bluuebunny/crossref_metadata_2025 huggingface dataset:
426 Conservative Management of Bilateral Undescended Testes in an Adult
Authors: Langman F , Rahman A , Quraishi MK , Plail R
Published: November 2022

Bilateral undescended testes are an uncommon finding in children and even a rarer phenomenon in adults. Undescent of the testes (UDT) has important consequences on fertility, testicular injury, hormonal concerns, testicular torsion, and testicular cancer risk, as well as psychological health.

We present the case of a then 21-year-old native caucasian who was referred to the urology clinic with an ‘empty scrotum’ in 2009. On examination, he had secondary sexual characteristics with expected pubertal transformation. Testes were palpated as small smooth ovoid masses in each groin with the inability to be reduced into the scrotum. The basic hormonal screen was within the normal range. Ultrasound of the scrotum and groins identified testes in the left and right inguinal canal, respectively. Semen analysis showed azoospermia.

Treatment wise no pharmacological therapies were warranted in view of normal hormonal function. The patient opted for conservative options for fertility in view of likely low success rates in atrophic testes including sperm extraction techniques After detailed discussions around the dilemmas of Bilateral UDT, a decision for a tailored surveillance regimen including ultrasound and self-examination was taken. Psychological counselling was declined by the patient as felt unwarranted. He continues to remain well in himself to date with his wife and adopted children.

Greater awareness of testicular self-examination amongst young men should be advocated. With established neonatal screening availability, UDT in adults is seldom heard of but it is a primary risk factor for testicular cancer. Proper counselling advice and prosthesis should be offered proactively.
455 The Changing Trends of Image Guided Biopsy of Small Renal Masses Before Intervention- an Analysis of European Multinational Prospective EuRECA Registry
Authors: Chan VWS , Keeley F , Lagerveld B , Breen D , King A , Nielsen T , van Strijen M , Garnon J , Alcorn D , Graumann O , de Kerviler E , Zondervan P , Walkden M , Lughezzani G , Wah TM
Published: November 2022

Aim

To evaluate the use of pre-cryoablation biopsy for small renal masses (SRMs) and the effects of increasing up take on histological results of treated SMRs.

Method

From 2015 to 2019, patients with sporadic T1N0M0 SRMs undergoing percutaneous, laparoscopic or open cryoablation from 14 European institutions within the European Registry For Renal Cryoablation (EuRECA) were included for the retrospective analysis. Univariate and multivariate logistic models were used to evaluate the trends, histological results and the factors influencing use of pre-cryoablation biopsy.

Results

871 patients (Median [IQR] age, 69[14], 298 women) undergoing cryoablation were evaluated. The use of pre-cryoablation biopsy has significantly increased from 42% (65/156) in 2015 to 72% (88/122) in 2019 (p<0.001). Patients treated for a benign histology are significantly more likely to have presented later in the trend, where pre-cryoablation biopsy is more prevalent (OR: 0.64, 95% CI 0.51–0.81, p<0.001). Patients treated for undiagnosed histology are also significantly less likely to have presented in 2018 compared to 2016 (OR 0.31, 95% CI 0.10–0.97, p=0.044). Patients aged 70+ are less likely to be biopsies pre-cryoablation (p<0.05). R.E.N.A.L. nephrometry score of 10+ and a Charlson Comorbidity Index >1 are factors associated with lower likelihood to not have received a pre-cryoablation biopsy (p<0.05).

Conclusion

An increased use of pre-cryoablation biopsy was observed and cryoablation patients treated with a benign histology is more likely to have presented in periods where pre-cryoablation biopsy is not as prevalent. Comparative studies are needed to draw definitive conclusions on the effect of pre-cryoablation biopsy on SRM treatments.
456 Ten-Year Outcomes of Image-Guided Ablation and Partial Nephrectomy for T1 Renal Cell Carcinoma
Authors: Chan VWS , Osman FH , Cartledge J , Gregory W , Kimuli M , Vasudev N , Ralph C , Jagdev S , Bhattarai S , Smith J , Lenton J , Wah TM
Published: November 2022

Objective

This is the first study to compare 10-year oncological outcomes and peri-operative outcomes of IGA and PN in patients with confirmed small renal cell carcinomas (RCC).

Method

This is a retrospective cohort study of localised RCC (T1a/bN0M0) patients undergoing cryoablation (CRYO), radio-frequency ablation (RFA) or laparoscopic PN at our institution from 2003 to 2016. Oncological outcomes were compared using Cox regression and log-rank analysis. eGFR changes were compared using Kruskal-Wallis and Wilcoxon-rank tests.

Results

296 (238 T1a, 58 T1b) patients were identified, 103, 100 and 93 patients underwent CRYO, RFA and PN, respectively. Median follow-up time was 75, 98 and 71 months, respectively. Patients undergoing PN are significantly younger and have fewer complex tumours than those undergoing CRYO or RFA (p<0.001). On univariate analysis, all oncological outcomes were comparable amongst CRYO, RFA and PN (p>0.05). On multivariate analysis, T1a patients undergoing RFA had improved local-recurrence-free survival (LRFS) (HR 0.002, 95%CI 0.00–0.11, p=0.003) and metastasis-free survival (HR 0.002, 95%CI 0.00–0.52, p=0.029) compared to PN. In T1a and T1b patients combined, both CRYO (HR 0.07, 95%CI 0.01–0.73, p=0.026) and RFA (HR 0.04, 95%CI 0.03–0.48, p=0.011) had improved LRFS rates. Patients undergoing CRYO and RFA had a significantly smaller median decrease in eGFR post-operatively compared to PN (T1a: p<0.001; T1b: p=0.047). Limitations include retrospective design and limited statistical power.

