James Douglas

Objectives: To assess to what extent hospitals meet the uniform English National Health Service ‘timely’ treatment standard, what happens after a breach, and determinants of delay for patients with high‐risk renal cell carcinoma (RCC). Patient and Methods: Population‐based study using linked data for 7030 patients with high‐risk and 10 708 patients with low‐risk RCC, 2019–2023. The probabilities of ‘timely’ treatment and prolonged delay (≤31 days or >62 days from decision‐to‐treat, respectively) were estimated using multilevel logistic regression. Daily treatment probabilities beyond 31 days were represented using smoothed hazard rates. Results: For a typical patient with high‐risk RCC, timely treatment declined from 83.7% (2019) to 64.8% (2023), with a corresponding decline in the low‐risk group from 71.3% to 47.6%, while prolonged delays more than doubled, from 3.9% to 9.4%. Patients with high‐risk RCC were prioritised over those with low‐risk disease (73.6% vs 58.2%; adjusted risk ratio 1.26, 95% confidence interval 1.22–1.31). Older and more socioeconomically deprived patients experienced longer delays. Once the standard was breached, the daily probability of surgery declined sharply. Adjusted percentages of patients with high‐ and low‐risk RCC treated within the standard were strongly correlated ( r = 0.78). Conclusion: Prioritisation of patients with high‐risk RCC was maintained throughout the study period but did not prevent a system‐wide decline in timely treatment. Patients who breach the timely treatment standard face diminishing daily probabilities of surgery. Risk‐stratified standards, ring‐fenced surgical capacity, and monitoring beyond defined timely treatment standards are needed to safeguard patients against delays that have significant prognostic implications.

Radical cystectomy (RC) with a pelvic lymph node dissection (LND) is the gold standard for the treatment of muscle invasive bladder cancer (MIBC) as well as for some high-risk non-muscle invasive bladder cancers. The therapeutic advantage of LND, in terms of cancer-specific survival (CSS), still divides opinion and, certainly, the question of the extent of LND at the time of cystectomy is still debated. In this article, we have reviewed the evidence supporting the practice of extending LND in order to help clinicians determine what is appropriate in their practice. There still remains a lack of prospective randomized studies addressing whether extended LND provides a survival benefit in patients undergoing RC for BC. However, there is large body of evidence that suggests there is a positive impact on the oncological outcomes in these patients without an apparent cost of unacceptable adverse events. Cite this article as: Dawson V, Sinha M, Smith J, Somani BK, Douglas J. The role of extended lymph node dissection in patients undergoing radical cystectomy. Turk J Urol 2020; 47(Supp. 1): S27-S32.

Hydrocoeles are a common cause of scrotal swelling and discomfort in a significant proportion of men. We report a case of compartment syndrome within the tunica vaginalis. This is an unusual and previously unreported complication of a hydrocoele.