Cystinuria is a genetic disease that leads to frequent formation of stones. In patients with recurrent stone formation, particularly patients <30 years old or those who have siblings with stone disease, urologists should maintain a high index of suspicion of the diagnosis of cystinuria. Patients with cystinuria require frequent follow-up and a multidisciplinary approach to diagnosis, prevention and management. Patients have reported success in preventing stone episodes by maintaining dietary changes using a tailored review from a specialist dietician. For patients who do not respond to conservative lifestyle measures, medical therapy to alkalinize urine and thiol-binding drugs can help. A pre-emptive approach to the surgical management of cystine stones is recommended by treating smaller stones with minimally invasive techniques before they enlarge to a size that makes management difficult. However, a multimodal approach can be required for larger complex stones. Current cystinuria research is focused on methods of monitoring disease activity, novel drug therapies and genotype-phenotype studies. The future of research is collaboration at a national and international level, facilitated by groups such as the Rare Kidney Stone Consortium and the UK Registry of Rare Kidney Diseases.

We report on the largest surgical series of renal oncocytomas. In the UK, the complication rate associated with surgical removal of a renal oncocytoma was not negligible. Centralisation of specialist services and increased utilisation of biopsy may inform management, reduce overtreatment, and change patient outcomes for this benign tumour.

ObjectiveTo quantify changes in surgical practice in the treatment of stress urinary incontinence (SUI), urge urinary incontinence (UUI) and post-prostatectomy stress incontinence (PPI) in England, using the Hospital Episode Statistics (HES) database. Patients and MethodsWe used public domain information from the HES database, an administrative dataset recording all hospital admissions and procedures in England, to find evidence of change in the use of various surgical procedures for urinary incontinence from 2000 to 2012. ResultsFor the treatment of SUI, a general increase in the use of synthetic mid-urethral tapes, such as tension-free vaginal tape (TVTO) and transobturator tape (TOT), was observed, while there was a significant decrease in colposuspension procedures over the same period. The number of procedures to remove TVT and TOT has also increased in recent years. In the treatment of overactive bladder and UUI, there has been a significant increase in the use of botulinum toxin A and neuromodulation in recent years. This coincided with a steady decline in the recorded use of clam ileocystoplasty. A steady increase was observed in the insertion of artificial urinary sphincter (AUS) devices in men, related to PPI. ConclusionsMid-urethral synthetic tapes now represent the mainstream treatment of SUI in women, but tape-related complications have led to an increase in procedures to remove these devices. The uptake of botulinum toxin A and sacral neuromodulation has led to fewer clam ileocystoplasty procedures being performed. The steady increase in insertions of AUSs in men is unsurprising and reflects the widespread uptake of radical prostatectomy in recent years. There are limitations to results sourced from the HES database, with potential inaccuracy of coding; however, these data support the trends observed by experts in this field. KeywordsHospital Episodes Statistics, HES, urinary incontinence, stress urinary incontinence, overactive bladder, post-prostatectomy incontinence IntroductionUrinary incontinence represents a major health burden. Results from the Epidemiology of LUTS study, a cross-sectional, population-representative survey conducted in the UK, USA and Sweden, indicate that 0.4% of men and 14.8% of women experienced stress urinary incontinence (SUI) on laughing, sneezing or coughing at least a few times each week [1]. In addition, 4.5% of men and 13.1% of women were found to experience 'urgency incontinence' at least a few times each week.The European Prospective Investigation into Cancer and Nutrition study was a population-based, cross-sectional survey, conducted between April and December 2005 in Canada, Germany, Italy, Sweden and the UK, using computer-assisted telephone interviews [2]. This study reported overall weighted prevalences of SUI to be 0.6% in men and 6.4% in women, urge urinary incontinence (UUI) to be 1.2% in men and 1.5% in women and mixed SUI and UUI to be 0.6% in men and 2.4% in women.Incontinence after radical prostatectomy is known to be common. The Scandinavian Prostat...