Sri Lankans appear to be having a low incidence of prostate cancer, but a larger proportion of high-grade cancers in comparison to the UK and USA. Although genetic differences may exist, a dietary or an environmental factor is more likely to be the cause for these changes. The protective effect of this factor appears to wane as South Asians emigrate and live in UK and USA.

Chances of successful RUS were low in patients with ureteric obstruction in the presence of tumour recurrences or elevated serum creatinine. Even if ureteric stenting was successful, their life expectancy was short.

Introduction: Haemospermia is an alarming symptom for ordinary members of the public. The worry become greater as it has been described as a warning sign of a prostate cancer in the media. Objectives: The aim of the study was to identify the aetiological factors and outcome of haemospermia in a cohort of patients. Methods: All patients with newly diagnosed haemospermia treated at the urology unit of Colombo South Teaching Hospital over a period of 5 years (2013-2018) constituted the study sample. Data related to demographics, symptomatology, clinical findings, investigations, treatment given and outcome during follow-up were recorded prospectively. Results: There were 94 men with haemospermia who sought treatment during the study period. Mean age was 43.7 years (range: 23-67, median = 41). Twenty-seven (29%) patients had clinical evidence of prostatitis and/or a positive seminal fluid culture. One patient each had prostate carcinoma, prostatic cyst, severe hypertension, sclerotherapy for haemorrhoids, post-chemotherapy and post-epididymectomy. The patient who had high blood pressure (220/150 mmHg) was found to have mesangio-proliferative glomerulonephritis. In 61 (65%) patients, there was no identifiable cause. Conclusion: The majority of patients with haemospermia are aged < 45 years and have a benign aetiology. As haemospermia is self-limiting in the majority of cases, extensive investigations are unnecessary. Advanced and invasive tests should be confined to those with abnormal clinical findings, and to those with persistent or recurrent haemospermia.

We read with interest the article titled 'Non-parasitic chyluria: A rare cause of acute urinary retention in a young Caucasian male' in the Journal of Clinical Urology. 1 The authors have described an interesting case of chyluria leading to acute urinary retention. They should be lauded for highlighting the importance of differentiating heavy proteinuria that can be associated with chyluria from that of nephrotic syndrome in order to avoid unnecessary invasive investigations. Although the authors have indicated that hypoalbuminaemia and high serum creatinine levels would be useful to differentiate the two conditions, we feel that this is erroneous. Hypoalbuminaemia can occur in chyluria too and high serum creatinine is not a common finding in uncomplicated nephrotic syndrome. 2 The tests that would differentiate the two conditions would be the urine Sudan III test to identify fat globules in chylous urine and serum cholesterol level, which would be high in nephrotic syndrome but low in chyluria. 2,3