bluuebunny/crossref_metadata_2025 huggingface dataset:
372 Is the Mixing of Local Anaesthetic Agents for Perineal Block in TP Prostate Biopsy Patients Advantageous? a Comparative Study of Local Anaesthetic Efficacy
Authors: Bhopal K , Allat O A , Noureldin M , Gubby C , Firth E , Craggs J , Heybourne A , Mehnaj Noor M , Rajkumar G , Emara A , Hindley R
Published: August 2023

Aim

Traditional mixing of short and long-acting local anaesthetics for perineal blocks for TP Biopsies might risk altering their pH and allow the use of suboptimal dose of the mixed agents.

Method

This is a prospective study in which we look at 102 patients who have had transperineal prostate biopsies. The patients were divided into 2 groups according to the type of peri-prostatic local anaesthetic i.e. mixed (10mls of 1% lignocaine and 10 mls of 0.5% levobupivacaine) and non-mixed (20mls 0.5% levobupivacaine). Patients were asked to fill a pain score and satisfaction questionnaire after the procedure.

Results

The two groups were matched in their demographics including age, PSA and prostate volume.

The pain threshold was similar in both groups during administration of the perineal block. The difference in pain threshold between the ‘mixed’ vs ‘non-mix’ group was statistically significant during the biopsy sampling i.e., 4(std 2) for the ‘mixed’ and 2(std1) for the ‘non-mix’ group.

84.8% of the ‘mixed’ group vs 97.7% of the ‘non-mix’ group said they would recommend the procedure. The response was the same when asked whether they would repeat the procedure if required (84.4% in ‘mixed’ vs 97.7% in ‘non-mix’). The cancer detection rate had no statistical difference between the 2 groups although core-length’s taken from target lesions were shorter in ‘mixed’ vs ‘non-mixed’ group (mean 7mm vs 9.5mm).

Conclusions

Our study confirms that using a pure agent gave better pain scores with the same cancer detection rates as compared to mixed agents.
384 Acute Scrotal Pain and Covid-19 in a Busy Acute Hospital in the UK
Authors: Ibrahim M
Published: August 2023

Introduction

Published reports highlighted an association between recent COVID-19 infection and testicular pain and infertility.

Aim

To assess the effect of the disease on our surgical practice & scrotal exploration.

Method

We retrospectively analyzed the clinical presentation and surgical outcomes of all patients with sudden onset acute testicular pain who presented to our acute hospital in the period between Jan 2018 till Jan 2022.

Results

Total 335 patients presented with acute scrotum required exploration between 2018-2022 and divided into 2 categories:

[category 1] prior to the start of covid-19 pandemic and [category 2] after the pandemic “≥2020”. The analyses revealed a 13% increase in the number of presentations, though this was not statistically significant [P = 0.09].

The sub-analysis of category 2 looked at the relationship of covid-19 status at the time of presentation with acute pain. This showed a significant correlation between covid-19 +ve status and pain with negative exploration [P = 0.0263].

Table 1: Sub-analysis of the covid-19 status at the time of presentation after 2019. Fisher exact test.

Analyzing the data found to be statistically significant of value of 0.0263 where the result is significant at P<0.05.

Conclusions

Our data show a strong correlation between the covid-19 pandemic and acute scrotal pain that may indicate a viral induced orchitis.
422 Local Anaesthetic Trans-Perineal Prostate Biopsy: Outcomes from Our First 250 Cases
Authors: Abdalla A , Hamdoon M , Shendy M , Craciun M
Published: August 2023

Aim

Trans-perineal ultrasound prostate biopsy (TPBx) with prior multiparametric MRI (mpMRI) represents the standard of care in prostate cancer diagnostic. We present our first experience with TPBx in our unit. We also looked at discrepancies between the mpMRI and the TPBx results.

Method

We performed a retrospective analysis of collected data from all the patients who underwent TPBx following mpMRI from March 2021 to June 2022. All patients had combined systematic and targeted prostate biopsies.

Results

The total 250 patients underwent TPBx. 10 patients were already known to have prostate cancer. The mean age was 69 years. The average PSA value was PSA: 8.41 ng/ml with an average PSA density of 0.23.

43 patients underwent previous transrectal ultrasound-guided prostate (TRUS) biopsy while 207 patients were biopsy naïve.

The overall cancer detection rate was 76 %. In 25 % of patients, there were some discrepancies between the mpMRI lesion site and histology results.

Majority of the histology results were ISUP grade group 2, 30 % of the case, grade group 3 in 22 % of the cases, grade group 4 in 14 % of the cases, grade group 1 in 6% of the cases grade group 5 in 2 % of the cases.

Conclusions

A higher PIRADs score is likely to be associated with a higher -grade group histology. Our cancer detection rate is acceptable in comparison to TRUS prostate biopsy (76 % vs 40 %), however there are some discrepancies between the mpMRI and biopsy results which suggests additional criteria are needed to aid in decision management (like PSA density).
517 Ethnic Diversity in the English Urology Workforce and BAUS Leadership 2009-2020: A Retrospective Analysis
Authors: Adasonla K , Newman T , Ellis R , Parry M , Shrotri N , Cresswell J , Green J
Published: August 2023

Aim

Little is known about the ethnic composition of the national urology workforce. To assess the impact of existing strategies to promote equitable progression, with respect to ethnicity, in the English urology workforce and British Association of Urological Surgeons (BAUS) leadership between 2009 and 2020.

