Nephrolithiasis during pregnancy can represent a clinical dilemma because of potential risks to both mother and fetus. While the incidence of symptomatic nephrolithiasis during pregnancy varies between 1 in 244 to 1 in 2000 pregnancies, the actual incidence is likely to be higher. A significant proportion of patients with asymptomatic renal calculi are detected incidentally in the nonpregnant population compared with pregnant women. Factors that contribute to the diagnostic challenges include anatomic and physiologic changes to the female urinary tract during pregnancy and the limitations on the use of ionizing radiation. The treatment of such patients requires a multidisciplinary team approach involving the urologist, obstetrician, and radiologist. The potential hazards of intervention (either surgical or medical) and anesthesia need to be considered carefully.

RESULTSWe received 270 (66%) replies, of which six were excluded because they were from subspeciality interests (e.g. paediatric urology) or had ambiguous answers; 264 (64%) were therefore available for analysis. Urethral catheterization was the initial management of choice (98%), failing which a suprapubic catheter was inserted. Two-thirds (65.5%) admitted the patient after catheterization. Most consultants initiated a -blockers (70.5%), with 64% (118) of these using a TWOC 2 days after starting them. One failed TWOC was an indication for transurethral resection of the prostate for 192 (72.8%), with 136 (49.8%) re-admitting the patient for surgery later. Routine follow-up after a successful TWOC was advocated by 77.3%. Just over half the respondents (52.6%) felt that there was no need for uniform guidelines in the management of AUR secondary to BPH. CONCLUSIONThis survey identified a reasonable national uniformity in managing AUR secondary to BPH in the UK, but significant aspects of current practice are not evidence-based. KEYWORDSacute urinary retention, management, a -blocker, trial without catheter, BPH, surgery OBJECTIVETo analyse current practice in the management of acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH) in the UK, and to assess how much of this is evidence-based. METHODSIn all, 410 consultant urologists practising in UK hospitals were sent a questionnaire about the management of AUR secondary to BPH. Data were collected on practice relating to initial management, trial without catheter (TWOC), the use of a -blockers and the followup. The need for a uniform guideline in the management of AUR secondary to BPH was also assessed. INTRODUCTIONAcute urinary retention (AUR) remains the most common urological emergency and is usually caused by BPH [1]. We sought to assess the current practice in the management of AUR secondary to BPH in the UK, and to what degree this was evidence-based. METHODSWithin the UK, 410 consultant urologists were sent a questionnaire about the management of AUR specifically secondary to BPH. We received 270 (65.9%) responses, of which six were excluded from the analysis because of their speciality interests (paediatric urology) or ambiguity in the answers. The remaining 264 were evaluated. RESULTSMost urologists preferred urethral catheterization as the initial management, failing which a suprapubic catheter was inserted (98%). Apart from routine blood investigations, ultrasonography (26.5%), a plain film of the abdomen (15.5%) and PSA assay (24.6%) were part of the routine assessment by some. Nearly 71% (186) started their patients on a -blockers, with 64% (118) using a trial without catheter (TWOC) 2 days after starting them; 39% (103) used a TWOC only if the residual urine volume was <1 L at the time of initial catheterization, and 77% followed patients who had had a successful TWOC. One failed TWOC was an indication for TURP for 72.8% (192) of the respondents, with 49.8% (136/233) undertaking TURP at a separate admission. A second TWOC was ad...

RESULTSQuestionnaires were sent to 116 eligible patients and 82 were returned for analysis (mean partner age 63 years). When asked to recall the treatment options initially discussed, all partners recalled radiotherapy (EBRT), all but one radical prostatectomy (RP), 51% brachytherapy, but only 29% watchful waiting (WW); 41% of partners stated RP as their chosen option, 37% EBRT, 12% brachytherapy and 10% no clear favourite. None preferred WW. Employment and education status were not significant predictors of partners' preference but retired partners and those aged >65 years were 3 times more likely to prefer EBRT than were their employed and younger counterparts, respectively. The partners' mean (median, SD ) self-assessed influence factor was 4.8 (5, 3.4).Of the partners, 88% reported active involvement throughout the process, identifying information-gathering and emotional support as their primary roles. Most deliberately chose not to influence the patient's final decision. CONCLUSIONPartner preference is influenced by preexisting conceptions about cancer and its treatment. While undoubtedly influential throughout the decision-making process, partners deliberately left the final decision to the patient.

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Inhalation of Entonox or periprostatic infiltration with 1% lidocaine can be used for analgesia during TRUS guided biopsy of the prostate since each provides significant and similar pain relief.