bluuebunny/crossref_metadata_2025 huggingface dataset:
1346 Hardware Complications in Cephalomedullary Nailing for Intertrochanteric Hip Fractures: A Retrospective Cohort Study
Authors: Legg P , To C , Selmon G
Published: October 2021

Introduction

Intertrochanteric hip fractures are common injuries in elderly patients and can result in significant morbidity. The use of cephalomedullary femoral nailing (CMN) has gained popularity, particularly for unstable fracture patterns. We investigated hardware complications and mortality of patients undergoing long and short CMN for intertrochanteric hip fractures.

Method

We conducted a retrospective cohort study of consecutive cases in a single UK-based trauma unit between 01 July 2016 – 31 Dec 2019. Primary outcome measures were implant failure and revision surgery. The secondary outcome measure was mortality.

Results

335 patients were included, mean age 82.9 years. 176 long (LN) and 167 short (SN) CMNs were performed. 25/335 (7.5%) hardware complications occurred resulting in 19 (5.7%) revision surgeries. Overall implant survivorship was 94.3%. There was no statistically significant difference in implant survivorship between LN and SN (p = 0.93), or between proximal screw configuration (p = 0.20). Cox regression analysis did not identify any independent predisposing factors leading to hardware complications. 30-day, 90-day and 1-year mortality rates were 7.9%, 15.2% and 26.5% respectively. There was no significant difference in mortality between LN and SN (p = 0.53). Regression analysis identified age and male gender as statistically significant independent factors of increased mortality.

Conclusions

For intertrochanteric fractures, there is no difference in hardware complications or mortality between long and short cephalomedullary nails. We highlight the risk of implant fracture at the lag screw-nail interface; accounting for one-quarter of failures. The revision rate of 5.7% due to hardware failure should be a consideration for surgeons undertaking CMN for intertrochanteric fractures.
1436 A Stab in The Back: Assessment of Suspected Cauda Equina Syndrome by The Emergency Department Prior To Referral to Orthopaedics in A District General Hospital
Authors: Hyett V , Campbell N , Olukoya O
Published: October 2021

Introduction

Within the UK, Cauda Equina Syndrome (CES) is a rare surgical emergency which has the potential to cause significant morbidity. Within hospitals that do not have an on-site neurosurgical service, assessment of potential CES patients is performed in the Emergency Department (ED) prior to referral to either local orthopaedic or regional neurosurgical services. Delay or inefficiency in this assessment can result in delayed treatment and worsens patient outcomes.

Method

A retrospective study with patients identified from the orthopaedic trauma meeting lists over a 6-month period. Only patients assessed by the emergency department were included (25 total). Direct referrals and those with infective symptoms were excluded. ED clinical notes were assessed, and the documentation was compared against a standard from the American Spinal Cord Injury Association. Documentation of pre- and post-void bladder scan was also assessed.

Results

Of the 25 total patients, 60% had a full lower limb neurological examination documented. 20% had no documented neurological examination and 20% had an incomplete neurological examination. Only 68% of patients had a Per Rectal exam performed, of those 94% had perianal sensation assessed. 56% of patients did not have a post-void bladder scan documented.

Conclusions

Limitations to initial ED assessment of likely CES patients can delay diagnosis and treatment which can have devastating consequences for the patient. The data is limited by reliance on an accurate trauma list and exclusion of patients who were referred directly to neurosurgery from ED. Our recommendations include introduction of a CES assessment proforma within ED and a re-audit cycle.
1453 Assessing Procedure-Specific Risk Discussion in Elective Arthroplasty
Authors: Heylen J , Antoniou V , Kemp O , Roberts J , Vats A
Published: October 2021

Introduction

Improper consent is a failure of clinical care and also a major cause of litigation within health care authorities. 4% of surgical negligence claims are attributed to improper consenting in the NHS, with an average settlement fee of approximately £40,000 per claim. Improving quality of consenting therefore not only improves patient care but could also reduce healthcare cost.

Method

A retrospective analysis of 100 elective hip and knee arthroplasties at a district general hospital in the South of England. Clinic letters and consent forms were reviewed, using the British Orthopaedic Association (BOA) consent proforma as a comparison standard. Quality of consent was reviewed based upon inclusion of BOA associated risks.

Results

40% of hip arthroplasty clinic letters and 20% of knee arthroplasty clinic letters did not include a risk discussion. Common risks on consent forms when compared to BOA standards were 84.8% compliant in knees and 88.8% in hips. Less common risks on consent forms were 100% compliant in knees and 96% in hips. Rare risks on consent forms were 74.8% compliant in knees and 57.7% in hips. Notably blood clots and infection were consented for in almost all patients. Risk of death meanwhile, was only consented for 62% of the time, across both procedures.

Conclusions

Standard of consenting in this audit falls short of BOA standards. Improvement is needed to improve patient care and avoid medical litigation. An integrated electronic form linking consent process of both outpatient and pre-operative review could be a beneficial intervention.
862 A Retrospective Audit on Management of Ankle fracture In a District General Hospital in South east England
Authors: Thanuja Jayadhar A , Kesharwani D , Freire de Almeida P H S , Sobti A , Menon K , Unnitan A
Published: October 2021

Aim

Ankle fractures are common injuries encountered by orthopaedic surgeons on a daily basis. Primary aim of the audit is to compare management of ankle fracture in Ashford and St Peter’s Hospital under NHS trust with the BOAST guidelines. As a secondary objective, quality of life of patients less than 60 years of age is assessed in order to review the specificity of timing of surgery as mentioned in the guidelines.