Conclusions

IGA is potentially as good as PN in oncological durability. IGA preserves kidney function significantly better than PN. More studies with larger sample size should be performed to establish IGA as a first-line treatment alongside PN.
460 Prostate Biopsy Sepsis Rates – Are We Meeting National Average Levels?
Authors: Arang H , Mehta A , Roberts R , Mehta A , Beknazirov K , Ahmed I , Lynch M
Published: November 2022

Aim

To identify the prevalence of sepsis following trans rectal ultrasound (TRUS) biopsy of the prostate at our unit and identify potential causes for this, and to implement change to reduce the sepsis rate.

Method

A retrospective observational audit was performed between 01/10/19–17/01/20 for TRUS biopsy, followed by two re-audits between 05/03/20–28/05/20 and 06/08/20–17/09/2020 for trans perineal (TP) biopsy. A descriptive statistical analysis was performed on the data as well as an N-1 Chi-squared test on the data with a p<0.05 set as statistically significant. We compared our procedure to the BAUS guideline and NICE guideline for TRUS and TP biopsy.

Results

A total of 202 patients had TRUS biopsies between 01/10/19 to 17/01/20. 7.9% of patients presented with sepsis following their biopsy. Following our recommendation, between 05/03/20 to 28/05/20, a total of 19 patients had TP biopsy at our unit with 0 developing sepsis. A re-audit of 44 patients who underwent TP biopsy between 06/08/20 to 17/09/2020 showed no patients developing sepsis, indicating sustained improvement.

Conclusion

The rate of TRUS biopsy sepsis was four times higher than average levels at our department. There were zero patients who became septic following their TP biopsy. Over a 3-month period our TRUS biopsy audit showed 69 days of sepsis related admission, this is greater than £30,000 in costs. TP biopsy therefore leads to improved patient experiences with their care and also a significant cost saving to the trust.
569 Trial Without Catheter – Are We Performing the Procedure Correctly?
Authors: Mehta A , Arang H , Anyomih T , Arsanious N
Published: November 2022

Aim

To assess the trial without catheter (TWOC) practice at our unit by ensuring there is accurate recording of data onto electronic records and factors affecting successful TWOC are being addressed.

Method

2 months of retrospective data on TWOC practice was collected between 01/07/2019–30/08/2019. The Guy's and St Thomas’ TWOC guideline was used as the standard to compare to. Factors that could affect TWOC outcomes were checked on our electronic patient records. A re-audit was performed between 31/07/2020–30/08/2020.

Results

55 sets of data were collected with 16 (42%) patients having no documentation of post void residual volume (PVR). There were 6 adverse outcomes following TWOC, 3 patients returned in acute urinary retention (AUR) and 3 had delayed discharges. 3/6 of these adverse outcomes were linked to poor TWOC practice. 4/5 patients who failed TWOC were not on Tamsulosin and 0/5 were on laxatives. Following our implemented changes the re-audit showed no adverse outcomes, and only 2 patients without PVR documented.

Conclusions

Our first audit demonstrated significant adverse outcomes from poor TWOC practices at our unit. We implemented changes including writing an official TWOC guideline for the trust and regional teaching from our catheter workshop that included correct TWOC practice. Following these changes, the rates of adverse outcomes following TWOC were significantly reduced.
642 Racial Disparities in Uric Acid Stones - a Tertiary Centre Cohort Study
Authors: Hoq MN , Ahmed MD , Al-Jadir B , Subramonian K
Published: November 2022

Aim

The prevalence of urolithiasis has been increasing over decades with uric acid stones accounting for 10% of all urinary tract stones. While hyperuricosuria states have been well recognised as risk factors in the pathogenesis of uric acid stones; its association with ethnic variations is poorly understood. We followed up on our single-centre cohort study to analyse and understand the patient characteristics in uric acid stones and differences between racial groups.

Method

We conducted retrospective analysis of 487 patients with stone analysis results treated at a single tertiary centre. Patients with Uric acid stones were identified and data on Age, BMI, Serum Uric acid level and Urine pH were compared amongst different patient populations using STATA.

Results

Out of 487 stone analysis results, 63 were identified as uric acid stones as either major (n=42) or minor (n=21) component and were included in our analysis. 71.43% (n=45) of these patients were Caucasian while 28.57% (n=18) were Asian. Male gender predominance was also noted (n=46). Of the diverse aetiologies, metabolic disorders were the most prevalent and include aciduria, diabetes mellitus, metabolic syndrome, and obesity. Amongst the Asian population, there was a significant propensity to lower age, lower BMI, higher uric acid level and higher urine pH.

