Conventional surgery for female stress incontinence is usually successful but recurrent cases are difficult to treat. This study of 20 such cases treated by the Remeex TRT system shows symptomatic benefit up to 5 years following insertion of the device. The benefit of this procedure is that the sling can be adjusted to the correct tension in the optimum leak position and circumstances, and anytime thereafter without the need to repeat the entire operation. As a result, the voiding dysfunction rate and need to intermittent self-catheterise is reduced, even with a low pressure urethra. The cost per procedure and complication rate is higher that standard TVT, and the device may occasionally need removal due to persistent seroma. However, the improved quality of life makes this operation an attractive option in recurrent cases of female stress incontinence.

Key content Urethral diverticulum (UD) is uncommon but is underdiagnosed. Imaging is essential before surgery is planned. Missed diagnosis may result in continued symptoms. Surgery for UD is challenging and complications are common. Learning objectives To review the symptomatic presentation of UD. To review the differential diagnosis of a mass in the urethra. To understand how imaging may help in the diagnosis of UD. To review the management of complications of UD. To review the surgical treatment of UD. Ethical issues If not performed adequately surgery may result in a worsening of symptoms especially urinary incontinence. Surgery is difficult and should be performed by specially trained individuals

Obstetric anal sphincter injuries (OASIS) are common and may greatly affect a patient's quality of life. There is very little information regarding optimum management in future pregnancies. Based upon anecdotal experience, this study describes the recommendations of a cohort of consultant obstetricians in the UK, in this clinical situation. There is limited adherence to the available national guidelines due to the absence of available equipment and expertise to perform endo-anal ultrasound and manometry. Elective episiotomy is still recommended by a small number of obstetricians but the majority of patients are routinely followed-up. Caesarean section is only advised for asymptomatic patients with a previous stage 4 tear, and for any symptomatic patient with a previous stage 3 or 4 tear, irrespective of subgrade. A request for elective caesarean section is likely to be granted, irrespective of OASIS grade. The use of postpartum endo-anal ultrasound would help identify those women in whom a further vaginal delivery is unlikely to exacerbate any symptoms of faecal incontinence.

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Intrathoracic kidneys are rare. A case is described in which the initial intravenous urogram performed for prostatism appeared to show a non-functioning right kidney. A subsequent ultrasound examination revealed that the right kidney was situated in the right hemithorax, well above the liver. Pelvic ectopic kidneys are common and standard teaching is to perform a full length film should an immediate or 5 minute renal area radiograph suggest an absent/non-functioning kidney. With the increasing use of ultrasound in the initial assessment of patients with prostatism, the possible intrathoracic location of a kidney should be remembered when there is failure to demonstrate a kidney in the abdomen or pelvis.