Method

An audit was conducted among patients who have undergone open reduction and internal fixation for ankle fracture during a period of one year in Ashford and St. Peter’s hospital. BOAST guidelines was kept as a standard to compare the management practice in the trust. Quality of life is assessed with the help of COST (Chertsey Outcome Scoring for Trauma) scoring method.

Results

Trust showed good compliance with the guidelines regarding documentation and reviewing patients within 6 weeks’ time. Only 45% of the patients, less than 60 years old had surgery within 24 hours. The average COST score does not show any significant difference between those who had surgery within 24 hours and after that.

Conclusions

To conclude, trust showed good compliance in certain aspects like documentation and reviewing patients, but the surgery was delayed up to 19 days for patients less than 60 years of age. The average COST score showed that there are no functional benefits for patients who had surgery on an early date. So, the specificity of timing in the BOAST guideline is questionable.
1574 Does Use of Intra-Operative PPE Affect Post-Operative Infection Rates in Hip Fracture Patients?
Authors: Mercer A
Published: October 2021

Aim

COVID-19 has required significant change to theatre protocol. Regional guidelines dictate full PPE must be donned for all procedures where aerosol generating procedures (AGP) occur. Additionally, no one may enter or leave theatre whilst an operation is in progress, or until 20 minutes after an AGP. We hypothesized that adopting these protocols may lead to a reduction in post-operative infection in hip fracture patients.

Method

Multicentre retrospective cohort study comparing post-operative infection and return to theatre rates (<30-days post-op) from 18/03/20 to 27/04/20 with respective period in 2019. COVID-19 was considered endemic in Northern Ireland from 18/03/20. Patients were identified from the Fracture Outcomes Research Department database and relevant inpatient episode reviewed via Electronic Care Record.

Results

464 patients were included– 261(2020) and 203(2019). In 2019, 4 patients (1.5%) returned to theatre within 30-days, however only one was due to wound dehiscence. In 2020, 1 patient (0.5%) returned to theatre for traumatic wound dehiscence, however they had no documented infection.

Conclusions

There was no difference in post-operative complication rate requiring return to theatre within 30 days between cohorts. Whilst PPE can be considered important for protection of patients and staff against COVID-19, it may not have significant effect on post-operative infection rates.
1665 Characterising the Escalation in Hospital Trauma Admission During the Easing of the COVID-19 Level 4 Lockdown Restrictions
Authors: Holt L , Sud A , Dixon G , Rutka O , Taylor J
Published: October 2021

Introduction

Major trauma reduced by over a third during the institution of UK level-4 national lockdown (Rajput K. et al; 2020). Easing of lockdown on a societal level posed unprecedented uncertainties. With the easing of restrictions, it is expected that the quantity of trauma would increase. In the absence of ‘normality’ it remains uncertain about the extent of the quantity, severity and aetiology of the trauma. The effect of lockdown easing on patterns of traumatic admissions has not been studied and it has important implications upon service provision.

Method

A retrospective cohort study using the data from 2017-2019 were used as a 3-year control to compare each month of 2020. Regional trauma data (TARN data) from Aintree level-1 Major Trauma Centre, the regional tertiary Specialist Units. Easing of restrictions to the regional tier system began in May-July. This index 3months was compared to the control data.

Results

Following easing of restrictions there was a significant increase in the Incident Severity Scores from trauma admissions. The %mortality during the level-4 lockdown decreases but as restrictions are eased there is an increase in the % mortality. The number of stabbings and road traffic collisions are also seen to increase following the ease of restrictions.

Conclusions

There is a decrease in the number of trauma calls seen following the easing of restrictions, yet the severity of the incident and the mortality rate has increased. Therefore, is the trauma more severe of does COVID-19 influence this?
84 Optimising The Assessment and Management of Acute Renal Colic in Secondary Care
Authors: Fonseka T , Ellis R , Gowda A , Tuckwood L , Careless A , Satherly H , Stanford R , Caddeo G
Published: October 2021

Aim

The latest guidance in acute renal colic states that patients should have serum calcium and urate (stone bloods) measured during inpatient admission. The guidance also states that follow-up imaging should be in the form of computed tomography (CT)-, ultrasound (USS)-, or X-ray- kidney, ureters and bladder (KUB). X-ray intravenous urogram (IVU) is now considered obsolete as it can result in over-exposing patients to radiation. Aims of this 2-cycle QIP were twofold;

Method

Data was extracted from electronic patient records on whether or not they had stone bloods measured during admission and also what follow-up imaging was requested. In the first cycle baseline data was extracted. A stone proforma was then created, incorporating the latest guidelines. In the second cycle the impact of the stone proforma was assessed.

Results

The study included 119 patients. After introducing the stone proforma we were successful in improving the rate of stone bloods being measured, increasing from 13% to 53%. We were also successful in reducing the rate of performing X-ray IVU, decreasing from 25% to 14% of patients.

