invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines... more invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines recommend CT urography (CTU) for initial diagnosis and staging of UTUCs. Diagnostic ureteroscopy (URS) is used second line where diagnosis is unclear. The COVID-19 pandemic has limited theatre access and may delay diagnosis of suspected UTUC. Our aim was to evaluate specific CTU findings in predicting UTUC to aid prompt diagnosis and risk stratification in a tertiary centre. Method: A retrospective analysis was performed on 122 patients who underwent CTU with diagnostic URS over two years from 2018-2019 for possible UTUC. Data including demographics, imaging and histology were collected from our electronic database. Results: 57 patients had confirmed UTUC, all had CT changes. CTU had an overall positive predictive value (PPV) of 45%. CT findings were divided into: hydronephrosis; filling defect/lesion; urothelial thickening; normal; or other. The PPV was highest for filling defects/lesions at 60%, hydronephrosis was 38%, urothelial thickening was 30%, and other was 33%. Of those with high-grade histology, 61% had evidence of filling defects/lesions and 24% had hydronephrosis. Conclusions: A specific CTU finding of filling defect/lesion in combination with cytology can aid diagnosis and risk stratification of UTUC. This may enable us to reduce use of diagnostic URS, as well as associated risks of intravesical seeding, necessary in the COVID-19 pandemic. With other CTU findings of hydronephrosis or urothelial thickening, a diagnostic URS may be required.
Accessibility to coursework (8.6/10) and enhanced flexibility (8.4/10) were considered to be the ... more Accessibility to coursework (8.6/10) and enhanced flexibility (8.4/10) were considered to be the biggest advantages of VL. Overall, 44% of students felt VL had a negative impact on their learning, with 23% of students considered to have failed to meet the learning objectives set out in these sessions. Conclusions: Beyond the COVID-19 pandemic VL will continue to play a role in medical education. However, there is room for improvement in both delivery and engagement to improve student experience and satisfaction. blood tests increased to 62% of patients, urate tested in 66% and calcium 76%. Conclusions: Compliance with key screening tests for renal colic patients was generally poor in a district general hospital setting. A key causative factor identified was a lack of awareness of guidelines by junior clinicians. Education demonstrated modest improvement within a short time scale.
Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure ... more Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.
Introduction Multi-parametric MRI (MP-MRI) prior to prostate biopsy is the investigation of choic... more Introduction Multi-parametric MRI (MP-MRI) prior to prostate biopsy is the investigation of choice for an elevated agerelated PSA and abnormal digital rectal examination. MP-MRI in combination with transperineal template mapping biopsy has facilitated the development of the concept of targeted biopsies, either cognitively or with software fusion. Urinary retention is a recognised complication of transperineal prostate biopsy, with reported incidence being 1.6-11.4%. We present patient and procedure-related factors, which influence occurrence of urinary retention after transperineal template biopsy. Patients and methods Retrospective data collection of 243 consecutive cases of transperineal template biopsies performed at a single institution were recorded and analysed. Biopsies were taken using a standard 5-mm template in 4-6 sectors, depending on the prostate volume. Results 31/243 (12.8%) patients developed urinary retention, defined as patient discomfort and inability to micturate and bladder scan of ≥ 600 ml. Patients in the retention group were significantly older (mean 68.7 vs. 65.8 years, P = 0.034). Prostate volume was significantly greater in comparison with the non-retention group (mean 75.4 vs. 57.2 cc, P = 0.0016). The number of biopsies taken was positively correlated with urinary retention (median 35 vs. 32 biopsies, P = 0.045), and this was independent of prostate size (R 2 = 0.2). Presenting PSA, pre-operative flow and histopathological outcome were independent of urinary retention. Conclusions Factors resulting in an increased risk of urinary retention are advancing age (> 68.7 years); a larger prostate volume (> 75 cc); greater number of biopsies (> 35); greater severity of lower urinary tract symptoms prior to biopsy and diabetes. Targeted biopsies alone, instead of a full template, may avoid urinary retention in the high-risk groups identified.