Conclusion

Our study shows that Asians suffer from uric acid stones at a younger age, have relatively lower BMI, higher uric acid levels and relatively higher urine pH. We have previously done this analysis with a smaller population and our repeat analysis shows the same trend which strengthens our findings.
685 Management of Patients Presenting Acutely with Suspected Ureteric Colic
Authors: Sturgess G , Elmussareh M
Published: November 2022

Aim

To assess how patients presenting with suspected ureteric colic are managed compared to NICE guidance (renal and ureteric stones, QS195 July 2020). Also, to review the incidence of ureteric stones occurring in all referrals received in a hospital where patients are referred prior to imaging confirmation of stones.

Method

The dataset was formed by retrospective handover screening during a three-month period in 2019 prior to the impact of COVID-19 with any patient included who was referred to urology with a suspected ureteric calculus, generating 149 cases. Demographic information, imaging modality and treatment were recorded as well as comparisons to five NICE quality statements on the management of ureteric stones.

Results

Of the 149 referrals 88 were male with a median age of 45 years. Ureteric stones were found in 61/149 of referrals with 99/149 receiving CT scan first line whilst the remainder were initially imaged using ultrasound. Forty referrals were received for women under the age of 50 with only 3/40 having a ureteric stone. Pick-up rate of ureteric stones was higher in older and male patients. CT within 24 hours of referral was achieved in 82.8% and 69.9% were given appropriate analgesia. In patients in which it was necessary primary treatment occurred within 48 hours in 45.4% of patients.

Conclusions

Less than half of referrals received had a ureteric stone with particularly low pick-up rates in young women. A large proportion of patients having ultrasound first line had subsequent CT imaging. Adherence to NICE quality standards was comparable to other centres.
719 2WW Prostate Cancer Referrals - Are We Over Investigating Patients with Normal PSA Results?
Authors: Ravindraanandan M , Willard K , Cotton R , Dawson S , Nair B , Pankaj P , Luscombe C , Gommersall L
Published: November 2022

Aim

Nationally, men are referred by GPs to urologists for suspected prostate cancer using a cancer pathway proforma for an appointment within two weeks. Criteria include a PSA level above the age-specific range, or an abnormal DRE regardless of PSA result. In this study, we look at the number of cancers detected from patients referred with abnormal DREs and a normal PSA.

Method

In a single major tertiary urological centre, data on patients referred with suspected prostate cancer were retrospectively collected over a 12-month period. Variables focussed on included those referred with a normal PSA, but abnormal DRE, and analysed using descriptive statistics.

Results

Over a 12-month period, 935 referrals were made by GPs for suspected prostate cancer. Of those, 15.3% (n=143) were referred due to an abnormal DRE but a normal PSA. The median age of our cohort was 73 (38–92, mean 70.15) with a median PIRADS score of 2, and a median PSA density of 0.04 (0.01–0.19, mean 0.05).

From our cohort, 6.3% of men (n=9) had malignant histology. From those with malignant histology, 2.1% (n=3) had clinically significant prostate cancer with a mean age of 79. None of the three men were suitable for radical treatment. Only one man with non-clinically significant prostate cancer went on to have radical treatment.

Conclusions

Significant time and resources are used for those referred with abnormal DREs and normal PSA results, who for the overwhelming majority do not require any treatment. There may be scope to streamline referral criteria to reduce burden on services.
724 Do Renal Mass Biopsies Influence Patient Management? a Case Series Study in a Tertiary Hospital
Authors: Kretzmer L , Nour E , Akinjise-Ferdinand O , Mohammed M , Bhatt R
Published: November 2022

In recent years renal mass biopsy (RMB) has been increasingly adopted to guide management in patients with renal lesions. Indications include the evaluation of renal masses or cysts, and diagnosis prior to initiating targeted chemotherapy or ablation.

A case series of 232 RMBs was collected from 2009–2020. Inclusion criteria were RMBs taken from native kidneys.

Participants' mean age was 64.7 years (SD = 13.57 years), with 67% being male. The diagnostic rate of RMB was 78.45% (n = 182/232). Whether masses were solid or cystic did not influence diagnostic rate (p = .94143). Positive predictive value (PPV) of RMB compared with surgical histology was .8775. Only 1.3% (n = 3/232) of cases had significant complications.

Patients with non-diagnostic biopsies were more likely to be managed with surveillance alone (56.0% vs 32.4%; p < .05). Diagnostic RMBs did not statistically influence whether patients had surgical management (p = .188914). Of non-diagnostic RMBs, 100% (n = 7/7) of patients with surgical histology had renal cell carcinoma (RCC).

RMB has specific implications in two special populations: In small renal masses, PPV of RMB increased to 1.0. 16.7% (n = 3/18) of patients diagnosed with oncocytoma at RMB had a diagnosis of RCC.

RMBs are safe with a high diagnostic rate. However, it seems to not influence definitive patient management. Clinicians should be wary when dealing with special populations. Results must be viewed in the context of the patient's history and imaging, and management should be determined using a multi-disciplinary approach.
806 The Efficacy of Prostatic Arterial Embolisation as Indicated by Clinical Outcomes
Authors: Parmar S , McRae B , Hines J , Munneke G , Walkden M , Von Stempel C
Published: November 2022

Aim

PAE (prostatic arterial embolisation) is a non-surgical, minimally invasive procedure used to treat symptoms of benign prostatic hyperplasia (BPH). It is used to treat patients with moderate to severe lower urinary tract symptoms including those requiring long term urinary catheter placement and intermittent self-catheterisation. The incidence of urinary tract infection is greater in this group at baseline and the risk of infection as a complication of PAE is recognised in the literature. This study aimed to compare the clinical outcomes of PAE to those of TURP (transurethral resection of the prostate), the reference standard for BPH treatment.