Conclusions

This QIP demonstrates that management of acute renal colic can be optimised using a stone proforma and move current practice towards best practice. This is supported by the ‘Getting it Right First Time’ (GIRFT) Urology report 2018. The third cycle is currently underway, and we hope to see further improved outcomes.
324 Outcomes of Prostate Artery Embolisation In Catheterised Patients: A Case Series
Authors: Johnston M , Majkowska A , Ahmad M , Kamaledeen S , New F , Beckett D , Bent C , Turner K , Hanna L
Published: October 2021

Aim

Prostate artery embolisation (PAE) is an approved treatment for men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS). Evidence of efficacy for PAE in patients who are unable to void urine spontaneously is scant, however. Traditional treatments for BPH-LUTS have evidence in retention patients and this series aims to report outcomes for PAE in catheterised patients.

Method

The records of consecutive men with BPH-LUTS which required either an indwelling bladder catheter or clean intermittent self-catheterisation (CISC) who subsequently underwent PAE were retrospectively reviewed. Basic demographics were collected along with information on the prostate volume and PAE procedure specifics. The primary outcome was whether patients were catheter/CISC free at 3 months. Other outcomes include complications, use of medications and the need for other surgical treatments post-PAE.

Results

63 men underwent PAE for urinary retention and BPH-LUTS between 2013 and 2020. Of these, 7 underwent a unilateral embolisation for aberrant anatomy. The mean prostate volume was 128ml. 61% of men were free from a catheter/CISC post-treatment. 4 patients suffered post-PAE UTI, whilst 3 patients subsequently underwent Transurethral Resection of the Prostate following PAE for failure to become catheter free. 13 men were entirely free from BPH-LUTS medications.

Conclusions

PAE for catheterised men results in a similar catheter-free rate post procedure to several more invasive BPH treatments. It has a low side-effect profile and gives men with poor health an option to try to become catheter free. PAE should be discussed with men with catheters as a treatment option.
327 Relative Benefits of Extracorporeal Shockwave Lithotripsy (ESWL) Compared to Observation in Acute Renal Colic
Authors: Lovegrove C , Spencer M , Turney B , Neal N
Published: October 2021

Aim

NICE guidance recommends patients with renal colic be offered surgical treatment, including extracorporeal shockwave lithotripsy (ESWL), within 48 hours if pain is uncontrolled or stones unlikely to pass. We compared outcomes for ureteric stone passage after ESWL with those of observation to ascertain the relative benefits of ESWL.

Method

We collected data on stone location, size, and number of ESWL treatments required prospectively over 18 months. Stone passage was confirmed radiologically. Data were compared with MIMIC, a multi-centre collaborative study examining spontaneous stone passage after observation alone.

Results

166 patients had ESWL for ureteric stones. Median size was 6.5mm (IQR 5.0-8.0mm). 57.2% (N = 95) were proximal stones. Smaller stones required fewer treatments (P = 0.003). Patients with a ureteric stone <5mm required median 1.0 ESWL treatments (IQR 1.0-2.0). Ureteric stones 5-7mm had median 1.0 treatments (IQR 1.0-2.0) and stones >7mm median 2.0 treatments (IQR 1.0-2.0). Compared to MIMIC, patients with ESWL for stones <5mm were 11% more likely to achieve stone clearance (100.0% vs 89.0%, P = 0.001). ESWL for 5-7mm stones had 28.1% greater clearance compared to observation (77.1% vs. 49.0%, P < 0.001) and ESWL for stones >7mm 21% greater likelihood of clearance (50.0% vs. 29.0%, P < 0.001). Proximal ureteric stones were 16.4% more likely to pass with ESWL than observation (68.4% vs 52%, P = 0.02). Distal stones showed similar passage with ESWL (77.5%) and observation (83.0%), P = 0.43.

Conclusions

Proximal ureteric stones and those >5mm stones benefit most from ESWL. Results aid identification of patients whose stones are less likely to pass and warrant urgent review to consider ESWL.
494 Is it Time to Reassess Thromboprophylaxis in Endourology?
Authors: Simpkins S , Nalagatla S , Nalagatla S
Published: October 2021

Introduction

Evidence regarding risk of post-operative venous thromboembolism (VTE) versus bleeding in Endourology is acknowledged as weak. Sequela of both post-operative VTE and bleeding, whilst low in Endourology procedures, can represent significant morbidity and mortality for patients. European Association of Urology (EAU) guidelines advise against pharmacological VTE prophylaxis in Endourology procedures. A retrospective audit of the rate of VTE and bleeding, as well as adherence to EAU guidelines was performed.

Method

Patient data was gathered on those undergoing Endourology procedures at our institution, over a 6-week period. Medical records were reviewed for pre-operative VTE risk factors, VTE prescribing and adherence to EAU procedure-specific guidelines. The incidence of VTE and post-operative bleeding was also studied.

Results

A total of 21 patients underwent Endourology procedures, with 15 undergoing an Ureteroscopy, 5 Percutaneous Nephrolithotomies (PCNLs) and 1 Cystoscopy. One patient was identified as high-risk for VTE in accordance with the EAU guidelines. A further 7 and 13 patients were deemed as medium and low risk respectively. Pharmacological prophylaxis was prescribed in 66.6% of patients. No post-operative VTE or bleeding was reported. However, only 33.3% of patients had VTE prophylaxis prescribed in accordance with EAU guidelines.