Background and Objectives Cystinuria is a rare genetic cause of recurrent urolithiasis and requir... more Background and Objectives Cystinuria is a rare genetic cause of recurrent urolithiasis and requires multimodal treatment, and stringent follow up. We wanted to evaluate the fears and concerns of patients with cystinuria during the COVID-19 pandemic. Materials and Methods An online survey using Google Forms was emailed to 165 patients with cystinuria who are maintained on a prospective database and had previously consented for email correspondence. Results Fifty-five responses were received following a single invitation, 23 were men and 32 women with a median age of 43 (range: 18-72) years. Thirty-nine (70.9%) out of 55 were isolating during the COVID-19 pandemic although only 7(12.7%) were given specific advice to shield officially. Six (10.9%) reported having COVID or COVID like symptoms, but none reported having a positive test. Only 9 (16.4%) had been able to work as usual. In comparison, 20 (36.4%) were able to work from home. Ten out of 19 patients (52.6%) on chelating medication described difficulty in access to their medicine, either due to a shortage at the pharmacy or prescription access. Reassuringly 34 (61.8%) patients described no issues with access to any of their cystinuria medications. Twenty-two patients (40%) reported experiencing pain or passing a stone during the COVID-19 pandemic, while 30 (54.5%) reported no problems. Of patients who felt it applicable, 16/31 (51.6%) were worried about attending the Emergency Department during this time. Of patients who had scheduled hospital appointments during this time, 26/44 (59.1%) had experienced cancellations. The majority of the respondents (37 (67.3%)) did not state any difference in the ability to stay hydrated during the lockdown. Twenty-eight (50.9%) were more anxious about their overall health during the pandemic, and 20 (36.4%) had expressed more concern about their kidney stones. Conclusion This personal fully patient-reported snapshot of the impact of the COVID-19 pandemic on a population of cystine stone formers in the United Kingdom has highlighted additional challenges for patients with a rare disease. The lockdown measures enforced have had a varying effect on patients' ability to work as normal, access medications, health anxieties, in addition to cancellations of the planned hospital appointments and Emergency Department attendance, which will impact on their future health and pose evolving challenges in delivery of their future care.
composite outcome was 9 months (range 0e84). When comparing same stage groups, those classified u... more composite outcome was 9 months (range 0e84). When comparing same stage groups, those classified using MRI showed improved PFS on Kaplan-Meier curves compared to the same stage classified by DRE. The difference was significant in the T1 and T3 groups. Univariable analysis showed that patients with DRE T1 disease (HR 0.10 95%, CI 0.01-0.73, p[0.02) or DRE T3 (HR 0.70, CI 0.51-0.97, p[0.03) were at higher risk for failure. Multivariable analysis was performed in a subgroup fashion, comparing corresponding DRE and MRI stages corrected for age, grade group and PSA. Only DRE T1 remained a significant predictor for worst outcome (HR 0.08, CI 0.010.59, p[0.01). CONCLUSIONS: Our results suggest that stage classified by MRI rather than DRE leads to a possible Will Rogers phenomenon. Current risk groups were developed and validated on clinical stage and should be used with caution when counselling patients in whom local stage is often based on MRI.
