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Focus on quality of life after prostate cancer is vital to improve patient care. Improved assessment and proactive management of post-treatment functional outcomes is essential. Many aspects of the patients’ aftercare need to be improved in order to set up a clear path following prostatectomy. These improvements will enable a timely and efficient escalation of treatment and ameliorate patients’ survivorship experience.

Correspondence to Mr Anthony Emmanuel; anthony.emmanuel@nhs.net Description Fournier’s gangrene is a rare necrotising fasciitis of the genital, perineal and perianal regions with high contemporary mortality rates of up to 20%.1 Isolated Fournier’s gangrene of the penis is an extremely rare clinical entity due to its rich vascular network.2 Type 1 necrotising fasciitis, which encompasses the majority (80%) of presentations, is easier to recognise clinically than type 2 necrotising fasciitis, which is aggressive and easily missed clinically, due to minimal clinical signs such as lack of subcutaneous emphysema.3 Type 1 necrotising fasciitis is caused by the synergistic effect of polymicrobial organisms and usually affects those who are immunocompromised or with underlying abdominal or genitoperineal pathology.1 3 Whereas type 2 necrotising fasciitis is usually caused by monomicrobial gram-positive organisms such as group A Streptococcus in healthy individuals secondary to skin or throat derived direct inoculation from potential trauma or injectables.3 We present a case of a fit and healthy man in his 40s who attended accident and emergency with a 1 day history of gradual onset penile pain, bruising and swelling following a lengthy sexual intercourse session while under the influence of multiple stimulant drugs termed ‘chemsex’. [...]clinical reviews at 2 hours (figure 1B) and 3 hours (figure 1C) revealed rapidly progressing ecchymosis, worsening disproportionate pain and hypotension with a systolic blood pressure of 96, without any evidence of subcutaneous emphysema or fever on examination. Laboratory results revealed a raised lactate (5.1 mmol/L (reference range: 0–2 mmol/L)), metabolic acidosis (pH 7.28 (reference range: pH 7.35–7.45)), hyperkalaemia (6.5 mmol/L (reference range: 3.5–5.3 mmol/L)) and raised inflammatory markers (white blood cells (16×109 /L (reference range: 4–11 x 109 /L)) and C reactive protein (309 mg/L (reference range: 0–5 mg/L))). [...]taking into account the rapidly deteriorating clinical and biochemical picture, the initial thought of simple penile ecchymosis and swelling secondary to vigorous coitus (figure 1A, red arrow) was instead a discrete area of necrosis confirming the diagnosis of penile Fournier’s gangrene.

Across health care, clinicians are increasingly using patient-reported outcome measures (PROMs) to give a voice to patients and to help standardize the assessment of patients for comparison purposes. With this increasing use, the limitations of these PROMs should not be underestimated within the diverse population that we treat.

The refractory overactive bladder is a clinically challenging entity to manage and affects millions of people worldwide. Current surgical treatment options include botulinum toxin type A, sacral neuromodulation, and bladder reconstruction surgery all of which require careful attention to the individual patients needs and circumstances. In our paper we present a detailed up-to-date review on all the above mentioned surgical techniques from current literature and briefly describe our units experience with sacral neuromodulation.

Objectives To determine the safety of urological admissions and procedures during the height of the COVID‐19 pandemic using “hot” and “cold” sites. The secondary objective is to determine risk factors of contracting COVID‐19 within our cohort. Patients and methods A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high‐volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a “cold” site requiring a negative COVID‐19 swab 72‐hours prior to admission and patients were required to self‐isolate for 14‐days preoperatively, while all acute admissions were admitted to the “hot” site. Complications related to COVID‐19 were presented as percentages. Risk factors for developing COVID‐19 infection were determined using multivariate logistic regression analysis. Results A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44‐70) were admitted under the urology team; 101 (16.5%) on the “cold” site and 510 (83.5%) on the “hot” site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID‐19 postoperatively with one (0.2%) postoperative mortality due to COVID‐19. Overall, COVID‐19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID‐19 in our cohort (OR 1.25, 95% CI 1.13‐1.39). Conclusions Continuation of urological procedures using “hot” and “cold” sites throughout the COVID‐19 pandemic was safe practice, although the risk of COVID‐19 remained and is underlined by a postoperative mortality.

Androgens play a crucial role in bone, muscle and fat metabolism, erythropoiesis and cognitive health. In men aged 40-79 years the incidence of biochemical deficiency and symptomatic hypogonadism is 2.1-5.7%. Decreased libido or reduced frequency and quality of erections, fatigue, irritability, infertility or a diminished feeling of wellbeing may be presenting complaints. However, a significant proportion of men with androgen deficiency will be identified when they present for unrelated concerns. Important factors to elicit from the history in addition to the presenting complaint include: a medical history of obesity, type 2 diabetes, systemic diseases or metabolic syndrome which all impact on testosterone physiology. A comprehensive medical review will identify agents which can cause low testosterone levels such as statins, steroids, opioids, dopamine antagonists and 5-alpha reductase inhibitors. Alcohol, anabolic steroids and illicit substance use such as marihuana can impact on testosterone levels and non-prescribed drug use should be routinely discussed. The mainstay of treatment in persisting androgen deficiency is to restore normal physiological levels of testosterone by using exogenous testosterone. It may take at least three to six weeks to notice any clinical improvement in symptoms. Men receiving testosterone supplementation should be followed closely and have their testosterone, haematocrit and PSA levels checked at three, six and twelve months after initiation of testosterone replacement therapy. Men should then be reviewed at least annually thereafter.