Method

A Freedom of Information (FOI) Act request was made to NHS Digital regarding demographic data of clinicians working in urology in England between 2009 and 2020. Data was collected on urology consultants, specialist registrars, specialty, and associate specialist (SAS) doctors over this period. The ethnicities of British Association of Urological Surgeons (BAUS) Trustees and Council Members were determined over the same period, by review of public profiles. Statistical analysis was performed using the Cochran-Armitage test.

Results

The proportion of consultant urologists identified as White decreased from 65.5% to 53.6%, p<.0001), while the proportion of Asian/Asian British consultants increased (26.9% to 36.6%, p<.0001). There was a significant increase in Black/Black British trainees (3.0% to 11.0%, p<0.0001) but a decrease in the proportion of Asian/Asian British trainees. There was a non-significant decrease in the proportion of White urologists occupying BAUS leadership positions (80.6% to 67.6%, p = 0.5).

Conclusions

Trends towards increased ethnic diversity was seen across all groups, especially consultants. More limited change was observed in the urology leadership, suggesting both a time lag and that there is further work to be done in addressing barriers to progression in the highest echelons of urology leadership in the UK.
558 Comparison of Length of Post-Operative Hospital Stay Following Robot-Assisted Laparoscopic Nephrectomies with Traditional Laparoscopic Nephrectomies: A Single-Centre Retrospective Study
Authors: Le H B T , Park E , Cheah M W E , Wilson I
Published: August 2023

Aim

The study aims to compare the length of post-operative hospital stay following robot-assisted laparoscopic (RAL) nephrectomies with stays following traditional laparoscopic (LAP) nephrectomies at a district general hospital.

Method

This study retrospectively compares the post-operative length of hospital stay using information documented on patient’s paper notes scanned onto an online system. Between January 2021 and December 2021, 25 patients underwent LAP nephrectomies in this unit. Following the introduction of RAL at our unit, all patients requiring a nephrectomy had this procedure done using RAL. Between January 2022 to November 2022, 33 patients underwent a RAL, 3 of which required conversion to open and excluded from this study. Additionally, data on age, BMI, tumour size and ASA score was collected to identify any evidence of systemic bias.

Results

Mean post LAP hospital stay was 3.60 (±3.24) nights, while post RAL was shorter at 2.07 (±1.44) nights to a statistically significant degree (p-value = 0.0357). There was no significant difference in any of the demographic factors between the two groups (LAP and RAL). When including data for partial nephrectomies (n = 20; LAP = 11, RAL = 9) and pyeloplasties (n = 9; LAP = 5, RAL = 4), length of post-operation hospital stay was still significantly shorter for patients who had undergone robot-assisted laparoscopy. Mean post-LAP hospital stay was 3.56 (±2.62) nights, while post-RAL was shorter at 2.21 (±1.68) nights to a statistically significant degree (p-value = 0.00666).

Conclusions

The use of robot-assistance during laparoscopic nephrectomies was associated with significantly shorter post-operative hospital stays over traditional laparoscopic procedures in this cohort of patients.
618 Flexible Cystoscopy: The Differences in Patient Recall of Post Procedural Complications When Using Verbal Consent as Opposed to Written Consent
Authors: G N , Abayomi O
Published: August 2023

Aim

To analyse the efficacy of taking verbal consent for flexible cystoscopy as opposed to taking written consent and whether it affected patient recall of complications related to the procedure.

Method

Flexible cystoscopy has 3 main complications that we mention to the patients – Dysuria, Haematuria and Infection. The 3-month long study from September to November 2022 involved 40 patients who underwent flexible cystoscopy in Aberdeen Royal Infirmary. 20 patients had verbal consent prior to the procedure and the other 20 had a written and signed consent form. We then asked these patients post procedure, if they recollected the 3 important complications mentioned earlier.

Results

65% of the patients who gave verbal consent and 75% of those who gave written consent recalled that dysuria could be expected post procedure. Also, 55% of the patients who had a written and signed consent recalled haematuria as a complication as compared to 40% of the patients who had verbal consent. 40% of the patients who had a written and signed consent recollected that they might have a urinary tract infection post procedure. This was 55% in the group that gave verbal consent

Conclusions

Informed consent is an important in any clinical intervention. It safeguards patient autonomy, is a legal requirement and is a central feature of the covenant relationship between the healthcare professional and the patient. Putting pen to paper increases patient recall and makes written consent the gold standard for flexible cystoscopy.
687 Comparison of Perioperative Outcomes Betweenlaparoscopic Versus Open Versus Robotic Partialnephrectomy: A Systematic Review
Authors: Wong R , Biyani S
Published: August 2023

Aim

This systematic review aims to evaluate the perioperative outcomes between laparoscopic (LPN), open (OPN), and robotic-assisted partial nephrectomy (RPN) using the standardised system, Clavien-Dindo Classification (CDC).

Method

The systematic review was conducted in accordance with the PRISMA guidelines. A search was performed on Cochrane, Embase and PubMed databases. Articles between January 2016 to December 2021 were included. Perioperative outcomes investigated include: estimated blood loss (EBL), operating time (OT), conversion rate (CR), warm ischaemia time (WIT), positive surgical margin (PSM), and postoperative complications using CDC.

Results

This study included 12 studies, with a total of 3,908 patients. (LPN = 1,120, OPN = 1,206, RPN = 1,580). LPN demonstrated a lower overall EBL (p = 0.004). There was no significant difference between OT (p = 0.291), CR (p = 0.200), WIT (p = 0.760), PSM (p = 0.549), CDC I (p = 0.556), CDC II (p = 0.779) and CDC≥III (p = 0.663) of the three surgical approaches.