Background: Advances in imaging techniques are allowing early diagnosis and localization of tumor... more Background: Advances in imaging techniques are allowing early diagnosis and localization of tumor recurrence after local treatment failure. In this context, patients with lymph nodal recurrence (LNR) after radical prostatectomy (RP) can benefit from a rescue lymphadenectomy (LDNR) or radiotherapy (RT). We analyze our series of treated patients diagnosed with LNR after RP. Material and methods: Between May 2012 and March 2016, 15 patients, with a mean age of 67 years (60-82) were included. Pathological stage of PR: 6pT2 and 8 pT3. Two patients had Gleason 6 and 12 Gleason 7. The diagnosis was made by PET-CT cholina in 10 patients and by magnetic resonances in 4 patients. The LDNR was bilateral and RT was applied on the affected unilateral lymph nodes with 3e6 months of neoadjuvant androgen deprivation (DA). Biochemical recurrence (BR) after LDNR was defined as rising PSA >0.2 ng/ml and after RT increase >10% PSA compared to pre-treatment value. Results: LNR were diagnosed at a median 33 m after PR. Median PSA at diagnosis was 2.5 ng/ml (range 0.57e4.18) and all were located in the pelvis. Eleven received salvage RT and 4 LNDR (n ¼ 4). After RT, with a mean follow-up of 25 months, 7 patients were free of biochemical recurrence. Two patients treated with RT plus short-term AD are free of BR 4 and 3 years after this treatment. With LNDR and a mean follow-up of 15 months all had BR. Not a patient had any toxicity for both treatments. Conclusions: The LDNR and RT in patients with LNR are safe and feasible. Urologists and radiation oncologist must inform to the patients about these treatments. It requires a longer follow up to objective their both long term potential benefit. Conflict of interest: No conflict of interest.
Aim Group & Save (G&S) is conducted prior to Transurethral Resection of Bladder Tumour (TURBT) or... more Aim Group & Save (G&S) is conducted prior to Transurethral Resection of Bladder Tumour (TURBT) or Rigid Cystoscopy + Bladder Biopsy (BB) during pre-operative assessment (PoA). Each G&S costs £7.54 and 2 samples are required. The aim of this audit was to determine whether G&S is clinically required for these two procedures. Method This two-cycle audit reviewed the PoA components of patients undergoing TURBT or BB over a 6month period prior to the COVID-19 pandemic (July-Dec2019), in which PoA were face-to-face, and a subsequent re-audit during telephone PoA (July-Dec2020), where it was deemed unnecessary to have a G&S. Results 1st Cycle: 64 patients were included, 32.8%(21/64) had a preoperative G&S. 98.4%(63/64) had Hb measured. Mean Hb was 131.56 (79 – 165) g/l. 25%(16/64) were on anti-coagulants, of which 50%(8/16) were continued. No patients required a peri or post-operative blood transfusion. 2nd Cycle: 48 patients were included and 6.25%(3/48) had a G&S within the 1 month prece...
Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putti... more Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putting pressure on urological services. The British Association of Urological Surgeons (BAUS) guidelines indicate that for patients managed expectantly, a clinic review should be undertaken within 4 weeks of presentation. This quality improvement project reports the benefit of a dedicated virtual colic clinic to facilitate an efficient care pathway and reduce patient waiting times. A retrospective cycle analysed patients referred from the emergency department (ED) with uncomplicated acute ureteric colic (excluding those admitted for immediate intervention) over 2 months in 2019. A further cycle was carried out 12 months later following the introduction of a new dedicated virtual colic clinic with updated ED referral guidance. The mean time from ED referral to urology clinic review fell from 7.5 to 3.5 weeks. The percentage of patients reviewed in clinic within 4 weeks increased from 25% to 8...
Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed ... more Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed expectantly with acute ureteric colic: a quality improvement project.