Conclusions

The audit highlighted sub-optimal VTE prophylaxis prescribing in accordance with the EAU guidelines, with patients being over prescribed VTE prophylaxis. However, the criteria may underestimate potential morbidity and mortality in high-risk patient groups. It is therefore prudent to take into account patient and procedure risk, to more accurately estimate both VTE and post-operative bleeding.
757 An Audit of Post-Vasectomy Semen Analysis Adherence
Authors: Michael K , Walbaum C , Gonzalez V , Bourdoumis A , Surange R
Published: October 2021

Aim

Following vasectomy, patients undergo post-vasectomy semen analysis (PVSA) to determine whether they can be “cleared” to safely discontinue contraception. The adherence rates to PVSA are notoriously poor in the literature. The aim of this project is to assess our patient’s adherence to PVSA and identify areas for improvement.

Method

All vasectomies undertaken at a large urology centre between 01/01/2019 and 31/12/2019 were included. PVSAs were scrutinised one year later to determine clearance or special clearance according to the 2016 Laboratory Guidelines for Post-vasectomy Semen Analysis endorsed by the British Andrology Society.

Results

256 patients underwent bilateral vasectomy, with 132 (51.6%) undergoing PVSA, at a median of 16.4 weeks (range 7.3 – 71.6). At time of review, 71 (54.5%) of these have been cleared; 45 (63.4%) after a single PVSA and 19 (26.8%) after the second. Seven patients (9.9%) received special clearance, two patients (1.5%) were not cleared despite meeting the special clearance criteria and one patient suffered early failure (0.8%). Clearance letters were issued at a median of 2.7 weeks (range 0.1 – 28.8) following satisfactory PVSA results. Moreover, 33 patients (25%) had at least one PVSA sample rejected by the lab, mainly due to timing issues or incomplete information on the request form.

Conclusions

The adherence rate to PVSA in our cohort is in keeping with the literature, and the majority of patients who are cleared achieve this with just one PVSA. Interventions aimed at counselling patients about the importance of PVSA, reducing unnecessary repeats and reducing rejected samples are necessary.
853 Post-BCG Surveillance – General Anesthetic Rigid Cystoscopy in Intermediate/High-Risk Bladder Cancer. A Quality Improvement Project Done at A District General Hospital in South-East England
Authors: Kesharwani D , Raja Thinagaran J K , Tadtayev S , Arumainayagam N
Published: October 2021

Aim

High/ intermediate risk bladder cancer is treated with BCG immunotherapy and cystoscopy surveillance is the standard of care. Performing a General Anesthetic Rigid Cystoscopy (GARC) enables resection or sampling of suspicious lesions. We aim to evaluate its benefits while the alternative is Local Anesthetic Flexible Cystoscopy (LAFC).

Method

A retrospective analysis of patients that underwent rigid cystoscopy under GA over 2 years from January 2018-December 2019, post induction & maintenance cycles of BCG following primary TURBT. Overall inference (cystoscopy outcomes) was based on intra-operative findings, BCG cycle, suspicious lesions, recurrence/disease progression based on histology.

Results

A total of 53 patients had 114 procedures. Mean age of 72.29±8.98. 14 inpatient admissions due to GA/procedural complications or social reasons. 58.2% of patients primarily had G3T1 disease, 22.6% G2, 14.3% G1 & 4.9% had primary CIS. T1 & Ta disease were 42% & 43% respectively. GA cystoscopy showed normal findings in 57.1%, 33.33% suspicious lesions & 9.6% visible recurrence. 88% suspicious lesions upon biopsy showed benign findings on histology and only 12% malignant. 24% of lesions thought to be recurrence showed benign findings on histology, 56% as G3T1 disease and 20% as G3Ta disease. No one had stage progression and 3 patients had grade progression. Sub-analysis of various stages and grades showed an average of about 10% malignant findings only.

Conclusions

LAFC as first line for post-BCG surveillance can be recommended which aim to prevent GA complications, extra admissions, overall cost reduction in management of bladder cancers and GARC can be reserved for second line
1014 Assessment of Prostate Gland Volume Estimations Using MRI And TRUS Compared to Radical Prostatectomy Specimens
Authors: Yallappa S , Aneke I A , Amjad M , Clark A , Gommersall L
Published: October 2021

Introduction

The prostate volume is an essential criterion to calculate prostate specific antigen density (PSAD). When selecting patients for active surveillance (AS), in newly diagnosed low risk prostate cancer group or continuing AS in previously diagnosed cancer prostate, PSAD plays a major role. Estimation of the volume using digital rectal exam or PSA are inaccurate. This study aims to conduct a retrospective review to evaluate the accuracy of prostatic volume estimates in patients who had TRUS and MRI scans, comparing the obtained volumes to the reference standard which is the actual volume of radical prostatectomy specimen.

Method

Data was collected retrospectively for all patients who had robotic assisted radical prostatectomy (RRP) at the Royal Stoke Hospital between October 2015 and October 2018. Clinical information of TRUS and MRI prostate volumes were extracted from PACS and prostate specimen volume was collected from the histopathology report of RRP specimen.

