Prostate cancer (PCa) has high prevalence rates in men and is a leading cause of cancer-related death. Transrectal (TR) biopsy has traditionally been the gold standard for diagnosis, but transperineal (TP) biopsy is increasingly favoured due to its lower infection risk. However, debate remains regarding which method has superior cancer detection rates. This review compares the efficacy and safety of the TP as compared to the TR prostate biopsy approach, summarizing the largest body of evidence available to date. A literature search was performed on the PubMed, Google Scholar, Cochrane Library, and Embase databases. We searched from the inception of the databases up to August 2024 for relevant studies comparing the cancer detection rate of TP versus TR prostate biopsy and compared their complication rates. Twenty-one studies met the inclusion criteria. The pooled odds ratios with 95% confidence intervals were calculated to evaluate the differences between the TR and TP groups in the PCa detection rate. This meta-analysis included 21 studies (6 randomized control trials and 15 cohort studies) with a total of 13,818 patients (TP = 7917; TR = 5901), who were accrued between 2008 and 2024 and divided into the TR group and the TP group. The analysis revealed no significant difference in prostate cancer detection rates between the TP and TR approaches in both RCTs (OR 1.02, 95% CI (0.74, 1.41), p = 0.90) and cohort studies (OR 1.07, 95% CI (0.85, 1.35), p = 0.36). Complication profiles were largely comparable; TP demonstrated a significantly lower risk of urinary tract infections (OR 0.26, 95% CI (0.11, 0.61)) but no notable differences in acute urinary retention, haematuria, or rectal bleeding. Our findings advocate the TP approach as a safer biopsy alternative where feasible, particularly in infection-sensitive populations, without compromising diagnostic accuracy. MRI should complement biopsy strategies to enhance diagnostic precision. Future research should focus on standardized, large-scale RCTs to further refine and personalize prostate cancer diagnostic pathways.

Throughout history, many innovations have contributed to the development of modern urological surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern urological surgery: External shockwave lithotripsy, transurethral resection of prostate, cystoscope, perioperative prostate-specific antigen and robotic surgery. The selection of innovations for inclusion in this article was meticulously determined through expert consensus and an extensive literature review. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of urological surgery and their ongoing relevance in contemporary and perioperative practice.

Sepsis is a life-threatening condition that needs the clinician to act quickly and swiftly in order to provide the best medical outcome for the patient. Sepsis can lead to multi-organ dysfunction, which is not only a risk to life but also utilizes multiple resources within the healthcare services. The management of any infection is reliant on two major factors: antimicrobial therapy and source control. We present two cases where source control, in the form of a ureteric stent insertion, was performed at bedside via the use of flexible cystoscopy to provide source control in the management of a septic patient.

The ureteral insertion of a silicone tube was first performed in 1967. A validated ureteral stent symptom questionnaire (USSQ) is used for an objective assessment of patient-reported stent-related symptoms. As the impact of stent diameter on the incidence of stent-related symptoms is unclear, we aimed to perform a systematic review and meta-analysis comparing USSQ reported outcomes when using a 6 Fr diameter ureteric stent, versus smaller diameter stents (4.7-5 Fr) when inserted for ureteric stones. All randomized control trials and comparative studies of 6 Fr versus 4.7-5 Fr ureteric stents were reviewed. The USSQ outcomes were considered as the primary outcome measures while stent migration was considered as a secondary outcome measure. A total of 61 articles were identified of which four studies met the eligibility criteria. There was a statistically significant association between the use of wider (6 Fr) diameter stents and the incidence of urinary symptoms as measured by the urinary index score. Larger stent diameters were associated with a statistically significant increase in the pain index score. There was no statistically significant difference in the scores between the compared stent diameters with regard to work performance score, general health index score, additional problems index score, and stent migration. There were insufficient reported outcomes to perform a meta-analysis of sexual matters index score. Our meta-analysis shows that using smaller diameter ureteric stents is associated with reduced urinary symptoms and patient-reported pain. Other USSQ parameter outcomes are statistically similar in the 6 Fr ureteric stent cohort versus the 4.7-5 Fr ureteric stent cohort. Our meta-analysis was limited due to the limited number of studies and gross heterogeneity of reporting parameters in various studies. We hope a large-scale homogeneous randomized control trial will further shed more insight into the stent symptoms response to stent diameter.