Introduction & Objectives: Patients are often given printed information leaflets as part of infor... more Introduction & Objectives: Patients are often given printed information leaflets as part of informed consent for a procedure or explanation of their condition. Challenges of the COVID-19 pandemic and restrictions on face-to-face (F2F) consultations have required alternative methods of distributing information. We evaluated frequency of patient information leaflet use; preliminary cost benefit of electronic methods; and effectiveness of using QR codes to access digital leaflets. Materials & Methods: An international online survey of Urologists was distributed, and leaflet costs were estimated. QR codes were generated for commonly used British Association of Urological Surgeons (BAUS) patient information leaflets and were incorporated into a poster for display in the outpatient department. Evaluation of poster use was sought from patients through a questionnaire. Results: 108 Urologists responded to the initial survey, 44% of whom were Consultant grade. 54% provided >50% of patients with an information leaflet during F2F clinics. During transition to telephone clinics, this fell to 33% during the COVID-19 pandemic. Instead, 47% patients were provided Abstracts EAU22-37th Annual EAU Congress Eur Urol Suppl 2022;81(S 1):S135 with an internet link or directed to search engine terms in the clinical letter, instead of a printed leaflet. In a F2F clinic, each leaflet costs 40p to print, using a departmental model of 25 clinics/week, each clinician seeing 12 patients, if 53% receive a leaflet, the cost saving could be £3,307 per year. In response to the QR codes poster for digital provision of patient leaflets, in a patient population mostly male (82%) and older (60% between 60-80 years), 40% were familiar with QR codes and 73% could access the internet on a personal smartphone. 53% reporting using their smartphone to find information, 46% found the poster easy to use or follow, and 61% found it informative. Conclusions: Patient information leaflets are important for a Urologists' practice, frequently distributed, and printed forms can be costly. Providing paperless digital leaflets via a QR code offers many benefits including being cost-effective, touch-free, was well received by patients and has potential to increase patient engagement and education. Patient perception varies with age group and smartphone usage, therefore may not be suitable for all patient groups. This use of QR codes to provide direct access to digital patient information can be easily applied to other societies and specialties.
It is hypothesised that simulation enhances progression along the initial phase of the surgical l... more It is hypothesised that simulation enhances progression along the initial phase of the surgical learning curve. To evaluate whether residents undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. This international, multicentre, randomised controlled trial recruited 94 urology residents with experience of zero to ten procedures and no prior exposure to simulation in ureterorenoscopy, selected as an index procedure. Participants were randomised to simulation or conventional operating room training, as is the current standard globally, and followed for 25 procedures or over 18 mo. The number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on the Objective Structured Assessment of Technical Skill (OSATS) scale over three consecutive operations, was measured. Surgical complications were evaluated as a key secondary outcome. This trial is registered at www.isrctn.com as ISCRTN 12260261. A total of 1140 cases were performed by 65 participants, with proficiency achieved by 21 simulation and 18 conventional participants over a median of eight and nine procedures, respectively (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.72-2.75). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring a lower number of procedures (HR 0.89, 95% CI 0.39-2.02). Significant differences were observed in overall comparison of OSATS scores between the groups (mean difference 1.42, 95% CI 0.91-1.92; p < 0.001), with fewer total complications (15 vs 37; p = 0.003) and ureteric injuries (3 vs 9; p < 0.001) in the simulation group. Although the number of procedures required to reach proficiency was similar, simulation-based training led to higher overall proficiency scores than for conventional training. Fewer procedures were required to achieve proficiency in the complex form of the index procedure, with fewer serious complications overall. This study investigated the effect of simulation training in junior surgeons and found that it may improve performance in real operating settings and reduce surgical complications for complex procedures.
invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines... more invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines recommend CT urography (CTU) for initial diagnosis and staging of UTUCs. Diagnostic ureteroscopy (URS) is used second line where diagnosis is unclear. The COVID-19 pandemic has limited theatre access and may delay diagnosis of suspected UTUC. Our aim was to evaluate specific CTU findings in predicting UTUC to aid prompt diagnosis and risk stratification in a tertiary centre. Method: A retrospective analysis was performed on 122 patients who underwent CTU with diagnostic URS over two years from 2018-2019 for possible UTUC. Data including demographics, imaging and histology were collected from our electronic database. Results: 57 patients had confirmed UTUC, all had CT changes. CTU had an overall positive predictive value (PPV) of 45%. CT findings were divided into: hydronephrosis; filling defect/lesion; urothelial thickening; normal; or other. The PPV was highest for filling defects/lesions at 60%, hydronephrosis was 38%, urothelial thickening was 30%, and other was 33%. Of those with high-grade histology, 61% had evidence of filling defects/lesions and 24% had hydronephrosis. Conclusions: A specific CTU finding of filling defect/lesion in combination with cytology can aid diagnosis and risk stratification of UTUC. This may enable us to reduce use of diagnostic URS, as well as associated risks of intravesical seeding, necessary in the COVID-19 pandemic. With other CTU findings of hydronephrosis or urothelial thickening, a diagnostic URS may be required.