Results

Pathological specimen prostate volume showed a positive relationship between MRI and TRUS prostate volume with a correlation efficient of 0.71 for MRI vs RRP specimen volume and 0.81 for TRUS vs RRP specimen volume. Mean TRUS volume underestimated prostate volume by 7.33cc and mean MRI volume underestimated prostate volume by 0.02cc

Conclusions

Although the study showed positive correlation between measuring prostate volume using MRI and TRUS as compared to RRP specimens, MRI showed a greater accuracy as compared to TRUS. We conclude that using MRI prostate volume gives more precise prostate volume estimate aiding appropriate therapeutic planning of patients with prostate cancer.
1048 Patient and Clinician Satisfaction with Urology Telephone Consultations During the Covid-19 Pandemic
Authors: Colemeadow J , Pandian S K
Published: October 2021

Aim

To establish the level of both patient and clinician satisfaction with regard to the newly implemented telephone clinics and determine ways in which the service can be improved. The telephone clinics have been implemented during the Covid-19 pandemic within the urology department at a busy university hospital.

Method

An online and paper questionnaire was distributed to patients who received a telephone consultation between April and August 2020. A similar online questionnaire was distributed to urology staff undertaking telephone consultations.

Results

44 patient responses were received, with 8 clinician responses. 72% of patients were satisfied or very satisfied with the telephone clinic service provided. The same proportion of patients received their appointment on schedule. 98% of patients could hear and understand the information relayed to them. 78% of patients would opt for a telephone clinic in the future. Only 21% of patients would have preferred the addition of a video feature to their telephone consultation. 63% of clinicians felt that telephone consultations were a suitable alternative and 89% reported their consultations ran to time. With regards to improvements, 89% of clinicians felt that a language interpretation service should be readily available and that headsets may facilitate ease of consultation.

Conclusions

Telephone consultations are effective and appropriate during the restricted services resulting from the COVID-19 pandemic. Patients have received telephone clinics well. The majority of clinicians felt that telephone clinics were a suitable alternative, however several improvements to the service have been suggested.
1060 Upper Tract Urothelial Carcinoma (UTUC) – What Can We Learn from Historical Cases
Authors: Nandra N , Rajan K , KandaSwamy G , Jefferies M
Published: October 2021

Background

UTUC has a poor prognosis with many patients presenting late, often without cardinal symptoms such as visible haematuria. Aims of this study were to assess presenting features, diagnostic tests and outcomes of patients with UTUC.

Method

Retrospective data collection was performed for patients diagnosed with UTUC (ureteric /renal) between Jan 2013-Dec 2017. Data was collected on demographics, presenting features, diagnostic tests, presence of concurrent bladder UC and outcome/survival.

Results

67 patients were diagnosed with UTUC, 37 renal pelvis and 30 ureteric. The median age was 74 years (Range 49-90 years), M:F-2:1. 39 (58.2%) presented with haematuria, 1 having non-visible. 9 (13.4%) had loin pain, 4 (6.0%) systemic features (weight loss/lethargy), 15 (22.4%) other (detected on surveillance imaging, renal impairment). 61 had an USS of which 12 (19.7%) were normal and 49 demonstrated hydronephrosis or mass (80.3%). 21 (31.3%) had concurrent bladder UC. 9 (13.4%) prior to UTUC diagnosis (2 post cystectomy and 7 prior superficial UC) and 12 post diagnosis. 50 (74.6%) of UTUC were treated curatively with surgery and 17 (25.4%) palliated. The 2- and 5-year survival for those treated with curative intent was 79.9% and 58.5% compared to 31.25 and 7.5% for those treated with palliative intent.

Conclusions

Most patients with UTUC presented with visible hematuria, pain, or systemic features. USS has a high sensitivity, but cases will still be missed. The presence of prior bladder cancer is a significant risk factor and regular upper tract monitoring should be performed in high-risk patients (post-cystectomy, high-risk non muscle-invasive UC).
1191 The Use of CT Urography to Diagnose Upper Tract Urothelial Carcinomas (UTUC); Managing Surgical Resources During The COVID-19 Pandemic
Authors: Wong S , Sehgal R , Birks T , Allen D , Goyal A , Kucheria R , Ajayi L , Ellis G
Published: October 2021

Introduction

Upper tract urothelial carcinomas (UTUC) account for 5-10% of urothelial malignancies. Rapid diagnosis is essential as 60% are 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.
1234 Emergency Urology Procedures During COVID-19 Pandemic: A 2 Monthly Prospective Study
Authors: Georgiou M , Ridzuan-Allen A , Chamsin A , Tolofari S , Ejikeme C , Jones R , Siddiqui Z , Napier-Hemy T , Rotas S , Hughes K E , Khattak A Q , McCabe J E , Omar A M , Mistry R , Samsudin A , Gana H.BY , Floyd M.S.
Published: October 2021

Introduction

COVID-19 resulted in Regional tiered restrictions being introduced across the UK with subsequent implications for planned and emergency care. Specific to Merseyside Tier 4 and Tier 2 restrictions were introduced in late 2020. At the onset of the pandemic in the Spring, elective work ceased, and emergency admissions were minimal. The purpose of this study was to examine the volume and nature of all emergency admissions to a Urology unit in Merseyside in the 2nd wave of the pandemic during two different tiers of national restrictions.