Conclusions

Compared with OPN and RPN, LPN demonstrated a lower EBL. All other perioperative outcomes demonstrated similar results between the three treatment modalities. Future large-scale, prospective, randomised studies is necessary to draw a definitive conclusion from this analysis.
697 Day Case Trans-Urethral Resection of Bladder Tumour (TURBT) Without a Day Surgery Unit. Making Most of the Available Resources
Authors: Olaniyi P , Botham J , Birch E , Pearsall J , Warren K , Burden H
Published: August 2023

Aim

Transurethral resection of bladder tumour (TURBT) is one of the commonest urological procedures. Day case TURBT within a day case unit has been shown to be efficient, safe and plausible. In Southmead Hospital, Bristol, there is no such day case unit. All operative procedures are performed in the main theatres, and we have a combined admission and recovery area, called Medirooms. The aim of this retrospective review of our current practice is to show that high day case rates are achievable within a non-day case setting within the context of a standardised day case pathway.

Method

Retrospective data collection was performed to identify patients who underwent TURBT over a 3-month period. Basic demographics were collected, and we ascertained tumour characteristics, re-admission rates within 30 days.

Results

A total of 100 patients were included in this study. Of these, 66% were males and 34% females. TURBT was performed as a day case for 75% patients and 25% patients stayed overnight. Non-muscle invasive bladder cancer was found in 87% of the patients. Of these, 78% had muscle present and 40% received peri operative Mitomycin in theatre. We discharged 44% patients home with a catheter after their TURBT. This was mainly due to deep resection and precaution from the operating surgeons. The rate of re-admission within 30-days was 9%, of which 6% were due to urological reasons and 3% were due to non-urological reasons.

Conclusions

This study shows that day case TURBT is possible without a dedicated day case unit.
728 A Comparison of mpMRI and Template Biopsy in the Prediction of Clinically Significant Prostate Cancer at Final Radical Prostatectomy Pathology
Authors: Ong W , Bates A , Nabi G
Published: August 2023

Aim

Diagnosis and precise risk stratification of prostate cancer (PCa) is essential for individualized treatment decisions.

Method

This single-centred retrospective study included consecutive patients undergoing elective RP due to PCa with prior mpMRI and TPMBs biopsy between 2017-2022. We evaluated the value of PI-RAD v2 score, Gleason score (GS) and TPMB cores against RP specimens to determine its efficacy in identifying csPCa i.e Gleason score ≥3+4, or any cancer >6mm in size.

Results

A total of 49 patients were included. Mean age was 70 years (IQR 67-75) and PSA 11.7 ng/ml (IQR 6.4-13.6). For PI-RAD ≥ 3, 86% (42/49) vs 96% (47/49) had csPCa on TPMB and RP respectively. No statistically significant association was found between PI-RAD v2 score and GS of TPMB or RP (p = 0.9). When comparing the cumulative GS of TPMB versus RP (p<0.001), 49% (n = 24) had identical scores, 29% (n = 14) were downgraded, 22% (n = 11) were upgraded. For upgrading, 6/11 (55%) were PI-RAD 5 lesions. Only 2/11 (18%) and 3/11 (27%) constituted of PI-RAD 3 & 4 respectively.

Conclusions

There is no correlation between the PI-RAD v2 scoring system and final histopathology of RP specimens, and a low proportion of PI-RAD 3 or 4 lesions are upgraded at final pathology.
775 Incidental Prostate Cancer Following Holmium Laser Enucleation of Prostate
Authors: So C P , Bates A , Kalpee A
Published: August 2023

Aim

 To review the incidence and predictors of incidental prostate cancer (IPCa) following Holmium Laser Enucleation of Prostate (HoLEP).

Method

 This was a departmental retrospective review of 148 patients undergoing HoLEP between 2017 to 2022. Demographic, perioperative, and pathologic data were gathered. For patients diagnosed with IPCa, information on work up, management, and oncologic outcome were gathered. Univariate and multivariate logistic regression were used to identify predictors of IPCa. 

Results

 13 patients had IPCa (8.78%). The mean age was 73.4 years (SD 6.6); pre-procedural prostate volume 85.3ml (SD 32.9); pre-procedural PSA 6.7ng/ml (SD 6.1); PSA density 0.08ng/mL2 (SD 0.06); weight of enucleated tissue 52.8g (SD 39.4); enucleated tissue PSA density 0.14ng/mL2 (SD 0.10). Prostate volume was strongly correlated with weight of enucleated tissue (Pearson 0.8, P = 0.006). Lower pre-procedure prostate volume was the only significant predictor of IPCa (P = 0.018). A prostate volume of <99.0ml had sensitivity of 0.67 and specificity of 0.63 (Area under ROC = 0.70). Mean reduction in post-procedural PSA was 5.6ng/ml (SD 6.3). 61.5% (n = 8) patients had clinically significant IPCa (Gleason≥GG2 or >5% volume). 3 patients had radical treatment, and 5 patients were under active surveillance. The other 5 patients with insignificant IPCa continue on active surveillance (AS) (n = 3) and watchful waiting (WW) (n = 2). None with insignificant disease had disease progression. 

Conclusions

 Of patients with IPCa, 61.5% (n = 8) patients had clinically significant IPCa, and the optimal mode of detecting incidental clinically significant prostate cancer, prior to HoLEP might include pre-operative MRI in selected patients based on gland size.
827 Greenlight Laser Prostatectomy: A Safe and Effective Day Case Option for Bladder Outlet Obstruction in the Elderly Population
Authors: Weight G , Tsoi H
Published: August 2023

Aim

Greenlight-laser prostatectomy (GLLP) is becoming a popular treatment option for bladder outlet obstruction. In this retrospective study, we aim to explore the patient selection, perioperative morbidity, and functional outcomes of GLLP.