Accessibility to coursework (8.6/10) and enhanced flexibility (8.4/10) were considered to be the ... more Accessibility to coursework (8.6/10) and enhanced flexibility (8.4/10) were considered to be the biggest advantages of VL. Overall, 44% of students felt VL had a negative impact on their learning, with 23% of students considered to have failed to meet the learning objectives set out in these sessions. Conclusions: Beyond the COVID-19 pandemic VL will continue to play a role in medical education. However, there is room for improvement in both delivery and engagement to improve student experience and satisfaction. blood tests increased to 62% of patients, urate tested in 66% and calcium 76%. Conclusions: Compliance with key screening tests for renal colic patients was generally poor in a district general hospital setting. A key causative factor identified was a lack of awareness of guidelines by junior clinicians. Education demonstrated modest improvement within a short time scale.
Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure ... more Prostate biopsy is the definitive investigation to diagnose prostate cancer. The ideal procedure would be one that offers fast and efficient results safely as an outpatient procedure. Historically, transrectal ultrasound (TRUS) biopsy is considered the gold standard but transrectal biopsy can under-sample the anterior and apical regions of the prostate and is associated with a risk of prostate biopsy-related sepsis, which may require intensive care admission. Transperineal (TP) biopsy addresses the inefficient sampling of TRUS biopsy but historically has been done under general anaesthetic, which makes it difficult to incorporate into timed diagnostic pathways such as the National Health Service (NHS) 2-week cancer pathway. TRUS biopsy has remained the mainstay of clinical diagnosis because of its simplicity; however, the recent development of simpler local anaesthetic transperineal techniques has transformed outpatient biopsy practice. These techniques practically eliminate prostate biopsy-related sepsis, have a shallow learning curve and offer effective sampling of all areas of the prostate in an outpatient setting. The effectiveness of TP biopsy has been enhanced by the introduction of multiparametric MRI prior to biopsy, the use of PSA density for risk stratification in equivocal cases and combined with more efficient targeted and systematic biopsies techniques, such as the Ginsburg Protocol, has improved the tolerability and diagnostic yield of local anaesthetic TP biopsies, reducing the risk of complications from the oversampling associated with transperineal template mapping biopsies. Areas where the literature remains unclear is the optimum number of cores needed to detect clinically significant disease (CSD) in patients with a definable lesion on MRI, in particular, whether there is a need for systematic biopsy in the face of equivocal MRI findings to ensure no CSD is missed. The Covid-19 pandemic has had a profound impact on prostate cancer referrals and prostate biopsy techniques within the UK; prior to the pandemic 65% of all prostate biopsies were TRUS, since the pandemic the proportions have reversed such that now over 65% of all prostate biopsies in the NHS are transperineal.
Introduction Multi-parametric MRI (MP-MRI) prior to prostate biopsy is the investigation of choic... more Introduction Multi-parametric MRI (MP-MRI) prior to prostate biopsy is the investigation of choice for an elevated agerelated PSA and abnormal digital rectal examination. MP-MRI in combination with transperineal template mapping biopsy has facilitated the development of the concept of targeted biopsies, either cognitively or with software fusion. Urinary retention is a recognised complication of transperineal prostate biopsy, with reported incidence being 1.6-11.4%. We present patient and procedure-related factors, which influence occurrence of urinary retention after transperineal template biopsy. Patients and methods Retrospective data collection of 243 consecutive cases of transperineal template biopsies performed at a single institution were recorded and analysed. Biopsies were taken using a standard 5-mm template in 4-6 sectors, depending on the prostate volume. Results 31/243 (12.8%) patients developed urinary retention, defined as patient discomfort and inability to micturate and bladder scan of ≥ 600 ml. Patients in the retention group were significantly older (mean 68.7 vs. 65.8 years, P = 0.034). Prostate volume was significantly greater in comparison with the non-retention group (mean 75.4 vs. 57.2 cc, P = 0.0016). The number of biopsies taken was positively correlated with urinary retention (median 35 vs. 32 biopsies, P = 0.045), and this was independent of prostate size (R 2 = 0.2). Presenting PSA, pre-operative flow and histopathological outcome were independent of urinary retention. Conclusions Factors resulting in an increased risk of urinary retention are advancing age (> 68.7 years); a larger prostate volume (> 75 cc); greater number of biopsies (> 35); greater severity of lower urinary tract symptoms prior to biopsy and diabetes. Targeted biopsies alone, instead of a full template, may avoid urinary retention in the high-risk groups identified.
