Abbreviations & AcronymsObjective: To report discontinuation rates, inter-injection interval and complication rates after repeated intravesical botulinum toxin type A for the treatment of detrusor overactivity. Method: Patients with urodyamically proven detrusor overactivity who had two or more botulinum toxin type A injections in the period 2004-2011 at Freeman Hospital, Newcastle Upon Tyne, UK, were considered for the present study. Discontinuation rates, complication rates and interval between botulinum toxin type A treatments were retrospectively analyzed. Results: Overall, 125 patients (median age 53 years, range 19-83 years) were included in the analysis. The female-to-male ratio was 2.4:1 and median follow up was 38 months. A total of 96 patients had idiopathic detrusor overactivity, whereas 29 had neurogenic detrusor overactivity. A total of 667 injections were carried out, with 125 patients receiving two injections, 60 receiving three injections, 28 receiving four injections, 14 receiving five injections, three receiving six injections, three receiving seven injections and two receiving eight injections. The mean interval (±standard deviation) between the first and second injection (n = 125) was 17.6 months (±10.4), between the second and third (n = 60) was 15.7 ± 7.4 months, between the third and fourth (n = 28) was 15.4 ± 8.6 months, and between the fourth and subsequent injections (n = 22) was 11.6 ± 4.5 months. A total of 26% required intermittent catheterization, and 18% developed recurrent urinary tract infections. There was a discontinuation rate of 25% at 60 months. Conclusion: Repeated botulinum toxin type A injections represent a safe and effective method for managing patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity. We have shown that the inter-injection interval remains unchanged up to five injections.

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Objective: Transurethral resection of the prostate (TURP) operations are frequently deferred. Consequently, patients awaiting TURP have multiple urology-related admissions for problems such as urinary retention. This audit aims to determine the effect of TURP deferments on the frequency and duration of urology-related admissions, as well as the financial implication in our institution over a three-month period. Patients and methods: A retrospective, electronic database review of patients who received a TURP at Northwick Park Hospital, between 1 January 2014-31 March 2014, was carried out. The following data were extracted: (a) date the patient was listed for TURP; (b) date patient underwent TURP; (c) number of deferments between a patient being listed for surgery and receiving their operation; (d) reason(s) for deferment; and (e) number, duration and indication of urology-related inpatient admissions whilst awaiting TURP. Using this data, we calculated the cost of urology-related admissions whilst awaiting surgery. Results: In total, 44 patients underwent a TURP operation. Of these, 21 patients had their TURP deferred. There were 23 urology-related admissions whilst patients awaited a TURP. Fifteen of these admissions were attributed to eight patients with deferments to surgery. They spent a total of 45 days/30 nights in hospital. The remaining eight urologyrelated admissions were accounted for by six patients with no deferments to surgery. They spent 12 days/3 nights in hospital. We approximate a daily cost of £250 for an NHS bed. This equates to a total cost of £11,250 (£1406 per patient) for the eight patients who had TURPs deferred versus £3000 (£500 per patient) for those six patients without deferments. Conclusion: Patients who have their TURP operations deferred have an increased frequency and duration of urologyrelated admissions, associated with an additional cost of at least £900 per patient.

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Large para-aortic mass enveloping both ureters with lymphadenopathy in the right and left iliac chain.