Method

Patients who underwent GLLP at a UK tertiary centre between June 2018 and November 2021 were included in this study. Retrospective data covering patient demographics, perioperative parameters and postoperative outcomes were collected using the electronic records systems.

Results

305 patients were included in this study with a median age of 74 (range 30-90) years. The most common indication (62.6%) for the procedure was patient’s wish to be free from long-term catheters (LTC) or intermittent catheterisation (ISC), followed by failed medical therapy for LUTS (36.4%). 84.6% of patients had an ASA ≥2, and 32.1% took anticoagulant or antiplatelet therapy. Inpatient stays were minimal, with the majority (68.2%) of patients were performed as day case, and 21.3% of patients discharged on the next day. The 3-month readmission rate was 10.8%, with the most common causes being haematuria and urinary-tract infection. The successful TWOC rate at follow up was 91.2%. Amongst the 19 patients who failed TWOC, 14 had LTC prior to the procedure and 4 had been performing ISC.

Conclusions

Our study shows that GLLP is a safe and effective day case treatment, and that with appropriate anaesthetic input it can be suitable for elderly and comorbid patients. Patients requiring LTC or ISC pre-operatively should be counselled carefully about the risk of not being catheter-free post procedure.
878 Outcomes of Men Undergoing Surgery for Gleason 8-10 Prostate Cancer: A Single Centre Retrospective Study
Authors: Smith S , Manley K , Mills R
Published: August 2023

Aim

In this retrospective study, we evaluate patient outcomes for patients with localised Gleason 8-10 prostate cancer opting for radical prostatectomy.

Method

A list of men with Gleason 8-10 localised prostate cancer on pre-operative prostate biopsy who underwent radical prostatectomy (RP) within our tertiary referral unit between 1st January 2002 and 2nd June 2020 were obtained through departmental operative and histology records. Electronic patient record systems were retrospectively reviewed for demographic information, pre-op PSA, biopsy histology, clinical staging, type of prostatectomy, final histology, post-operative information (PSA, time to biochemical recurrence, time to metastasis, duration of urology follow-up).

Results

104 patients with Gleason 8-10 disease underwent RP, with median follow-up period of 65 months. Mean (± SD) age at operation was 64.2 ± 6.1 years. Prostate biopsies revealed Gleason 9 disease in 54.8%, Gleason 8 in 40.4% and Gleason 10 in 4.8%. 28% of RP were performed laparoscopically, and 49% robot-assisted. 27% of patients had T3b status at surgery, and 7% had positive lymph nodes. 57.5% of all patients had positive surgical margins. 7.7% of patients required adjuvant radiotherapy, and 28.8% underwent salvage radiotherapy. 5-year overall survival was 90.9%; 10 year overall survival 77.1%. 5- and 10-year biochemical recurrence-free survival rates were 76.3% and 52.9% respectively; 5 and 10 year metastasis-free survival rates were 87.3% and 70.6% respectively.

Conclusions

Whilst many men who have radical prostatectomy for Gleason 8-10 prostate cancer develop biochemical recurrence, overall and metastasis-free survival rates are acceptable.
937 Investigation and Management of Symptomatic Hydronephrosis in Pregnancy, a Retrospective Study
Authors: Sharma V , Jeffery H
Published: August 2023

Aim

Although hydronephrosis in pregnancy can be a common physiological phenomenon, if symptomatic, it may represent a pathological process requiring further investigation and management. The purpose of the study was to determine how symptomatic hydronephrosis in pregnancy presents, and the proportion of cases requiring further investigation and management.

Method

A retrospective study was carried out at a District General Hospital. A search was conducted on PACS for all ultrasound abdomen/kidneys/urinary tract performed between August 2019 and August 2022, where requests/reports had the terms ‘pregnant’, ‘pregnancy’ or ‘gestation’.

Results

Of the 261 ultrasound scans performed, 39 had reported hydronephrosis (mean age 28.6, range 19-39; laterality: 22 right, 6 left, 11 bilateral), of which 31 were symptomatic of pain, dysuria and/or pyrexia. Seven patients warranted further acute imaging (4 MRI, 2 low-dose CTKUB, 1 had both following inconclusive MRI). A majority of patients (33/39, 92%) with hydronephrosis were conservatively managed and had resolution of symptoms. Only 3 patients (8%) required eventual emergency management – two had nephrostomy insertion (without any further imaging other than ultrasound) and one had retrograde stenting (after management was planned using CT).

Conclusions

A majority of women with symptomatic hydronephrosis in pregnancy are successfully managed conservatively and will rarely require further investigation with radiation. Limited radiation may be indicated where this will impact upon treatment. There is need for a consensus to guide management of these patients, weighing up risks vs benefits of further investigation and intervention.
962 Are We Right to Continue to Omit Antibiotic Prophylaxis in Trans-Perineal Prostate Biopsies? A Clinical Audit in a Single NHS Trust
Authors: Cairns G , Trent N
Published: August 2023

Introduction

Transperineal Prostate Biopsies (TPPB) offer lower rates of infection-related complications than Transrectal Prostate Biopsies (TRPB), with post-procedural sepsis rates reported between 0.5% and 3%. The intuitive evolution from TRPB to TPPB has, however, involved the use of routine antibiotic prophylaxis, but studies have shown that there may be no difference in infection rates post procedure in patients with and without antibiotics.