Background and Objectives Cystinuria is a rare genetic cause of recurrent urolithiasis and requir... more Background and Objectives Cystinuria is a rare genetic cause of recurrent urolithiasis and requires multimodal treatment, and stringent follow up. We wanted to evaluate the fears and concerns of patients with cystinuria during the COVID-19 pandemic. Materials and Methods An online survey using Google Forms was emailed to 165 patients with cystinuria who are maintained on a prospective database and had previously consented for email correspondence. Results Fifty-five responses were received following a single invitation, 23 were men and 32 women with a median age of 43 (range: 18-72) years. Thirty-nine (70.9%) out of 55 were isolating during the COVID-19 pandemic although only 7(12.7%) were given specific advice to shield officially. Six (10.9%) reported having COVID or COVID like symptoms, but none reported having a positive test. Only 9 (16.4%) had been able to work as usual. In comparison, 20 (36.4%) were able to work from home. Ten out of 19 patients (52.6%) on chelating medication described difficulty in access to their medicine, either due to a shortage at the pharmacy or prescription access. Reassuringly 34 (61.8%) patients described no issues with access to any of their cystinuria medications. Twenty-two patients (40%) reported experiencing pain or passing a stone during the COVID-19 pandemic, while 30 (54.5%) reported no problems. Of patients who felt it applicable, 16/31 (51.6%) were worried about attending the Emergency Department during this time. Of patients who had scheduled hospital appointments during this time, 26/44 (59.1%) had experienced cancellations. The majority of the respondents (37 (67.3%)) did not state any difference in the ability to stay hydrated during the lockdown. Twenty-eight (50.9%) were more anxious about their overall health during the pandemic, and 20 (36.4%) had expressed more concern about their kidney stones. Conclusion This personal fully patient-reported snapshot of the impact of the COVID-19 pandemic on a population of cystine stone formers in the United Kingdom has highlighted additional challenges for patients with a rare disease. The lockdown measures enforced have had a varying effect on patients' ability to work as normal, access medications, health anxieties, in addition to cancellations of the planned hospital appointments and Emergency Department attendance, which will impact on their future health and pose evolving challenges in delivery of their future care.
composite outcome was 9 months (range 0e84). When comparing same stage groups, those classified u... more composite outcome was 9 months (range 0e84). When comparing same stage groups, those classified using MRI showed improved PFS on Kaplan-Meier curves compared to the same stage classified by DRE. The difference was significant in the T1 and T3 groups. Univariable analysis showed that patients with DRE T1 disease (HR 0.10 95%, CI 0.01-0.73, p[0.02) or DRE T3 (HR 0.70, CI 0.51-0.97, p[0.03) were at higher risk for failure. Multivariable analysis was performed in a subgroup fashion, comparing corresponding DRE and MRI stages corrected for age, grade group and PSA. Only DRE T1 remained a significant predictor for worst outcome (HR 0.08, CI 0.010.59, p[0.01). CONCLUSIONS: Our results suggest that stage classified by MRI rather than DRE leads to a possible Will Rogers phenomenon. Current risk groups were developed and validated on clinical stage and should be used with caution when counselling patients in whom local stage is often based on MRI.