Method

All patients who underwent PAE between 2019 to 2021 at a single centre were included in this retrospective study. Clinical outcomes of patients were also recorded including international prostate symptom score (IPSS) and urodynamic results. These were compared to TURP results provided in the UK ROPE study.

Results

82% of patients experienced an improved IPSS after PAE, with a median reduction of 15 points, compared with a median reduction of 17 points with TURP. PAE caused a greater reduction in median prostate volume but proved to be less effective in improving urodynamic test results when compared to TURP.

Conclusion

While still clinically effective, PAE is less effective for treatment of lower urinary tract symptoms from BPH when compared to TURP.
822 The Use of Prophylactic Antibiotics Pre-Orchidectomy – a Retrospective Cohort Study
Authors: Doherty J , Nambi Rajan T
Published: November 2022

Aim

NICE guidance recommends the use of antibiotic prophylaxis in clean-contaminated procedures and when a prosthetic is placed. However, the use in orchidectomies is not specified under the treatment summary heading of ‘Urological Procedures, Antibacterial Prophylaxis’. The use of prophylactic antibiotics pre-orchidectomy varied amongst senior urologists within a District General Hospital, where no specific protocol was in use. This retrospective cohort study aimed to decipher if the use of prophylactic antibiotics reduced post-operative infection incidence following radical orchidectomies.

Method

50 consecutive orchidectomies, performed between February 2019 and July 2021, were analysed. It was identified whether the patient had antibiotics administered pre-operatively and if they developed a subsequent wound infection through post-operative ward rounds, clinic letters and presentations to the Emergency Department. Orchidectomies performed by general surgeons were excluded from analysis.

Results

Of the 50 orchidectomies analysed, 30 patients received pre-operative antibiotics, four of whom subsequently developed a post-operative infection. Of the 20 patients that did not receive prophylactic antibiotics, nine developed a post-operative infection. The relative risk was calculated at 0.2963 with a 70.4% relative risk reduction if prophylactic antibiotics were administered. Chi squared tests calculated a p-value of 0.012 highlighting statistical significance. Eight patients had primary prosthesis placed at the time of orchidectomy, all of whom received prophylactic antibiotics.

Conclusion

Prophylactic antibiotics were effective in preventing post-orchiectomy wound infections and routine local protocols should advise the use in orchidectomies, which classify as clean-contaminated procedures as per NICE guidance.
894 What Proportion of Acute Admissions for Urinary Tract Infection Under Urology Require Surgical Intervention Within 6 Months?
Authors: Humayon D , Mowbray L , Baby A , Mahesan T
Published: November 2022

Introduction

All male patients with urinary tract infections (UTI) at this large district general hospital are admitted under the care of the urology department. This audit aims to establish how many male patients over the age of 70 with a diagnosis of UTI required surgical intervention in the 6 months following admission.

Method

We performed a retrospective audit of all patients over 70 admitted with a UTI over a five-month period. Patients with recent instrumentation or other pathologies, including visible haematuria or ureteric stones confirmed on imaging in the accident and emergency department were excluded.

Results

Of the 30 patients included, five (16.7%) required invasive intervention. Three (10%) acutely, (two ureteric stents, one nephrostomy), two (6%) as an outpatient on an elective basis (flexible ureteroscopy and prostate artery embolisation).

Conclusions

Over 80% of patients included in this audit did not require surgical intervention within six months. Whilst UTI is a significant finding in younger men suggestive of structural or systemic abnormality, UTIs in incontinent, catheterised, or older men does not carry the same risks and rarely requires intervention. Elderly care wards were established to ensure older patients receive support to improve health functioning and prevent acute deterioration in physical and mental health during admission. Given that less than 20% of men required intervention, this cohort of patients would be better admitted to wards geared towards elderly care who are better able to manage their co-morbidities and have the resources for early physiotherapy and occupational therapy input.
900 Documenting Escalation Status in Acute Urology Admissions with Known Urological Malignancy
Authors: Humayon D , Osmani Z , Mahesan T
Published: November 2022

Introduction

Knowledge of a patient's escalation status including cardiopulmonary resuscitation and invasive ventilation is crucial to ensure appropriate management. Patients with pre-existing advanced prostate or bladder cancer are often elderly and frail, and even more so in the context of an acute admission to hospital. This audit aims to establish how many patients admitted acutely under urology at a large district general hospital with known prostate and bladder cancers, had their escalation statuses appropriately documented.

Method

We performed a retrospective audit over a ten-week period. We included all patients admitted under urology with a diagnosis of prostate or bladder cancer.

Results

Of the 30 patients included, 4 (13.3%) had completed escalation forms. All were completed on admission.

Conclusions

Escalation status was poorly documented for this cohort of patients. This is likely due to a number of issues including pressure on the service and confusion about who can and should make these decisions.

That all forms were completed on admission highlights that this is likely to be the best opportunity and junior doctors must be encouraged to complete escalation forms at this time with decisions subsequently ratified by a consultant within 24 hours.

