients had both CT and KUB imaging on the same day. Stones were identified in 63% (68/108) of patients with KUB, with a mean length of 4.93 mm. There were 40/108 radiolucent stones subsequently measured on CT, with a mean length of 4.90 mm. Stones were seen on 47% (51/108) of the CT scouts, with a mean length of 5.22 mm. Importantly, all stones visible on CT scout were also visible on KUB. There was no correlation between stone location and visibility on KUB or CT scout films. CONCLUSIONKUB could be used for follow-up in 63% of cases. All stones seen on CT scout were also visible on KUB. Scout detected 75% of stones visible on KUB. We suggest CT scout film should be reported before proceeding to KUB. If the stone is visible on CT scout film, then the decision to use KUB for follow-up can be made. This minimizes radiation exposure and other costs.

Penile fracture: second episode in 5 yearsPenile fracture is a rare condition, accounting for 1 in 175 000 emergency presentations. 1 The most common cause is trauma during sexual intercourse, whereby the erect penis strikes the pubic symphysis or perineal body. It can be managed either surgically or conservatively. Gamal et al. reported 96% of patients treated with acute surgical repair achieving an erection adequate for intercourse, with no voiding dysfunction and no penile curvature versus 50% of those managed conservatively at a median follow-up of 20.8 months. 2 This result is consistent with other published series; however, there is only one other report of a patient who has had two penile fractures in the literature to date. 3 This is a rare case where a patient presented with his second penile fracture in 5 years and underwent acute surgical exploration and repair on both occasions.A 48-year-old man, previously well, non-smoker, presented to the emergency department with a painful, swollen penis. He describes having slipped during sexual intercourse 2 h prior and heard a 'popping' sound. The penis then became flaccid and swollen. He was still able to void without macroscopic haematuria. Clinically, the penis was deviated to the left with haematoma over the right ventral penile shaft. The patient was taken to theatre for an acute exploration.Five years ago, the patient had suffered a penile fracture via a similar mechanism. He underwent an acute exploration through a circumferential, sub-coronal incision, and a horizontal defect in the left corporal cavernosum was repaired.On this occasion, a 16Fr catheter was inserted with ease intraoperatively. The previous incision was used, and upon mobilization of the corpora spongiosum and right corpora cavernosum, it became clear that there was a longitudinal defect in the right corporal cavernosum ventro-medially, which required lateral retraction of the urethra to allow full visualization. The haematoma was then evacuated and defect was closed with simple, interrupted, inverted absorbable sutures.Post-operative recovery was unremarkable and he was discharged 2 days later. At the first follow-up visit 6 weeks later, there was good healing, and spontaneous erections to allow completion of intercourse with minimal penile curvature (see Fig. 1).This case reinforces the argument that acute exploration and repair is the gold standard treatment for penile fractures and is associated with highly successful and functional outcomes, even in the setting of a second penile fracture. References 1. Miller S, McAninch JW. Penile fractures and soft tissue injury. In: McAninch JW (ed.).

Waiting 5 min after PNB did not reduce pain in men undergoing TRUS-guided prostate biopsy.

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