Background: Advances in imaging techniques are allowing early diagnosis and localization of tumor... more Background: Advances in imaging techniques are allowing early diagnosis and localization of tumor recurrence after local treatment failure. In this context, patients with lymph nodal recurrence (LNR) after radical prostatectomy (RP) can benefit from a rescue lymphadenectomy (LDNR) or radiotherapy (RT). We analyze our series of treated patients diagnosed with LNR after RP. Material and methods: Between May 2012 and March 2016, 15 patients, with a mean age of 67 years (60-82) were included. Pathological stage of PR: 6pT2 and 8 pT3. Two patients had Gleason 6 and 12 Gleason 7. The diagnosis was made by PET-CT cholina in 10 patients and by magnetic resonances in 4 patients. The LDNR was bilateral and RT was applied on the affected unilateral lymph nodes with 3e6 months of neoadjuvant androgen deprivation (DA). Biochemical recurrence (BR) after LDNR was defined as rising PSA >0.2 ng/ml and after RT increase >10% PSA compared to pre-treatment value. Results: LNR were diagnosed at a median 33 m after PR. Median PSA at diagnosis was 2.5 ng/ml (range 0.57e4.18) and all were located in the pelvis. Eleven received salvage RT and 4 LNDR (n ¼ 4). After RT, with a mean follow-up of 25 months, 7 patients were free of biochemical recurrence. Two patients treated with RT plus short-term AD are free of BR 4 and 3 years after this treatment. With LNDR and a mean follow-up of 15 months all had BR. Not a patient had any toxicity for both treatments. Conclusions: The LDNR and RT in patients with LNR are safe and feasible. Urologists and radiation oncologist must inform to the patients about these treatments. It requires a longer follow up to objective their both long term potential benefit. Conflict of interest: No conflict of interest.
Aim Group & Save (G&S) is conducted prior to Transurethral Resection of Bladder Tumour (TURBT) or... more Aim Group & Save (G&S) is conducted prior to Transurethral Resection of Bladder Tumour (TURBT) or Rigid Cystoscopy + Bladder Biopsy (BB) during pre-operative assessment (PoA). Each G&S costs £7.54 and 2 samples are required. The aim of this audit was to determine whether G&S is clinically required for these two procedures. Method This two-cycle audit reviewed the PoA components of patients undergoing TURBT or BB over a 6month period prior to the COVID-19 pandemic (July-Dec2019), in which PoA were face-to-face, and a subsequent re-audit during telephone PoA (July-Dec2020), where it was deemed unnecessary to have a G&S. Results 1st Cycle: 64 patients were included, 32.8%(21/64) had a preoperative G&S. 98.4%(63/64) had Hb measured. Mean Hb was 131.56 (79 – 165) g/l. 25%(16/64) were on anti-coagulants, of which 50%(8/16) were continued. No patients required a peri or post-operative blood transfusion. 2nd Cycle: 48 patients were included and 6.25%(3/48) had a G&S within the 1 month prece...
Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putti... more Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putting pressure on urological services. The British Association of Urological Surgeons (BAUS) guidelines indicate that for patients managed expectantly, a clinic review should be undertaken within 4 weeks of presentation. This quality improvement project reports the benefit of a dedicated virtual colic clinic to facilitate an efficient care pathway and reduce patient waiting times. A retrospective cycle analysed patients referred from the emergency department (ED) with uncomplicated acute ureteric colic (excluding those admitted for immediate intervention) over 2 months in 2019. A further cycle was carried out 12 months later following the introduction of a new dedicated virtual colic clinic with updated ED referral guidance. The mean time from ED referral to urology clinic review fell from 7.5 to 3.5 weeks. The percentage of patients reviewed in clinic within 4 weeks increased from 25% to 8...
Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed ... more Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed expectantly with acute ureteric colic: a quality improvement project.