Method

A prospective audit examining all emergency urological activity was conducted in Whiston Hospital from October 2020 when the Tier 4 restrictions were introduced to Tier 2 was introduced. Data was obtained by identifying patients using the electronic theatre listing system.

Results

A total of 52 emergency cases were performed (24 in November Tier 4, 28 in December Tier 2). A total of 12 different procedures were performed. The commonest procedure performed was stent insertion (26), followed by scrotal exploration (7). One patient required transfer to a different hospital. In total 4 calls were made by general surgery and 2 by gynaecology for urological assistance in theatre. Two urology patients returned to theatre. Direct Consultant involvement occurred in 19 cases (37%).

Conclusions

Unlike the Spring lockdown acute urology operations presented despite regional restrictions. A total of 52 cases were performed with more occurring in Tier 2. Stent insertion was the commonest procedure with the majority of the cases performed by registrars.
1284 Comparison of British Association of Urological Surgeons (BAUS) 2008 and NICE 2015 Guidelines for Patients with Suspected Urinary Tract Cancer: An Audit of Haematuria Referrals
Authors: Kamble R , Lobo N
Published: October 2021

Introduction

BAUS guidelines for the investigation of haematuria were replaced by NICE guidelines in 2015. However, both criteria are currently used to refer patients to our Haematuria Clinic. We audit the haematuria referrals made to our unit and compare cancer yield.

Method

A retrospective review of all two-week wait haematuria referrals to a single UK teaching hospital between October 2019 and April 2020 was performed. Referrals were stratified into two groups: BAUS 2008 and NICE 2015 referral criteria. The outcomes of haematuria investigations were analyzed and the incidence of urinary tract cancer (UTC) compared between groups.

Results

316 referrals were analyzed. Of these, 123 (39%) and 193 (61%) referrals were made using BAUS and NICE criteria respectively. 233 (74%) patients were investigated for visible haematuria of which 68 (29%) were referred using BAUS criteria and 165 (71%) using NICE. UTC was identified in 20% of patients referred using NICE criteria and 4.4% using BAUS criteria. 83 (26%) patients were referred with non-visible haematuria. Of these, 55 (66%) were referred using BAUS criteria and 28 (34%) using NICE. UTC was identified in 2.5% of patients referred using BAUS criteria. No UTC was identified in referrals using NICE criteria.

Conclusions

Despite BAUS haematuria guidelines being superseded by NICE guidelines in 2015, these older guidelines still account for 40% of our two-week wait referrals. Furthermore, NICE guidelines have a higher cancer yield for visible haematuria compared to BAUS guidelines and should therefore take precedence to avoid subjecting patients to unnecessary and costly investigations.
213 Can Styloid Process and Internal Carotid Artery Anatomy Be Used to Predict Carotid Artery Dissection?
Authors: Cruddas L , Joffe M , Baker D
Published: October 2021

Aim

Carotid artery dissection is a common cause of stroke in the young. It has been related to the association of the carotid artery with fixed neighbouring anatomical structures. This study assesses the association between styloid process length, internal carotid artery position and cervical carotid artery dissection (CCAD). This information would provide potential predicative radiological measurements, which could prevent delays in CCAD diagnosis.

Method

Retrospective data was collected from two central London hospitals over five years. CCAD cases were identified from individuals who underwent computer topography angiography (CTA) of the neck for suspected CCAD. The following data was collected: evidence of CCAD; bilateral styloid process length and presence of styloid-hyoid ligament calcification; bilateral styloid process-internal carotid distance; calcification of carotid arteries and whether their position was aberrant. Cases were dissection-side, age and gender matched with two non-dissection controls.

Results

Three hundred and fifty-five individuals were identified. Fifty individuals had CCAD, of which 4 had bilateral dissection. In individuals with CCAD, average styloid process length was 27.5mm and styloid process-internal carotid distance was 5.14mm. There was no significant association between styloid process length or styloid process-internal carotid distance, and CCAD when compared with matched controls. Internal carotid artery aberrancy was significant for non-dissection.

Conclusions

In this study, there was no association between styloid process length and styloid process-internal carotid distance with CCAD. These measurements cannot be used to predict the possibility of a CCAD following trauma.
923 How Did the Initial Wave Of COVID-19 Affect CEPOD Waiting Times for Vascular Surgery? A Comparative Audit
Authors: Wallace J , Faiz J , Lowry D , Williams A , Davies C
Published: October 2021

Aim

Many vascular patients present acutely, relying on emergency theatre availability when surgical intervention is required. The prioritisation of the CEPOD operating list is a challenge, and the additional pressures of the COVID-19 pandemic have necessitated changes to established practice. The purpose of this audit was to review the effects of the pandemic on the CEPOD waiting times for vascular patients at the main centre for the South West Wales Vascular Network.

Method

The CEPOD waiting times for vascular patients during the initial wave of the COVID-19 pandemic were compared with the same period the previous year. Data was analysed according to booking category and procedure type.

Results

98 emergency vascular procedures were performed during the initial wave of the COVID pandemic, compared to 133 in 2019. In 2019, amputations (major and minor) accounted for 47% of cases, which rose to 53% during the pandemic. Median waiting times for category 1 and 2a operations were significantly shorter in 2020, whilst category 3 waiting times rose. There was no significant difference overall in the proportion of patients operated on within the target timescale, regardless of CEPOD booking category.