Aim

This audit aimed to assess infection-related complications in patients undergoing TPPB without antibiotic prophylaxis in a single NHS Trust, following the Trust decision to discontinue antibiotic use.

Method

Retrospective analysis of 200 patients that had been biopsied between April 2022 and October 2022 was performed. 28-day post procedure hospitalisation and sepsis rates were assessed, in addition to 28-day GP presentations, antibiotic prescriptions and relevant co-morbidities.

Results

The cohort had a mean age of 70.1 years. The most common co-morbidities included Hypertension and Type 2 Diabetes Mellitus. 1 patient presented to hospital with sepsis within 28 days, representing a post-procedure infection rate of 0.5%. This patient received IV antibiotics in hospital and was discharged after 3 days. No patients presented to their GP within 28 days post procedure or were prescribed antibiotics in the community.

Conclusions

Given the low post procedure infection rates, we believe the evidence provided in this audit further supports and justifies the discontinuation of routine prophylactic antibiotics in patients undergoing TPPB. We believe this to be relevant in a world where antibiotic stewardship is becoming an ever more important issue.
1017 Transurethral Laser Ablation for Non-Muscle Invasive Bladder Cancer: A Service Validation
Authors: Vaidya A , Dyer J
Published: August 2023

Aim

Transurethral laser ablation (TULA) for non-muscle invasive bladder cancer (NMIBC) allows outpatient treatment of suspected bladder cancer re-occurrence whilst avoiding the risks of the general anaesthetic. The COVID pandemic limited operating capacity was therefore TULA was adopted in a tertiary centre hospital in the UK in order to continue treatment for appropriate cases. We aimed to assess remission free period, the laser energy usage and waiting time for patients since the service started.

Method

A retrospective service evaluation since December 2020 till May 2022. All patients who were listed for TULA were eligible. Exclusion criteria was incomplete data and patients who did not have NMIBC. Demographic data, listing time, remission free period and lasering usage were all recorded. Patients were risk stratified as per the EAU guidelines; patients were upstaged to the higher category if there was incomplete data to stage accurately. Statistical analysis was conducting using a one-way ANOVA.

Results

183 patients underwent TULA; 165 patients were included. The mean age was 79 years. The mean time was listing to procedure was 77 days. 72 patients had not had a flexible cystoscope post TULA. There was no significant difference between remission rates and re-occurrence rates (p = 0.544) between risk categories (p = 0.96).

Conclusions

The re-occurrence rates following TULA did not vary depending on the risk of NIMBC, nor did the energy usage. Longer collection periods are required to ascertain if this alters with time. Further research is required to assess if earlier treatment of more aggressive forms of NMIBC allows for lower reoccurrence rates.
1114 Safety and Efficacy of Enbloc Low-Power HoLEP for Large Prostate Glands: A Single Centre Prospective Series
Authors: Tai J C J , Spazzapan M , Deen S , Ahmed M , Tasleem A , Nkwam N
Published: August 2023

Aim

HoLEP is the preferred technique for management of prostates >80cc in men with lower urinary tract symptoms. While evidence has shown that Low-Power (LP) HoLEP is comparable to High-Power HoLEP, the use of LP-HoLEP in enbloc enucleation for large prostates has not been demonstrated. We report a prospective series assessing the safety and feasibility of the technique.

Method

Data was prospectively collected on 105 patients who underwent LP-HoLEP from 12/02/2020 to 17/08/2022. A 50W Ho:YAG laser was used at 39.6W (2.2J, 18Hz). Prostate volume and uroflowmetry were assessed preoperatively, and patients were reviewed at three and 12 months postoperatively.

Results

The mean age of participants was 72 years with a median prostate volume of 117cc. Median enucleation time was 39 minutes, with a median enucleated weight of 73.0g and a median enucleation efficiency of 2.1g/min. Of the 105 patients, 60% were discharged on the same day with 94.3% of patients home by Day 1. Mean IPSS and QoL scores improved from 20.8 to 8.5 (p<0.001) and 4.2 to 2.0 (p<0.001) respectively. Qmax improved by 16.7ml/s (p<0.001) and post-void residual volume reduced by 144.8mL (p<0.001). Complications occurred in 27 (25.7%) patients [Clavien-Dindo 1: n = 23; 2: n = 2; 3A: n = 0; 3B: n = 2].

Conclusions

In the hands of an experienced operator, enbloc LP-HoLEP is technically feasible and effective for the treatment of large prostates which can be delivered safely as a daycase procedure.
1115 Assessing Patient Understanding of Treatment Indications and Follow-Up Procedures Following Emergency Ureteric Stent Insertion: A Single Centre Study
Authors: Kasbia H , Cheung B , Pai A
Published: August 2023

Aim

Ureteric stents are inserted to maintain urinary drainage from the kidney to the bladder in the presence of ureteral obstruction or injury. Over the last 24 months, multiple stents have been retained at our institution, requiring additional invasive surgery to remove encrusted stents with associated loss of kidney function, infection, and morbidity. The aim of this audit is to assess patients’ understanding of the indications for ureteric stent insertion, duration of treatment and how to arrange timely stent removal to avoid the risk of further complications.

Method

We collected prospective data from patients undergoing emergency JJ-ureteric stent insertion within the Urology department of Northampton General Hospital. We assessed patient understanding of stent indications, treatment duration and stent removal using a questionnaire format.

