There appears little evidence to suggest that retrograde stent insertion leads to increased bacteraemia or is significantly more hazardous in the setting of acute obstruction. Further region-wide discussion between urologists and interventional radiologists is required to establish management protocols for these acutely unwell patients.

Objectives: The aim of this study was to correlate the prostate-specific antigen (PSA) level and Gleason score with staging bone scan result in patients with a new diagnosis of prostate cancer in order to establish the feasibility of implementing the European Association Urology guidelines, which state that a bone scan may not be indicated when PSA ,20 in well-moderately differentiated tumours. Methods: We identified 633 patients retrospectively and 186 patients prospectively with a new diagnosis of prostate cancer undergoing a staging bone scan between March 2005 and January 2010. Patients were excluded if there was no Gleason score available or if the PSA level was checked over 3 months prior to bone scan. Bone scan results were analysed with respect to age, PSA level and Gleason score. In the case of an equivocal result, subsequent imaging was taken into consideration or the initial bone scan was re-reviewed. In persistently equivocal cases, all relevant imaging was assessed by a blinded panel of radiologists to allow a final decision to be made. Results: Of 672 patients aged 39-93 years (median 71 years), who fulfilled the inclusion criteria, 54 (8%) had evidence of bony metastases. PSA level and Gleason score were both independent predictors of bone scan positivity and their predictive value was additive p,0.01. None of the 357 patients with a PSA level of ,20 and a Gleason score of ,8 had a positive bone scan. Conclusion: Staging bone scans in newly diagnosed prostate cancer patients with a PSA level of ,20 and a Gleason score of ,8 can be safely omitted, with these criteria having a negative predictive value of 100% in our series.

From 1999, the NHS Ayrshire and Arran Health Board implemented an innovative nurse-led collaborative care model for the management of patients with prostate cancer (PC). This article describes the model and presents the results of a local evaluation to assess its impact. The evaluation comprised a retrospective audit of the service against national standards for PC management, undertaken in 2012. Seventy-one patients, who were under the care of the service during June 2008, were included. Patient and staff satisfaction were also assessed using questionnaires distributed to 75 patients undergoing outpatient or telephone reviews during April 2012 and 7 one-to-one semi-structured staff interviews. The patient audit showed good compliance with standards relating to selection of appropriate PC treatments according to tumour stage and grade; radiotherapy dosing and referral-to-treatment times. Areas requiring improvement were the documentation of patients' risk and performance status and provision of verbal and written information to patients and carers. Seventy-three per cent of the patient questionnaires were returned, with 96% of respondents rating their overall care as 'excellent' or 'very good'. Staff satisfaction was also high and interviewees described many benefits of the service for patients, hospital staff, GPs and the NHS/health board. Negative responses related mainly to demand/capacity issues. Overall, the evaluation showed good compliance with many national standards and high levels of patient and staff satisfaction. This suggests that with trained and competent nursing staff and collaborative multidisciplinary team working, safe and appropriate care can be achieved for more complex, as well as very stable PC patients.

Pilot study looking at the combination of general anaesthetic hydrodistension and intravesical hyaluronic acid for treatment of refractory interstitial cystitis. Twenty-three treatment refractory patients were recruited with an average age 53.4 years. All underwent general anaesthetic cystoscopy, hydrodistension and instillation of hyaluronic acid (40 mg/50 ml). The bladder was then subsequently drained with the patient awake. Two initial treatments were carried out a month apart and duration between treatments increased depending upon symptom response. In the responders, the average number of treatments was 6.6 (median 4.5), duration between treatments was 3.1 months (median 2.6) and follow-up 15.8 months (median 16). Seventeen patients (74%) responded with immediate improvement in symptoms. In all responders, healing of ulceration and resolution of inflammation occurred. Average anaesthetic bladder capacity increased in the responder group from an average of 492 ml (median 500 ml) to an average of 776 ml (median 700 ml). Our pilot data suggests sequential hydrodistension and hyaluronic acid treatment under general anaesthesia may be considered for resistant cases of interstitial cystitis, especially those that cannot tolerate the instillation procedure under local anaesthesia. Further prospective trials are required.

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