Conclusions

Managing the impact of COVID-19 required change to established practice. Although fewer procedures were performed, significant logistical challenges were faced. By adjusting the organisation of CEPOD, the most urgent vascular cases were performed quicker during this time. It is important to identify and promote the positive organisational changes that have arisen as a result of COVID-19, and to continue to review procedures as the pandemic progresses.
1133 Long Term Survival After Standard EVAR: Have We Started to Treat The EVAR-2 Patient?
Authors: Khan K , Fisher R
Published: October 2021

Aim

Abdominal aortic aneurysm repair was traditionally preformed with open surgical repair (OSR). Recently endovascular aneurysm repair (EVAR) has increased in popularity due to its less invasive nature particularly in those deemed unfit for OSR. The EVAR-2 trial found no significant difference between BMT and EVAR in the 30 days all-cause mortality. This questioned whether EVAR was the best option in those medically unfit for OSR.

Method

Elective EVAR procedures from the 1st April 2012 to 1st September 2017 were analysed with Kaplan-Meier graphs. The patient data was stratified by year, age group and EVAR risk scoring.

Results

The all-cause mortality at 30 days was 1.8%, at 6 months it was 7%, and at 4 years it was 19.8%. There was no significant difference with log rank analysis of the year of EVAR operation and consultant (P > 0.05). The log rank analysis found a significant difference between the stratified age groups (P < 0.001) and the EVAR scoring (P = 0.032). At all time-points the RLUH EVAR patients had a lower all-cause mortality compared to the EVAR-2. At the 4-year time point, the RLUH EVAR group had lower all- cause mortality than both EVAR-1 and EVAR-2 trials.

Conclusions

The retrospective audit data from 2012-2017, suggest the RLUH EVAR treatment practice is not falling into the EVAR-2 trial findings. At all time-points the RLUH EVAR patients had a lower all-cause mortality compared to the EVAR-2. Therefore, it can be concluded the RLUH is not treating EVAR-2 patients.
994 Prolonged Survival in N3 Penile Cancer with Contralateral Inguinal Relapse - Outcome of A Multimodal Therapeutic Approach
Authors: Gurumurthi B , Nigel J P
Published: October 2021

Case Report

Penile squamous cell cancer (PSCC) is rare in the Western world, although higher in many developing countries. This has hindered comparative studies of therapeutic options, with ongoing uncertainty regarding best treatment options. However, greater centralisation of services in recent years is allowing some inroads into improving the management of these patients. Presentation with advanced inguinal lymphadenopathy has traditionally been associated with very poor prognosis. A multimodal approach has been advocated but benefits not yet proven in randomised series. We describe a case of PSCC presenting with a fixed nodal mass, treated with a multimodal approach, combining neo-adjuvant chemotherapy with surgery and then external beam radiotherapy (DXT) at contralateral relapse, resulting in long-term disease-free survival(>12 years) and good quality of life.
1637 Ablative Therapies Versus Partial Nephrectomy for Small Renal Masses: A Systematic Review and Meta-Analysis
Authors: Chan V W S , Abul A , Ng H H L , Osman F H , Wang K , Cartledge J , Wah T M
Published: October 2021

Introduction

The optimal management of small renal masses is unclear. Ablative therapies (AT) have been advocated as a potential alternative due to lower complication rates and non-inferior oncological outcomes. We performed a systematic review to compare AT and partial nephrectomy (PN) in patients with T1aN0M0 renal masses.

Method

This review is registered on PROSPERO (CRD42020199099). A search was performed on Medline, EMBASE, and Cochrane CENTRAL to identify studies comparing AT and PN. Different modalities and approaches were analysed as subgroups. Outcomes include cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS), metastatic-free survival (MFS), postoperative complications, and change in renal function.

Results

From 1,351 identified records, 30 studies incorporating 85,837 patients were included for meta-analysis. Patients receiving AT were found to have significantly worse CSS, OS, RFS when compared to patients receiving PN (p < 0.05). Patients undergoing AT have a non-inferior MFS and significantly fewer overall complications (HR: 0.79, 95% CI 0.41-1.51, p = 0.48; RR: 0.71, 95% CI 0.53-0.96, p = 0.03). Patients undergoing AT have a smaller decline in renal function post-operatively (SMD: 0.30, 95% CI 0.11-0.50). When limited to studies with propensity score matching, CSS and RFS are no longer significantly different between the two groups (HR: 1.54, 95% CI 0.67-3.52, p = 0.31, HR: 1.72, 95% CI 0.90-3.28, p = 0.10). Subgroup analyses did not show significant differences between different modalities and approaches of AT in all outcomes.

Conclusions

AT is potentially non-inferior to PN when managing small renal masses, and more high-quality propensity score-matched studies with long follow-up time are needed to confirm the non-inferiority.
330 Comparing Outcomes in Right Versus Left Kidney Transplantation; A Systematic Review and Meta-Analysis
Authors: Carolan C , Tingle S , Thompson E , Sen G , Wilson C
Published: October 2021

Introduction

Transplantation of right kidneys can pose technical challenges due to the short right renal vein. Whether this results in inferior outcomes remains controversial.

