With increases in the aging population, conditions affecting older people and relevant surgical techniques are becoming more pertinent. Modified supine percutaneous nephrolithotomy (PCNL) is increasingly being adopted. There are limited data on the safety of this position in the elderly patient population. We describe our experience of the modified supine position in patients aged 70 years and older. Between April 2011 and March 2021, patients aged 70 years and older undergoing a modified supine PCNL performed by a single surgeon were prospectively evaluated. Data including patient age, operative time, complications, stone clearance, and length of stay were collected and analysed. Sixty-nine procedures were performed on 67 patients with a mean age was 76.5 years. Median total operative time was 95 min with 20 (29%) patients having a combined procedure with ureterorenoscopy. Preoperative mean stone burden was 23.5 mm and complete stone clearance was achieved in 46 (66.7%) patients. Twelve (17.4%) patients had complications during their hospitalisation. Six were Clavien–Dindo class II or less and one Clavien–Dindo class V. The modified supine position for PCNL is safe in the elderly patient population and has advantages including reduced handling of patients and achieving adequate stone-free rates. These benefits are particularly important in the elderly population, which frequently has a reduced tolerance to adaptation.

Jackstones are a rare subtype of calculi, characterised by radiating spicules. We describe a case of multiple jackstones in the urinary upper tract. A 53-year-old man was referred for evaluation of left flank pain. Imaging revealed a left pelvic-ureteric junction obstruction and several left renal calculi. A left supine percutaneous nephrolithotomy was performed and two jackstone calculi were extracted. The presence of multiple jackstones in the renal pelvis should prompt for evaluation for obstruction and complete stone clearance should be achieved to avoid recurrence.

Background: Muscle-invasive bladder cancer has a poor prognosis. Accurate lymph node (LN) staging is crucial, yet conventional imaging demonstrates limited sensitivity for detecting metastasis, necessitating improved pre-operative assessment. Objectives: To evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT) compared to computed tomography (CT) for LN staging in patients with bladder cancer(BC) undergoing radical cystectomy (RC), and to assess the impact of imaging-determined nodal status on survival outcomes. Methods: This retrospective study analyzed 138 patients who underwent RC and pelvic LN dissection (PLND) at a multisite tertiary institution from 2008 to 2021. All patients received either pre-operative CT or FDG-PET/CT within 8 weeks before RC and PLND. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value for detecting LN metastasis (LNM) were calculated using pathological analysis as the reference standard. Kaplan–Meier survival analysis and Cox regression were employed to assess overall survival (OS). Results: FDG-PET/CT exhibited higher sensitivity (70% vs. 23.3%) and PPV (70% vs. 38.46%) compared to CT, but lower specificity (78.57% vs. 85.7%). Survival outcomes showed statistically significant differences in OS between node-positive and node-negative groups in the FDG-PET/CT cohort, but not in the CT cohort. Conclusion: FDG-PET/CT provides superior sensitivity and PPV compared to CT for LN staging in BC, facilitating more accurate pre-operative evaluation. The improved prognostic stratification associated with FDG-PET/CT may guide individualized treatment strategies.

Objectives: To compare the outcomes between re‐induction Bacillus Calmette‐Guérin (BCG) and sequential intravesical gemcitabine‐docetaxel (Gem/Doce) therapy in patients with high‐grade (HG) non‐muscle invasive bladder cancer (NMIBC) following failure of initial induction BCG.Materials and methods: We retrospectively identified patients who received induction BCG therapy between 2017 and 2023. Inclusion criteria were high‐grade NMIBC recurrence post‐BCG induction, with subsequent treatment by either re‐induction BCG or Gem/Doce.Results: From 2017 to 2023, 140 patients received induction BCG, with 30 (21.4%) showing persistent HG NMIBC. Of these, five (16.7%) were treated with re‐induction BCG and 11 (36.7%) with Gem/Doce. In the re‐induction BCG group, four patients (80%) had HGTa and one (20%) had HGT1. In the Gem/Doce group, eight patients (73%) had HGTa, two (18%) had HGT1 and one (9%) had carcinoma in situ (CIS). Initial post‐treatment cystoscopy showed recurrence in one re‐induction BCG patient (20%) with HGT1 and CIS and in two Gem/Doce patients (18%) with HGTa. No adverse events were reported with Gem/Doce.Conclusion: Our initial experience with intravesical Gem/Doce suggests that it is better tolerated, with fewer adverse events and comparable recurrence rates at three months, compared to re‐induction BCG in patients with BCG‐failure NMIBC.

Objectives: Although neoadjuvant chemotherapy (NAC) has been demonstrated to have significant benefits to survival in patients with muscle-invasive bladder cancer (MIBC), the current utilization of NAC in Australia is unknown. The aim of this study was to evaluate the patterns of neoadjuvant and adjuvant chemotherapy (AC) use in patients undergoing cystectomy for MIBC at a large tertiary institution in Australia. Methods: A retrospective study was conducted using data of patients who underwent a radical cystectomy (RC) at a high-volume centre for MIBC between 2011 and 2021. Results: Of 69 patients who had a cystectomy for ≥ pT2 bladder cancer, 73.9% were eligible for NAC. However, of those eligible, only five patients received NAC (9.8%). Of the total patients who were eligible for AC, only 44.4% received postoperative chemotherapy. Common reasons for the lack of uptake were due to patients being unfit or declining treatment. There was no difference in progression-free survival or overall survival in those who received NAC and AC. Conclusions: The majority of patients undergoing RC for MIBC received AC compared to NAC, reflecting the real-world challenge of NAC uptake. This highlights the need for ongoing improvements in selection and usage of NAC and less reliance of AC utilization post RC.

Introduction and Objectives: Voiding dysfunction remains a common side effect postprostate biopsy leading to significant morbidity. Alpha blockers have emerged as a potential therapeutic option to mitigate this risk, with various centres already incorporating its use in practice. Despite this, the literature regarding its efficacy remains inconclusive. Hence, a systematic review was performed to quantify the effect of perioperative alpha blockers on prostate biopsy‐related voiding function.Methods: A systematic search in MEDLINE, Embase and PubMed between January 1989 and July 2023 was performed to identify relevant articles. Two independent reviewers independently screened abstracts, full texts and performed data extraction. Data including International Prostate Symptom Scores (IPSS), voiding flow rates (Qmax), postvoid residuals (PVR), rates of acute urinary retention (AUR) and quality of life (QoL) scores were extracted. Results were combined in an inverse variance random effects meta‐analysis.Results: A total 808 patients from six randomised controlled trials (RCTs) comparing alpha blockers to controls were included. All articles excluded patients with pre‐existing voiding dysfunction. Pooled outcomes demonstrated statistically significant differences favouring alpha blocker usage in all objective and subjective measures including IPSS (mean difference 4.21, 95% confidence interval [CI] 2.58–5.84, p < 0.00001), PVR (mean difference 20.41 mL, 95% CI 3.44–37.39, p = 0.02), Qmax (mean difference 3.07 mL/s, 95% CI 2.55–3.59, p < 0.00001), QoL (weighted‐mean difference 0.82, CI 0.17–1.48, p = 0.01) as well as overall risk of AUR (odds ratio 0.22, CI 0.09–0.55, p = 0.001). There was variable heterogeneity (I² = 0–86%) between outcomes.Conclusions: This review highlights the potential role of alpha blockers in improving urinary function and reducing adverse voiding outcomes postprostate biopsy. The standard practice of incorporating the usage of perioperative alpha blockers may be considered to reduce the morbidity of voiding complications secondary to prostate biopsy.