[Prostate cancer screening benefit very low, even after 13 years]. / Opbrengst prostaatkankerscreening zeer laag, ook na 13 jaar.

The 13-year results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) have recently been published. Authors presented a 'substantial' reduction in prostate cancer-specific mortality of 20%. However, absolute risk reduction is very small (0.11 per 1000 person years) and no effect was shown on all-cause mortality. Additionally, the number of unnecessary prostate cancer diagnoses and the number of diagnostic procedures for this small effect are considerable. We believe that the discussion on the introduction of a population-based screening programme for prostate cancer could be at an end. Prostate cancer detection should be limited to men with signs or symptoms of the disease. Prostate-specific antigen (PSA) testing in non-symptomatic men should be a patient's personal decision, after weighing the pros and cons of any subsequent procedures.

[Complications due to lack of knowledge of the urinary sphincter prosthesis]. / Complicaties door gebrekkige kennis van urinaire sfincterprothese.

BACKGROUND: The placement of an artificial urinary sphincter prosthesis is a recognised treatment for men with urinary incontinence that is caused by insufficient sphincter action, although it is rarely used. Physicians from specialties other than urology know little about the components and mechanism of action of this prosthesis, which can lead to severe complications. CASE DESCRIPTION: A 67-year-old patient with a history of radical prostatectomy came to the emergency department with abdominal pain after a colonoscopy. A few years prior, he had received an artificial urinary sphincter prosthesis because of urinary incontinence. An abdominal CT scan showed a cystic lesion, which was punctured under ultrasonic guidance. The patient was completely incontinent after the intervention. It appeared to have been the pressure balloon of the urinary sphincter prosthesis that was punctured. The pressure balloon was operatively replaced several weeks later. During this procedure, the pressure balloon was placed intravesically instead of in the retropubic space and a reoperation was necessary. CONCLUSION: To prevent complications, all physicians should know how medical implants function, including the ones that are rarely used. In addition, patients need to be well informed of their use.