Objectives  To assess the blood loss accompanying TURP and investigate its association with the resected weight of prostatic tissue, type of anaesthesia, type of presentation, histology, different surgeons and their differing techniques, and thus to reduce the morbidity associated with blood loss and transfusion. Patients and methods  All prostatectomies carried out in a district general hospital were audited prospectively, recording the pre‐ and post‐operative haemoglobin concentration (Hb), blood transfusions and the variables listed above. The audit was repeated a year later. Results  The peri‐operative blood loss, as assessed by various indicators, was equivalent to a decrease in Hb of 10–15 g/L (8–11%). The weight of the resected prostatic tissue was the most important measurable factor in determining blood loss. Regional anaesthesia was associated with less blood loss than general anaesthesia. The added use of a suprapubic catheter for irrigation appeared to have a marginal advantage in large resections. The type of presentation, elective or otherwise, and the histological nature of the prostate did not influence blood loss. Smaller transfusions were probably avoidable in patients having smaller resections and a normal pre‐operative Hb. On re‐auditing, the overall transfusion rate was reduced from 10.8% to 8.2% and from 4.4% to 1% in patients having resections of <30 g. Conclusion  Blood transfusion can be reduced and rationalized. Patients with a normal pre‐operative Hb and undergoing resections of <30 g do not usually require transfusion. Regional anaesthesia is associated with less blood loss but its advantage is overshadowed in practice by the weight of the resected tissue. An audit of this type is repeatable and is useful in raising awareness, objectively assessing differences and advocating and assessing any changes made.

Objective  To evaluate the specificity and sensitivity of the Bard bladder tumour antigen (BTA) (Bard Inc, Covington, USA) test. Patients and methods  The performance of the BTA test was assessed prospectively in 98 patients (30 women and 68 men, mean age 64 years, median 67, sd 14.8) undergoing cystoscopy for various indications. The urine of the patients was assessed using the BTA test, cytology, culture and a dipstick test for haematuria, and the results compared with those from cystoscopy as the ‘standard’. Results  The overall specificity for the BTA test was 79% and the sensitivity 37%. The sensitivity was higher than for urine cytology (33%) but less than for the dipstick test (59%). The specificity was less than for cytology (100%) but higher than for the dipstick test (66%). Conclusion  The BTA test is a rapid, non‐invasive qualitative test identifying degradation products of the basement membrane of the transitional cell epithelium. It represents an advance in the search for a ‘tumour marker’ for carcinoma of the bladder. The specificity is acceptable but the sensitivity relatively low, which limits its value in everyday practice. Further research and development are needed to improve sensitivity.

The value of the correlation between age and PSA is sufficiently high to allow for its practical application up to age 60 years. Beyond that age the correlation is so low that its practical application becomes statistically flawed. This finding seems to match the practical experience when applying age-specific PSA ranges in the diagnosis of early prostate cancer.

Simple digital rectal pressure is a safe, effective and logical method of controlling venous bleeding from the dorsal venous or other plexus between the rectum and symphysis pubis.

Despite the diversity of the available markers, none is truly specific to transitional epithelium, let alone its tumors. Some of the markers used, such as hCG and CEA, are far better known in other fields and seem to be expressed in only a minority of urothelial tumors. The majority of the available markers are tumor associated and should perhaps be considered as by-products of the process of malignancy in the urinary tract. Newer tests which are simple, rapid and easy to use have a practical advantage. These are currently the Bard BTA, BTA Stat and Aura-Tek FDP tests. So far, these markers have achieved only an arguable and marginal role in daily clinical practice, challenging the role of cytology and helping decide the type of cystoscopy. A more substantial role awaits a test with higher and more consistent sensitivity and specificity, together with the capability to provide independent diagnostic and/or prognostic information. In this part of the review we examine the literature view of the above-mentioned tests, as well as other new and some older tests such as blood group-related antigens, Lewis antigen, cytokeratins and others.