Moving forward, intervention is clearly needed. As a department an imminent move towards a consultant of the week model will likely improve documentation, however junior doctors too must be encouraged to open these discussions early in the patient journey. Only then can we ensure patients receives care that is both appropriate and reflects their wishes.
921 Establishing the Role of Bedside Disposable Cystoscopes for Emergency Urethral Catheterisation
Authors: Albnhawy A , Humayon D , Henderson J , Mahesan T
Published: November 2022

Introduction

Where urethral catheterisation fails, cystoscopy may enable urologists’ adequate views to identify the urethral channel. Traditionally this has required a slot on the emergency operating list. Our district general hospital introduced single use flexible cystoscopes to allow for bedside catheterisation and here we present our experience.

Method

Data was collected prospectively each time a disposable scope was used for urethral catheterisation over a 4-month period. A form was designed and distributed to all six clinicians who used the device. We evaluated both assessment of the scope and the success of the procedure.

Results

16 forms were collected. Overall, the experience was described as good in 14 out of 16 instances. Catheterisation was successful in 14 cases. 13 forms described the image of the scope as being average, with three describing it as good. 10 forms reported good flexibility, with six reporting it as average. On seven occasions the clinician denied difficulty passing the scope through the narrowing. Six clinicians found the views of the bladder adequate although in eight of 16 cases, the bladder was not visualised. Not all feedback was positive with some clinicians reporting weak irrigation and the challenge of the scope having only one channel.

Discussion

The disposable scope showed high efficacy for insertion of a urethral catheter in cases of difficult urethral catheterisation. Clinicians highlighted good lighting and irrigation as well as flexibility. The introduction of disposable cystoscopes saves resources as well as being financially sensible. we will continue its use in our departments.
962 Prognostic Value of Neutrophil to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) for Small Renal Cell Carcinomas (RCC) After Image-Guided Cryoablation or Radio-Frequency Ablation (RFA)
Authors: Asif A , Osman F , Koe JSE , Ng A , Cartledge J , Kimuli M , Vasudev N , Ralph C , Jagdev S , Bhattarai S , Smith J , Lenton J , Chan VWS , Wah TM
Published: November 2022

Aim

This is the first study investigating the relationship between NLR or PLR and outcomes of percutaneous cryoablation or RFA for small RCCs with long-term outcomes.

Method

All patients undergoing cryoablation or RFA for small RCCs (<7cm) from 2003–2016 at a regional centre for RCC were included. Optimal cut-offs for NLR/PLR were determined using the ROC curve and AUC using the Youden method. Outcomes were compared using Cox or logistic regression.

Results

203 patients (Cryoablation:103, RFA:100) were included. Median follow-up was 75 months and 98 months, respectively.

Using the Youden method, high post-operative NLR values were associated with worsened local recurrence-free survival (LRFS) (NLR >5.38; HR: 5.13, p=0.037) and worsened Overall Survival (OS) (NLR >6.42; HR: 3.40, p<0.001) in all patients.

High post-operative PLR values were associated with worsened OS in all patients (PLR >192; HR: 2.31, p=0.006) and RFA patients alone (n=100; PLR >260; HR: 8.27, p<0.001).

Using continuous Cox regression model, greater changes in peri operative NLR were associated with worsened LRFS in cryoablation alone and all patients (Continous; HR: 1.09, p=0.028).

Higher post-operative NLR was also associated with worsened LRFS in cryoablation patients alone (HR: 1.10, p=0.046).

Post-operative NLR (HR:1.17, p=0.002), change in peri-operative NLR (HR:1.19, p=0.001), and change in peri-operative PLR (HR:1.20, p=0.009) were all associated with worsened CSS in all patients.

Pre-operative PLR and NLR were not associated with complications and change in renal function.

Conclusion

NLR and PLR are valuable prognostic factors for this group of patients and should be used to guide subsequent follow-up and monitoring of recurrence.
975 Evaluation of the Quality of Our Consent Forms Used for Ureteroscopy and Nephroureteroscopy - Is It Time to Go Digital?
Authors: Rafi AU , Breish M , Nadeem M
Published: November 2022

Aim

Consent documentation for surgical procedures must be precise and clear in order to achieve excellence in clinical practice. In this audit, we aim to compare our consent forms against BAUS information leaflets on ureteroscopy and stone procedure and assess the documentation of all serious and frequently occurring complications as mentioned on BAUS leaflet.

Method

We retrospectively reviewed the consent forms of 60 patients who underwent elective ureteroscopy between August 2020 - April 2021 to assess the quality of documentation as well as legibility of handwriting.

Results

As a total of 60 consent forms were reviewed. 35 males and 25 females contributed to the study with 59 being the median age. There were over 10 risks being commonly missed. Some of the important risks such as stone recurrence 95%, catheterisation 92%, major damage to ureter wall 86%, pain 71% and residual stone 61% were missed. The documentation also outlines other risks; ureteric stricture 53%, aesthetic risk 67%, failure to access ureter 51% and stent symptoms 47%. Minor damage to the wall of ureter 41%, alongside need of another surgery were recorded as other commonly neglected risks. However, only 7% of the consent forms did not mention bleeding and just 2% of the forms failed to include stent insertion as a common effect of procedure. Only 17% consent for did not have eligible handwriting, although this is subjective.