Results

All patients surveyed were aware of the indications for stenting. 75% of patients were aware of the minimum duration of stent treatment, however more than half of patients were unaware of when their stent needed to be removed. All patients surveyed did not know how to arrange a stent removal or change, or who to contact regarding this.

Conclusions

There is a notable lack of patient knowledge and understanding regarding stent removal. We have designed, and plan to implement, a stent passport to provide patients with the relevant information regarding the indications for stenting, duration of treatment and contact details to arrange stent removal. We plan to re-audit patient understanding and outcomes following implementation of the stent passport.
1116 An Institutional Review of Holmium LASER Enucleation of the Prostate Morbidity
Authors: So C P , Bates A , Kalpee A
Published: August 2023

Aim

To review morbidity rate of Holmium Laser Enucleation of Prostate (HoLEP) in at a single institution in the UK.

Method

A retrospective review of 148 patients who underwent HoLEP between 2017 and 2022 was performed. Demographic, intraoperative, immediate postoperative and postoperative follow up data were recorded to determine the incidence of complications. Mean data are presented.

Results

The mean age was 71.4 years (SD 7.5), prostate volume 109.7ml (SD 38.5), weight of enucleated tissue 61.4g (SD 41.4), and length of stay 1.5 days (SD 0.9). 76 patients (51.4%) had long term catheter and 18 patients (12.2%) had intermittent self-catheterization preoperatively. 114 patients (77%) had successful TWOC prior to discharge. 4 patients (2.7%) never had a successful TWOC. Clavien-Dindo II complications included urinary infection (2.8%, n = 4) and lavage for haematuria (2.7%, n = 4), and of those, clot retention in 1.4% (n = 2). Clavien-Dindo III complications included urethral stricture (1.4%, n = 2) and clot evacuation for hematuria (0.7%, n = 1). The 30-day readmission rate was 2.7 % (n = 4), all for clot retention. Among 5 patients (3.4%) with haematuria or clot retention, 4 patients were treated with lavage/irrigation, and 1 required bladder washout in theatre. There were 3 patients on anticoagulant medications and 1 patient on an antiplatelet within 30 days of HoLEP.

Conclusions

HoLEP is associated with low incidence of morbidity and low rate of readmission, however pre-operative anticoagulant use was associated with readmission due to haematuria.
1133 Radical Cystectomies: What Came First, the CRP or the Complication?
Authors: Yousaf A , Whiting D , Janardanan S , Perry M
Published: August 2023

Introduction

Despite being gold standard treatment for some bladder cancers, radical cystectomy is a procedure with high rates of morbidity and mortality often due to development of post-operative complications. Here we present the rates of complications for patients undergoing robotic-assisted radical cystectomies (RARC) in a single, high-volume centre and their association with early postoperative CRP values.

Method

This retrospective study looked at data from 500 patients who underwent RARC at one hospital from April 2013 to April 2021. Postoperative complications were analysed to assess the value of using early post-operative CRP as a predictor for development of those complications.

Results

499 patients were included in the study of which there were 369 men (74%) and 130 women (26%) with a mean age of 69.4 years. The majority of patients had a RARC with formation of ileal conduit (84.6%), or RARC with formation of a neobladder (4.6%). 154 patients experienced a complication fitting into Clavien-Dindo Class I or above. 92 patients experienced ileus (60%) followed by infection (20.1%). On multivariant analysis, we have identified a statistically significant association with early post-operative CRP values at days 1-3, peaking at day 3, and the development of post-operative complications.

Conclusions

We have shown that analysis of early postoperative CRP values may be beneficial for patients undergoing urological procedures. Earlier identification of patients whose investigations suggest they are likely to develop post-operative complications will allow clinicians to take action earlier on during their admission in an attempt to reduce morbidity for patients.
1245 Ex-Vivo Comparison of Stone Clearance Rates Using Trilogy™ vs Thulium Fibre Laser (TFL) Lithotripsy
Authors: Connor C O , Kelly J O , Scanlon L , Rauf H , Hennessey D
Published: August 2023

Introduction

There has been recent introduction of novel lithotripters and high-power lasers for stone disintegration. The latest in vitro and in vivo literature highlights the superiority of TFL vs standard Holmium:YAG (Ho:YAG) lithotripsy. This study aimed to evaluate the efficiency of Trilogy™ compared to TFL ex-vivo with regard to stone clearance rates.

Method

Kidney stone phantoms were made with BegoStone in 4 powder to water ratios of (15:3 to 15:6). The physical properties of these stone phantoms are comparable to kidney stones. The average clearance rate was calculated across a wide variety of settings (N = 27) for each of the 4 stone types with the Trilogy™ using size 34mm x 340mm probes. The settings of 1 Joule and 20 Hertz for a power of 20 Watts was used (N = 3) for the 4 different stone phantoms with the TFL using a size 500µm laser fibre utilised in percutaneous nephrolithotomy (PCNL).

Results

With the Trilogy™, calcium oxalate monohydrate (COM) (15:3) stone phantoms had an average stone clearance rate of 498.40 mm3/min, calcium phosphate (CaP) (15:4) had an average clearance rate of 493.60 mm3/min, uric acid (UA) (15:5) were cleared at a rate of 1267.61 mm3/min and struvite (15:6) cleared with a rate of 1299.64 mm3/min.

Using TFL, COM had an average clearance rate of 40.74 mm3/min, CaP were cleared at 39.65 mm3/min, UA at 39.5mm3/min and struvite were cleared at an average rate of 56.41 mm3/min.