Method

We used Healthcare Database Advanced Search (HDAS) to identify relevant studies. Two authors independently reviewed each study. Statistical analyses were performed using random effects models and results expressed as HR or relative risk (RR) with 95% confidence intervals. Subgroup analyses were performed in kidneys from deceased donors (DD) and living donors (LD).

Results

35 studies (257,429 participants) were identified. Both deceased and living donor right kidneys were at increased risk of delayed graft function (DGF; RR = 1.10[1.07-1.12] p < 0.00001). In absolute terms, for each 100 kidney pairs of DD kidneys transplanted there are 2.72 (1.67-3.78, p < 0.00001) excess episodes of DGF in right kidneys. Graft thrombosis rate was also significantly higher in right kidneys, in both DD and LD settings (RR = 1.55[1.41-1.69] p < 0.00001). Compared to DD left kidneys, DD right kidneys were at significantly higher risk of graft failure due to technical causes (RR = 1.54[1.25-1.90], P < 0.0001). The two largest DD studies (179,124 participants) found right kidneys to have significantly poorer graft survival; time-varying analyses demonstrated this was caused by early graft losses within the first year. There was no evidence that laterality alters long term graft survival in LD or DD.

Conclusions

Right kidneys are at increased risk of early complications in both DD and LD settings, although the absolute effects are small. Improved vascular reconstruction techniques for the right renal vein, which avoid detrimental impacts on ischaemia times, are essential.
UHPLC With On-Line Coupled Biochemical Detection for High Throughput Screening of Acetylcholinesterase Inhibitors in Coptidis Rhizoma and Cortex Phellodendri
Authors: Tan Jingling , Zhang Xueqiong , Fang Jiangji , Shen Huadan , Ding Xiaoping , Zheng Guohua
Published: October 2021

We developed a new on-line method of ultra-performance liquid chromatography coupled with biochemical detection (UHPLC-BCD) to screen acetylcholinesterase (AChE) inhibitors in complex matrixes. Chromatography separation was performed using an Xtimate UHPLC C18 column (100 mm × 2.1 mm, 1.8 μm) and a gradient elution with methanol–0.1% formic acid at a flow rate of 0.08 mL/min. The BCD was based on a colorimetric method using Ellman’s reagent, and the detection wavelength was at 405 nm. Galanthamine was used as a positive reference to validate the methodology. The detection and quantitation limits of the UHPLC-BCD method were 0.018 and 0.060 μg, respectively. A functional equation was generated in terms of the negative peak area (X) and galanthamine concentration (Y, μg/mL). The regression equation was Y = 0.0028X2 + 0.4574X + 50.7776, R2 = 0.9993. UHPLC-fourier-transform mass spectrometry detection results revealed that five alkaloids showed obvious AChE inhibitory activities including coptisin, epiberberine, jatrorrhizine, berberine and palmatine. The relative AChE inhibitory activities of jatrorrhizine, berberine and palmatine in the Coptidis Rhizoma sample were equal to that of 257.0, 2355 and 283.9 μg/mL of galanthamine, respectively. This work demonstrated that the UHPLC-BCD method was convenient and feasible, and could be widely used for the screening and activity evaluation of the bioactive components in the complex extracts.
Left ventricular and atrial remodelling in hypertensive patients using thresholds from international guidelines and EMINCA data
Authors: Sheng Yuanyuan , Li Mengmeng , Xu Mingjun , Zhang Yu , Xu Jinfeng , Huang Yuxiang , Li Xiaoyi , Yao Guihua , Sui Wenhai , Zhang Meng , Zhang Yuan , Zhang Cheng , Zhang Yun , Zhang Mei
Published: October 2021

Aims

To investigate differences in the prevalence of left ventricular (LV) and left atrial (LA) remodelling in hypertensive patients using various thresholds defined by international guidelines and data from the Echocardiographic Measurements in Normal Chinese Adults (EMINCA) study and different indexation methods.

Methods and results

LV mass (LVM), relative ventricular wall thickness, and LA volume (LAV) were measured using 2D echocardiography in 612 healthy volunteers selected from the EMINCA study population and 306 adult Chinese patients with hypertension who were age- and gender-matched using propensity score-matched analysis. LVM and LAV values were indexed to body surface area (BSA), height2.7, height1.7, and height2 recommended by guidelines or investigators. Using a previously reported method, LV geometry was divided into normal geometry, concentric remodelling, eccentric hypertrophy, and concentric hypertrophy. The prevalence of LV hypertrophy (LVH) and LV geometric patterns in hypertensive patients were compared using different thresholds and indexation methods. Echocardiographic thresholds from guidelines and healthy volunteers exhibited notable differences, particularly for LAV indexed to height2 and for LVM indexed to height1.7, which resulted in a significantly lower prevalence of LA dilatation and LVH in healthy volunteers. The total proportion of abnormal LV geometric patterns was significantly lower with thresholds from healthy volunteers than from guidelines when LVM was indexed to BSA, height1.7, and height2,7.

Conclusion

Using current echocardiographic thresholds and indexing methods recommended by guidelines may lead to significant misdiagnosis of LA dilatation, and abnormal LV geometry in Chinese patients with hypertension, and thresholds based on ethnic-specific normal echocardiographic reference values and an accurate indexing algorithm are warranted.