Conclusions

Documentation on consent forms for ureteroscopy lacks accuracy and missed important information. We propose use of digital consent form to assess compliance and quality of consent documentation.
46 Evaluating Clinical Outcomes in Temporal Artery Biopsy: A Retrospective Observational Study
Authors: Ishak P , Walker E , Boom S , Wallace D
Published: November 2022

Aim

Giant cell arteritis (GCA) is an inflammatory vasculopathy affecting large and medium calibre arteries, with temporal artery biopsy (TAB) constituting an important diagnostic component. The aim of this study was to analyse local practice in TAB and assess clinical outcomes with reference to current guidelines.

Method

All patients undergoing TAB in our institution between April 2018 and March 2021 were retrospectively studied and the American College of Rheumatology (ACR) score recorded.

Results

124 patients were included in the study. The female to male ratio was 2.2:1 and average age was 71±10 years. 95 patients presented with temporal artery signs and headache respectively. The mean time from steroid commencement to TAB was 6 days (range 0–36 days). 23 biopsies were positive (median ACR score of 4, range 2–4, excluding pathology result) – these patients were treated with steroids. 98 biopsies were negative or non-specific; most stopped steroid treatment, however 30 patients were clinically GCA and continued therapy (median ACR score of 3, range 2–4). Three patients were never prescribed steroids (median ACR score of 2).

Conclusions

GCA is a clinical diagnosis guided by symptoms and signs, inflammatory biochemical markers, and medium artery biopsy. The provisional ACR scoring is highly suggestive of the outcome of TAB.
54 Evaluating Best Medical Therapy Provision in Peripheral Arterial Disease Patients: A Prospective Audit
Authors: Ishak P , Iftikhar N , Nadarasa A , Boom S , Wallace D
Published: November 2022

Background

Best medical therapy (BMT) is a collection of evidence-based cost-effective interventions, which significantly decreases cerebrovascular and coronary mortality and morbidity risk by at least 20% in peripheral arterial disease (PAD) patients. Its implementation was audited in patients attended our vascular unit.

Method

A prospective audit of BMT implementation in PAD patients in University Hospital Ayr over a three-week period: diabetic and hypertension control, statin and antiplatelet therapy were audited from electronic notes and prescription charts. Exercise and smoking cessation advice given during consultations was recorded and audited.

Results

35 patients were randomly selected from ward admissions and vascular clinics. Their mean age was 69±12, 25 were male. 4 out of 11 current smokers received smoking cessation advice. All the patients attending the vascular clinic were given exercise advice. 3 patients had never had their HbA1c checked. 7 of 14 diabetic patients with poor control had changes to their medication. Stains were started in 7 out of 14 patients not currently on a statin and another 4 patients had their statin dose increased. 32 patients had their lipid profile checked. Both patients with newly diagnosed hypertension were not prescribed antihypertensive. Only 5 out of 12 patients who should have had an antiplatelet agent received them. 5 patients were changed from a single antiplatelet agent to dual therapy.

Conclusions

Primary and secondary care education is essential to improve BMT provision in PAD patients.
165 Antithrombotic Therapy for Aortic and Peripheral Artery Aneurysms: A Systematic Review and Meta-Analysis
Authors: Wong KHF , Zlatanovic P , Bosanquet D , Aboyans V , Saratzis A , Kakkos S , Hinchliffe R , Twine C
Published: November 2022

Aim

This systematic review and meta-analysis aimed to assess the impact of antithrombotic agents on extracranial aneurysms under surveillance or undergoing intervention.

Method

Medline, Embase, and CENTRAL databases were searched. Randomised-controlled trials and observational studies investigating the effect of antithrombotic therapy on clinical outcomes for patients with aortic or extracranial peripheral arterial aneurysms were included. Aneurysm growth rate, major adverse cardiovascular or limb events, mortality, endoleaks, re-intervention rates, and other outcomes were captured.

Results

Fifty-seven studies involving 121,451 patients were included (26 antiplatelets, 12 anticoagulants, 16 any antithrombotic agent(s), 2 intra-operative heparin). Aspirin reduced growth rates of aortic aneurysms under surveillance (mean difference -0.9mm/y, 95%CI -1.74 to -0.07, p=0.03; GRADE certainty: moderate). For aortic aneurysms undergoing intervention, antithrombotics increased 30-day mortality (odds ratio [OR] 2.30, 95%CI 1.51 to 3.51, p<0.001; GRADE certainty: moderate). Antiplatelets reduced long-term all-cause mortality (hazard ratio [HR] 0.84, 95%CI 0.76 to 0.92, p<0.001; GRADE certainty: moderate), whilst anticoagulants increased this risk (HR 1.64, 95%CI 1.14 to 2.37, p=0.008; GRADE certainty: very low). Anticoagulants increased incidence of endoleaks under 3 years, and re-intervention rates (p<0.05 for all). Antithrombotic agents did not significantly affect rupture rates in aortic aneurysms. Meta-analysis was not possible for ruptured aneurysms and popliteal aneurysms.