Conclusions

The Trilogy™ had statistically significantly faster stone clearance rates across all 4 stone types (p = 0.03).
1252 Body Mass Index (BMI) and Estimated Blood-Loss (EBL) in Patients Undergoing Robot Assisted Radical Prostatectomy (RARP)
Authors: Connor C O , Msellati A , Collins P , Hegazy M , Beirne E O , Galvin D , Hegarty N , Connolly S , Nason G , Malley K O
Published: August 2023

Introduction

Higher BMI is a factor which urologists associate with increased difficulty during RARP. (1) One previous review of 218 patients undergoing RARP found no significant differences in EBL in patients with a higher BMI. (2) The aim of this study was to examine the relationship between BMI and EBL in patients undergoing RARP.

Method

Between April 2019 and March 2022, 155 patients underwent RARP. Demographic and clinical variables were collated including EBL, pre-operative and post-operative haemoglobin checks, need for transfusion, length of stay (LOS) and BMI.

Pearson’s correlation coefficient was calculated to examine the relationship between increasing BMI and blood loss.

Results

The mean age of patient was 62 years (range 45-79). The mean BMI was 27.98 (range 19.4-40). The mean blood loss was 281.2mls (range 50-1000). No patient required a blood transfusion. The mean LOS was 2.4 days (range 1-16). There was a positive correlation between higher BMI and higher blood loss (r = 0.1746, p = 0.0421).

Conclusions

This review found a statistically significant increase in EBL in patients with higher BMI undergoing RARP.
1256 Fabricating Artificial Kidney Stones of Different Physical Properties for Ex Vivo Experimentation
Authors: Connor C O , Lyons L , Murphy J , Hennessey D
Published: August 2023

Introduction

There have been several new technologies introduced recently for lithotripsy. The optimal settings of these devices are unknown for different kidney stone densities. This study aims to develop artificial kidney stones for ex vivo studies.

Method

BegoStone was prepared with a powder to water ratio (by weight) ranging from 15:3 to 15:6. The phantoms' acoustic properties were characterised by using an ultrasound transmission technique, from which the corresponding mechanical properties can calculated based on elastic wave theory.

Results

The measured parameters for BegoStone phantoms of different water contents were assessed with regard to longitudinal wave speed & density. If transverse wave speeds were measured then longitudinal acoustic impedance, transverse acoustic impedance, Young's modulus, bulk modulus, and shear modulus can be derived. Longitudinal (CL (m/s)) and density (ρ (Kg/m3)) of BegoStone phantoms with different powder to water ratios corresponded to the known properties reported in natural kidney stones (Calcium Oxalate Monohydrate, Brushite, Uric acid and Struvite). A BegoStone water ratio of 15:3 had similar properties to Calcium Oxalate Monohydrate, 15:4 to be similar to Brushite, 15:5 was similar to Uric acid, and 15:6 was similar to Struvite.

Conclusions

This BegoStone preparation method can be used to fabricate artificial stones with physical properties matched with those of natural kidney stones of various chemical compositions.
1272 Are We Repeating MRI Prostate Scans Unnecessarily in Our Management of Suspected or Confirmed Prostate Cancer Patients, When Referred to Urology
Authors: Rokan N , Ahmad S
Published: August 2023

Aim

MRI Prostate aids in the detection of prostate cancer, however often following a single MRI if cancer is suspected or confirmed, subsequent MRIs are performed, and it is unclear if these are unnecessarily repeated.

Method

We reviewed 196 patients who underwent at least two MRI prostate scans between January 2019 to December 2022. Imaging, clinic letters and MDT reports were reviewed with active surveillance (AS), treatment initiated or discharge back to GP as management outcomes. We analysed whether management changed following multiple MRIs.

Results

Following a single MRI scan 115/196 (59%) commenced/continued AS and 81/196 (41%) were discharged. Following a second MRI 83/115 (72%) continued AS, 18/115 (16%) commenced treatment and 14/115 (12%) were discharged. 69/115 (60%) AS patients had a repeat MRI within one year with the majority (46/69, 67%) continuing AS, 11/69 (16%) being discharged and 12/69 (17%) commencing treatment.

In those 81/196 initially discharged, 56/81 (69%), were discharged following repeat MRI, 18/81 (22%) started AS and 7/81 (9%) commenced treatment. 19/81 (23%) patients underwent repeat MRI within one year with 13/19 (68%) subsequently discharged, 4/19 (21%) starting AS and 2/19 (11%) commencing treatment.

Conclusions

MRI is an important tool for diagnosis and AS in those with (suspected) prostate cancer, however we have shown that in the majority of patients, repeat MRI does not change the outcome of requiring treatment or AS in those initially discharged subsequent to MRI, particularly within 1 year. Discharged patients may require repeat imaging, however repeating this at a longer interval should be strongly considered.
1284 In Vitro Evaluation of Optimal Device Settings for the Swiss Lithoclast Trilogy Lithotripter
Authors: Connor C O , Lyons L , Hennessey D
Published: August 2023

Aim

The LithoClast Trilogy Lithotripter is the latest generation lithotripter. It has four modifiable settings for stone fragmentation - Impact (0-100%), frequency (0-12Hz), ultrasound (0-100%) and suction (0-100%). The configuration for different stone types is unknown. We aim to determine the optimal settings for four stone types.

Method

Calcium oxalate, calcium phosphate, uric acid and struvite 2cm3 phantoms were created using Begostone. Ultrasound and suction were kept constant at 100% and 40%. Impact and frequency were adjusted for a combination of 10 settings and repeated N = 3. Drill speed and fragment size were calculated using 34mm probes.

