Introduction: The role of antibiotic prophylaxis for routine flexible cystoscopy (FC) is not clear due to the varying practices of individual clinicians. There are no formal guidelines, and this may be due to a lack of formal summary of the data. Methods: A systematic review was conducted in April 2014 including all randomised control trials on prophylactic antibiotic use for FC. The main outcome measures were confirmed bacteriuria on mid-stream urine (MSU), asymptomatic bacteriuria and symptomatic bacteriuria. A meta-analysis was conducted with difference between groups expressed as an odds ratio (OR) and control group risk. Results: 5,107 patients were included, 2,173 in placebo and 2,934 in the antibiotic group. The OR for all three outcomes favoured the antibiotic group; the risk of developing symptomatic bacteriuria was 0.06 times more likely in the control group (OR 0.34), 0.054 (OR 0.40) for developing asymptomatic bacteriuria and 0.109 for confirming bacteriuria on MSU (OR 0.36). The number needed to treat (NNT) was 15 (13-19) for MSU positive bacteriuria; 32 (27-42) for symptomatic bacteriuria and 26 (23-33) for asymptomatic bacteriuria. Conclusions: Antibiotic prophylaxis did confer a reduction in cases of symptomatic and asymptomatic bacteriuria but the NNT were high. Therefore, the authors cannot advocate the use of antibiotic prophylaxis for routine FC procedures.

With an ever increasing demand for operative procedures within the NHS but little increase in capacity, waiting lists are lengthening, particularly for benign procedures. We sought to determine whether increasing time on a waiting list influences the outcome from a transurethral resection of prostate (TURP), with a primary outcome measure of success at inpatient trial without catheter (TWOC) and pre-operative, peri-operative and post-operative secondary outcome measures. Data was collected from four separate retrospective TURP audits performed between 2009-2015. A total of 379 TURP procedures were included with the time on the waiting list ranging from 8 to 384 days. In patients who were not catheterised pre-operatively success at in patient TWOC by 30 day intervals (in 30 day intervals from 1-30 days to over 151 days) was 79%, 83%, 88%, 87%, 100% and 83%; in those with a catheter, success was 46%, 71%, 75%, 100%, 50% and 86%. In conclusion waiting longer for a TURP does not adversely affect the outcome of inpatient TWOC. Level of evidence: Not applicable-this is a single centre audit over multiple time points.

Unusual clinical course Background:Chest wall reconstruction is sometimes needed after resection of a thoracic malignancy. Various materials and techniques have been utilized to restore stability and integrity to the chest wall. We report what we believe is the first use of a cadaveric Achilles tendon to restore stability and function to the chest wall of a young woman who underwent chest wall resection and right upper lobectomy for a superior sulcus tumor. Case Report:A 46-year-old woman underwent resection of her first through fourth right ribs in addition to her right upper lobe for a squamous cell superior sulcus tumor. Because it was felt her right scapula provided sufficient coverage of her resultant chest wall defect, her chest wall was not reconstructed post-operatively. The patient experienced 2 episodes of scapular prolapse into her thoracic cavity several months after her resection. After the second episode, her right chest wall was successfully reconstructed with a cadaveric Achilles tendon to prevent further episodes of prolapse. Conclusions:We believe this is the first description of chest wall reconstruction with a cadaveric Achilles tendon. The use of a cadaveric Achilles tendon should be considered for reconstruction of the chest wall after complex resection due to its strength characteristics, resistance to subsequent infection, and availability.

Objective: Oral dissolution therapy is a recognised treatment option for radiolucent kidney stones. A standardised nurse-led protocol was developed. Efficacy and compliance was audited and results reviewed. Methods: Twenty-two patients with radiolucent stones were prescribed oral sodium bicarbonate. Patients monitored their urinary pH and the Urology Nurse Practitioner checked compliance. Follow-up with non-contrast computerised tomography of the kidneys, ureters and bladder (CT KUB) was evaluated at 6 weeks. Results: Twenty patients with radiolucent stones completed treatment. Mean stone size was 8 mm (2–23 mm). Nine patients (45%) had complete dissolution, three (15%) had partial dissolution and eight (40%) had no visible response on follow-up CT KUB. The Hounsfield unit (HU) average was 464 (116–1285). Those patients with complete dissolution had HU of less than 605. Three patients with encrusted ureteric stents underwent complete dissolution. Conclusions: Utilisation of a nurse-led sodium bicarbonate dissolution therapy protocol for the treatment of radiolucent stones is effective and acceptable to patients in carefully selected cases. Orally dissolution therapy (ODT) is a suitable option in patients with multiple co-morbidities and high anaesthetic risk. In our series, ODT was also highly effective in treating radiolucent stent encrustation.