Conclusions

There is moderate quality evidence that aspirin reduces aneurysm growth rates. Antiplatelet agents reduced all-cause mortality in aneurysms after intervention; whilst anticoagulants increased this risk, along with endoleaks and re-interventions. Well-designed trials are required to determine therapeutic benefits of antithrombotic agents for patients with aneurysms.
412 Knowledge and Practices for the Prevention of the Diabetic Foot in North Wales
Authors: Morris R , O'Malley J , Gilliland E , Shaikh F
Published: November 2022

Aim

Diabetes mellitus can result in a wide range of foot complications such as ulceration, infection, and amputation. The National Institute for Health and Care Excellence (NICE) recommend that all diabetic patients should receive verbal and written information relating to their foot care. Here we assess our compliance with the national guidelines and the levels of patient knowledge amongst the diabetic population in the North West of Wales.

Method

A questionnaire was provided to all adult diabetic patients attending the outpatient podiatry service over the course of three weeks at Ysbyty Gwynedd, North Wales. The survey included compliance and knowledge-based questions regarding foot care.

Results

A total of 65 patients were recruited and completed questionnaires. The majority of the patients were males (male:female ratio 2:1) and over 70 years and had type II diabetes.

98% of patients admitted to receiving verbal diabetic advice while only 57% received written information. Compliance with daily foot checks was 82%. Regarding patient knowledge, over 90% of patients selected the correct answer to 11 out of the 15 knowledge-based questions. Despite 95% recognising that poor footwear can contribute to diabetic foot complications, only 86% recognised that walking barefoot carries similar risks.

Conclusions

Diabetic foot knowledge is high within our studied population. Use of patient information leaflets can be further improved to help educate patients in avoiding barefoot walking and to prevent diabetic foot complications and limb loss.
590 The Value of Peripheral Pulse Examination in the Diagnosis of Intermittent Claudication
Authors: Shannon J , Srinivasamurthy D
Published: November 2022

Aim

The primary aim was to objectively evaluate the use of peripheral pulse examination as a screening tool for IC by calculating the sensitivity and specificity. Our secondary aim was to describe the cohort of patients referred to the clinic by their GP and identify areas for improvement and early initiation of best medical therapy.

Method

This study used a retrospective analysis of a prospectively maintained database. Records of all patients referred to the claudication clinic were collected from October 2018 to October 2019. The most distal palpable pulse of each leg was assigned a value and combined to create a ‘peripheral pulse score’. Risk factors, ABPI results, Peripheral Artery Disease (PAD) status and details of ongoing medical therapy were also recorded.

Results

211 patients referred by their GP were included in the study. The absence of bilateral foot pulses was found to have a sensitivity of 86%, specificity 92%, PPV 95% and NPV 79%. There is a strong correlation between peripheral pulse score and ABPI. Only 27% of patients suspected of having IC by their GP were on best medical therapy at their initial clinic visit.

Conclusions

Peripheral pulse examination is a valuable diagnostic tool for identifying patients with IC and can be used to guide referral to specialist services. We provide evidence for the use of foot pulses as a screening tool to be used by primary care providers. More patients being referred to the IC clinic can be started on best medical therapy for secondary prevention at the time of referral.
649 Compliance of Carotid Endarterectomy Pathway at a Vascular Unit - a Regional Audit
Authors: Hakeem A , Najem M
Published: November 2022

Aim

To identify reasons for delays in a pathway for patients presenting with Transient Ischemic Attack (TIA) and requiring Carotid Endarterectomy (CEA).

Method

Bedford hospital is a vascular unit covering 3 hospitals (Bedford, Milton Keynes and Luton Hospital) requiring a complex referral system. Patients who develop TIA secondary to carotid disease are referred to the vascular team. This audit includes patients who underwent carotid endarterectomy from Dec 2020 to Jun 2021. Data was initially collected and analysed as a single vascular unit. The analysis included all steps of referrals and investigations, a subset of data was analysed to identify delays related to each hospital.

Results

A total of 73 patients were included in the analysis, overall delays (>14 Days) from the onset of symptoms to surgery was 57.5%, the delays were 19 (55%) at LDH, 14 (50%) BHT, 9 (90%) at MKUH. 41 (56%) were delayed referrals to the vascular team. 36 (49%) delays were related to factors after the referral was made. 8 (10%) patients had secondary events awaiting CEA.

Conclusions

The audit demonstrated that there were significant delays in the carotid endarterectomy referral pathway, there were patients who had delays at multiple levels, delays can be due to the complex referral system between 3 different hospitals. 10% of the patients had developed secondary events while awaiting treatment.
987 Protocol Driven Reduction of Haematoma Following Symptomatic Carotid Endarterectomy (CEA) – a Prospective Cohort Study
Authors: Marzouqa N , Jacob L , Busuttil A , Baker D
Published: November 2022

Aim

Stroke is the third leading cause of death in developed nations and the leading cause of long-term disability. Carotid artery stenosis accounts for 20 to 30% of ischaemic strokes. Carotid Endarterectomy, has proven highly effective in preventing the development of strokes, TIAs and reducing death among patients with symptomatic carotid artery stenosis of 50–99%. The most common complication of CEA is wound haematomas. This study evaluates a protocol driven haemostasis pathway aimed to address the findings of a recent QI project that identified a significantly high neck haematoma rate as well as a high return to theatre rate for the complication.

Method

A prospective cohort outcome study between June 2019 and June 2020 was conducted, with the introduction of this stepwise pathway introduced as a quality improvement measure.

This was implemented at the end of successful patch closure, for each CEA.

