Anejaculation as an atypical presentation of prostate cancer: a case report.

Anejaculation may occur as a result of neurological disease, iatrogenic injury or be drug induced. We report a case of a 66 year old man who presented with anejaculation following an emergency abdominal aortic aneurysm repair. Due to an elevated prostate specific antigen (PSA) level, the patient underwent a prostate biopsy and was diagnosed with a prostate adenocarcinoma. This was effectively managed using active surveillance, a treatment modality that aims to select only those patients with significant cancer for radical treatment. Despite the possible cause of anejaculation to be iatrogenic, the reader should be aware that prostate cancer may co-exist in, or cause any disorder of the lower urinary tract.

Management of simple intratesticular cysts: a single-institution 11-year experience.

OBJECTIVES: To evaluate the clinicoradiologic findings and outcomes of management of simple intratesticular cysts, by review of an 11-year experience. METHODS: From March 1994 to September 2005, 24 men underwent scrotal ultrasound scan and follow-up for simple intratesticular cysts. The median follow-up was 32 months (range, 6 to 124 months). The records were analyzed retrospectively for presentation, radiologic findings, and outcomes of management. RESULTS: All 24 patients with simple intratesticular cysts were managed successfully with radiologic surveillance. No patient underwent orchidectomy or required enucleation of the cyst. CONCLUSIONS: Simple intratesticular cysts can be managed conservatively with regular ultrasound surveillance by an experienced uroradiologist, without the need for surgical intervention.

Urological emergency: diagnosis and management of renal trauma.

Renal trauma can be a life-threatening emergency and, because of its rarity, knowledge of its recognition and management is limited. This review discusses the clinical diagnosis, classification of injury, management and complications of this emergency condition.

Effect of the rate of delivery of lignocaine gel on patient discomfort perception prior to performing flexible cystoscopy.

Flexible cystoscopy is commonly performed under local anaesthesia. Instillation of lignocaine gel is commonly associated with urethral discomfort, which in some cases results in fierce opposition to further flexible cystoscopy under local anaesthesia. Although studies have demonstrated that the temperature of lignocaine can influence the level of discomfort experienced, to date no study has investigated the influence of the rate of lignocaine delivery on perceived discomfort. We therefore performed a prospective, randomised study to investigate this in patients undergoing flexible cystoscopy. One hundred consenting men were randomised to receive 11 ml of 2% lignocaine hydrochloride gel over either 2 or 10 s. The groups were well matched for age. After instillation of the gel, the patients were immediately asked to score their discomfort using a visual analogue scale. The discomfort experienced by patients that received the gel over 10 s was significantly (p < 0.05; Student's t test) less than those that received it over 2 s. This was irrelevant of the age of the patient and the number of previous cystoscopies performed. We have demonstrated that slow administration results in decreased discomfort. This may, in turn, reduce the need to resort to general anaesthesia, which is associated with increased morbidity and cost.