Introduction & Objectives: Patients are often given printed information leaflets as part of infor... more Introduction & Objectives: Patients are often given printed information leaflets as part of informed consent for a procedure or explanation of their condition. Challenges of the COVID-19 pandemic and restrictions on face-to-face (F2F) consultations have required alternative methods of distributing information. We evaluated frequency of patient information leaflet use; preliminary cost benefit of electronic methods; and effectiveness of using QR codes to access digital leaflets. Materials & Methods: An international online survey of Urologists was distributed, and leaflet costs were estimated. QR codes were generated for commonly used British Association of Urological Surgeons (BAUS) patient information leaflets and were incorporated into a poster for display in the outpatient department. Evaluation of poster use was sought from patients through a questionnaire. Results: 108 Urologists responded to the initial survey, 44% of whom were Consultant grade. 54% provided >50% of patients with an information leaflet during F2F clinics. During transition to telephone clinics, this fell to 33% during the COVID-19 pandemic. Instead, 47% patients were provided Abstracts EAU22-37th Annual EAU Congress Eur Urol Suppl 2022;81(S 1):S135 with an internet link or directed to search engine terms in the clinical letter, instead of a printed leaflet. In a F2F clinic, each leaflet costs 40p to print, using a departmental model of 25 clinics/week, each clinician seeing 12 patients, if 53% receive a leaflet, the cost saving could be £3,307 per year. In response to the QR codes poster for digital provision of patient leaflets, in a patient population mostly male (82%) and older (60% between 60-80 years), 40% were familiar with QR codes and 73% could access the internet on a personal smartphone. 53% reporting using their smartphone to find information, 46% found the poster easy to use or follow, and 61% found it informative. Conclusions: Patient information leaflets are important for a Urologists' practice, frequently distributed, and printed forms can be costly. Providing paperless digital leaflets via a QR code offers many benefits including being cost-effective, touch-free, was well received by patients and has potential to increase patient engagement and education. Patient perception varies with age group and smartphone usage, therefore may not be suitable for all patient groups. This use of QR codes to provide direct access to digital patient information can be easily applied to other societies and specialties.
It is hypothesised that simulation enhances progression along the initial phase of the surgical l... more It is hypothesised that simulation enhances progression along the initial phase of the surgical learning curve. To evaluate whether residents undergoing additional simulation, compared to conventional training, are able to achieve proficiency sooner with better patient outcomes. This international, multicentre, randomised controlled trial recruited 94 urology residents with experience of zero to ten procedures and no prior exposure to simulation in ureterorenoscopy, selected as an index procedure. Participants were randomised to simulation or conventional operating room training, as is the current standard globally, and followed for 25 procedures or over 18 mo. The number of procedures required to achieve proficiency, defined as achieving a score of ≥28 on the Objective Structured Assessment of Technical Skill (OSATS) scale over three consecutive operations, was measured. Surgical complications were evaluated as a key secondary outcome. This trial is registered at www.isrctn.com as ISCRTN 12260261. A total of 1140 cases were performed by 65 participants, with proficiency achieved by 21 simulation and 18 conventional participants over a median of eight and nine procedures, respectively (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.72-2.75). More participants reached proficiency in the simulation arm in flexible ureterorenoscopy, requiring a lower number of procedures (HR 0.89, 95% CI 0.39-2.02). Significant differences were observed in overall comparison of OSATS scores between the groups (mean difference 1.42, 95% CI 0.91-1.92; p < 0.001), with fewer total complications (15 vs 37; p = 0.003) and ureteric injuries (3 vs 9; p < 0.001) in the simulation group. Although the number of procedures required to reach proficiency was similar, simulation-based training led to higher overall proficiency scores than for conventional training. Fewer procedures were required to achieve proficiency in the complex form of the index procedure, with fewer serious complications overall. This study investigated the effect of simulation training in junior surgeons and found that it may improve performance in real operating settings and reduce surgical complications for complex procedures.
Uploads
Papers by Francesca Kum