Results

Post-CEA haematoma rates decreased from 7% to 3.6%. Return to theatre rates reduced from 6% to 0.9% with no increase in peri-operative stroke rates.

Conclusion

Our protocol appears to reduce post-CEA haematoma rates. Return to theatre rates had also dropped without an increase in peri-operative stroke rates despite using protamine and tranexemic acid when needed.
Identification and prioritization of tumour-associated antigens for immunotherapeutic and diagnostic capacity in epithelial ovarian cancer: a systematic literature review
Authors: Wiseman Lucy , Cinti Noemi , Guinn Barbara-ann
Published: November 2022

Epithelial ovarian cancer (EOC) is a prevalent carcinoma in the female population associated with poor prognostic outcomes, in part due to the late stage of the disease at diagnosis. Aiming to identify tumour-associated antigens (TAAs) with the potential to facilitate earlier detection and targeted therapy of EOC, five scientific literature repositories were systemically searched for primary literature sources reporting the expression of a TAA in the tissue or serum of adult females diagnosed with EOC and healthy women. We identified 7120 articles of which 32 met our inclusion criteria and passed the bias-quality assessment. Subsequently, data were collated on 29 TAAs whose expression had been analysed in 2181 patients and 589 healthy individuals. Reports of CA125 and EpCAM expression were numerous while tissue expression data were available for 28 TAAs. Data were segregated into three meta-cohorts for statistical scrutiny and their capacity for diagnostic and treatment targeting was assessed. We showed that CA-125 was expressed homogenously in EOC patients while EpCAM was expressed heterogeneously. CA-125 was the most promising TAA target for both diagnosis and treatment, gaining a priority score of 12 (/12) while EpCAM gained a priority score of seven. Tissue expression of EOC TAAs was homogenous; 90% of the EOC population express any identified TAA while just 20% of healthy individuals will be positive for the same TAA. We suggest TAA profiling should be a fundamental aspect of EOC diagnosis, sitting alongside the FIGO framework, promoting reduced mortality and directing the development of TAA-targeted therapeutics.
Maximum power point tracking of photovoltaic power generation based on improved fuzzy control and conductance increment method
Authors: Wei Liming , Yu Bo
Published: November 2022

The National Development and Reform Commission of China announced in 2022 that it would promote the development of carbon peaking and carbon-neutrality. Therefore, gradual improvement in photovoltaic (PV) development technology would gradually show its advantages. Additionally, the development of the PV power generation industry is promoted significantly by the year-on-year increase in PV power generation. This study combines the traditional fuzzy control and incremental conductance methods by comparing the current maximum power point (MPP) intelligence with the traditional control algorithm. Furthermore, it proposes an optimization algorithm to improve the tracking speed of the MPP by using the partition variable step size. An incomplete partial differential equation is added to the judgment condition of the small step size to solve the problem of oscillation near the MPP caused by the ideal differential equation. A simulation model is established in MATLAB®/Simulink® and the method is simulated under specific conditions. The time to reach the first maximum output point is shortened by 0.21 and 0.14 s by analysing the oscillation process data of three simulation cycles of the incremental conductance, fuzzy control and fuzzy conductance methods, respectively. Additionally, the vibration loss caused by environmental mutation is reduced by 6.5% and 3.1%, respectively. The improved incremental conductance method utilizes the simulation results to optimize the problem of steady-state oscillation and improve the efficiency of the PV power generation. The feasibility and effectiveness of the improved incremental conductance method are verified by comparing the traditional control algorithm with the improved incremental conductance method.
BFS-based distributed algorithm for parallel local-directed subgraph enumeration
Authors: Levinas Itay , Scherz Roy , Louzoun Yoram
Published: November 2022

Estimating the frequency of subgraphs is of importance for many tasks, including subgraph isomorphism, kernel-based anomaly detection and network structure analysis. While multiple algorithms were proposed for full enumeration or sampling-based estimates, these methods fail in very large graphs. Recent advances in parallelization allow for estimates of total subgraph counts in very large graphs. The task of counting the frequency of each subgraph associated with each vertex also received excellent solutions for undirected graphs. However, there is currently no good solution for very large directed graphs.

We here propose VDMC (Vertex specific Distributed Motif Counting)—a fully distributed algorithm to optimally count all the three and four vertices connected directed graphs (network motifs) associated with each vertex of a graph. VDMC counts each motif only once and its efficiency is linear in the number of counted motifs. It is fully parallelized to be efficient in GPU-based computation. VDMC is based on three main elements: (1) Ordering the vertices and only counting motifs containing increasing order vertices; (2) sub-ordering motifs based on the average depth of the tree spanning them via a BFS traversal; and (3) removing isomorphisms only once for the entire graph. We here compare VDMC to analytical estimates of the expected number of motifs in Erdős–Rényi graphs and show its accuracy. VDMC is available as a highly efficient CPU and GPU code with a novel data structure for efficient graph manipulation. We show the efficacy of VDMC on real-world graphs. VDMC allows for the precise analysis of subgraph frequency around each vertex in large graphs and opens the way for the extension of methods until now limited to graphs of thousands of edges to graphs with millions of edges and above.

GIT: https://github.com/louzounlab/graph-measures/

PyPI: https://pypi.org/project/graph-measures/