Journal of Clinical Urology

This audit compared the management of epididymo-orchitis within our institution against the 2010 guidelines issued by the British Association of Sexual Health and HIV.

A Retrospective casenote analysis was performed on all patients diagnosed with epididymo-orchitis between August 2004 and August 2009. Patients were identified using Hospital Episode Statistics (HES) data. Data analysed included patient's age, investigations performed, treatment given, and patient follow-up.

In total, 232 patients were identified (mean age 41 years, range 1–-96). A mid-stream urine was performed in 105 (45%) patients, 12 (5%) had a urethral swab and 82 (35%) had an ultrasound scan. Twenty patients were surgically explored to exclude torsion. The mean length of stay was 1 night (range 0–-9). Antibiotics were prescribed in 94% of patients. Sexual history and advice to attend a genito-urinary clinic was documented in 16% and 4% of cases respectively. Referral for follow-up in the urology outpatient clinic occurred for 24% of patients.

The management of epididymo-orchitis in patients referred for secondary care review is an area for significant improvement in clinical practice. Implementation and dissemination of clear local guidelines are essential to ensure appropriate patient management and minimise unnecessary in-patient admissions and outpatient follow-up.

To determine whether early recurrence of non-muscle invasive bladder cancer confers prognostic value with respect to bladder cancer-specific survival. Patients and methods: Following local ethics committee approval, all patients that underwent TURBT for a bladder tumour within the Oxford Radcliffe Trust between 1997 and 2007 were entered into the local Cancer Research Uro-Oncology Database (CRUD©). The rate of positive histological recurrence of non-muscle invasive bladder cancer at first cystoscopy (<4 months) following the index TURBT was calculated and the cancer-specific survival calculated using data from the National Cancer Intelligence Network.

Median positive early recurrence of (NMIBC) non-muscle invasive bladder cancer was 18.9% for the period of 1997 to 2007 (mean 20.3%; range 13.9–-28.3%). Positive early recurrence was associated with significantly worse survival, with 5-year cancer specific survival falling from 82.3% (first cystoscopy negative) to 69.4%, (first cystoscopy positive), Log Rank p = 0.02.

Our results suggest that if histological recurrence is present at first cystoscopy then the patient is more likely to die from bladder cancer, with 5-year cancer specific mortality of 18% if first cystoscopy clear, compared to 31% if histological recurrence (relative risk 1.7). With the growing demand for surgical outcome measures, our study suggests that ‘positive recurrence at first cystoscopy’ is both simple to measure and a valid predictor of patient outcome.