Results

One hundred percent impact and frequency of 12 Hz resulted in the fastest clearance times of Struvite phantom stones, mean 83 seconds. For uric acid stone phantoms, impact of 30% and a frequency of 4 Hz was the fastest setting for stone clearance, mean 83 seconds. Calcium phosphate phantom stones were treated fastest at an impact of 30% and frequency of 4Hz (mean 217 seconds). The fastest clearance rate for calcium oxalate stone phantoms was at an impact of 30% and a frequency of 12Hz (mean 204 seconds). The slowest rate of calcium oxalate stone phantom clearance was an impact of 60% and 8Hz (mean 269 seconds).

Conclusions

Stone clearance rates, drill speeds and average fragment sizes were calculated for the most commonly occurring stones using the Swiss Lithoclast Trilogy lithotripter. The results indicate that harder stone phantoms may fragment more efficiently at lower device settings.
174 Functional Outcomes in Older Patients Following Major Limb Amputation
Authors: Jamal S , Luckhurst J , Hussey K
Published: August 2023

Aim

More than 5,000 major limb amputations (MLA) are performed annually in the United Kingdom. The relationship between medical co-morbidity and frailty is complex and can have an adverse effect on both mortality and functional capacity. This may be particularly important for older patients. We have attempted to define functional outcome by describing place of discharge, functional capacity and limb-fitting.

Method

This was a retrospective review of a prospectively collated data set on MLA performed in a single Scottish Health Board (NHS Greater Glasgow and Clyde). Older patients were defined as those over 80-years at the time of MLA. Primary outcome measures were place of discharge, functional capacity at the time of follow-up and successful limb fitting.

Results

There were 389 consecutive MLAs performed of which 33 were in patients over the age of 80-years. There were 3 (9.4%) inpatient deaths, and the median duration of stay was 57-days. Only 13 (43.3%) patients were discharged home to independent living. The remaining patients were discharged to either supported living or nursing home care. There were 13 (43.3%) patients who were discharged bed bound. Only 7 (21.2%) were successfully limb-fitted. At 12-months 22 (73.3%) of patients were dead.

Conclusions

MLA in older patients is associated with loss of function and therefore loss of independence. Most patients have died within a year of surgery. These data should help modify expectations for patients, families and clinicians and will help with the process of informed consent.
287 Role and Efficacy of "Frequency-Modulated Electromagnetic Neural Stimulation" in Treatment for Painful Peripheral Neuropathy in Patients with Diabetes Mellitus: A Retrospective Cohort Study
Authors: Shehata R , Bishara R
Published: August 2023

Aim

Evaluate the efficacy of frequency rhythmic electrical modulation system "FREMS" as a symptomatic treatment for painful peripheral neuropathy(PN) in patients with diabetes mellitus

Method

Retrospective cohort study on 75 patients with Painful PN , who had 10 FREMS sessions using APTIVA device (Lorenz Biotech, Italy), from January 2019 - February 2020.

Patients’ data were collected through the Diabetic Foot Center digital database.

Results

75 patients had APTIVA sessions; Pain assessment was done using Visual analog pain score 0 to 5: 0 = no pain / 5 = severe pain.

16 patients were excluded as they did not complete the 10 sessions and 59 patients were reviewed.

No treatment-related adverse events were recorded during the study rather than very slight burning sensation at the site of electrode placement.

Pain at the beginning

46/59(77.9%) of patients suffered from severe pain (grades 4 & 5), 10/59(16.9%) of patients suffered from moderate pain (grade 3,2) and 2/59 (5%) of patients suffered from mild pain (grades 1 &0).

Pain at the last session : The percentage of patients that suffered from severe pain dropped from 77 % before treatment to 11% after treatment.

From the 46 patients that suffered from severe pain, 12/46 patients (25%) of them improved to mild pain and 27/46 patients (58%) improved to moderate pain.

By comparing the pain score in patients before and after APTIVA, there was a significant statistical difference between the 2 groups using “Paired t-test” with P<0.0001.

Conclusions

APTIVA proved to be a safe & effective treatment in reduction of Pain for painful PN.
488 Comparison of Efficacy Between Suture-Mediated and Plug-Based Vascular Closure Devices Following Endovascular Procedures via Large-Bore Femoral Punctures
Authors: Hakeem A , Najem M , Chaudhuri A
Published: August 2023

Introduction

Endovascular aneurysm repair is typically performed via large-bore percutaneous femoral access; with haemostasis achieved using vascular closure devices (VCDs). Such VCDs include suture-mediated closure devices like ProGlide or plug-based such as the MANTA. We compared the efficacy of two techniques, early and late complications related to the devices.

Method

We undertook a retrospective analysis of a prospective database of large-bore access procedures from 2017-2022, comparing two groups by VCD used, designated Group A (ProGlide) and Group B (Manta). We classified haemostasis as Grade 1 (haemostasis without adjuncts), Grade 2 (haemostasis with adjuncts such as pressure dressings) and Grade 3 (failed haemostasis needing rescue). Grades 1 & 2 were considered successful haemostasis. We used Minitab 21 for statistical analysis.

Results

We assessed 207 endovascular procedures with 374 large-bore accesses (243 Group A and 131 Group B). The mean age was 74.9±8 (183 males), and the average BMI was 28±5.8. 191 had EVAR and 11 TEVAR. 5% had redo groins (11 Group A and 8 Group B, p = 0.47). The average sheath outer diameter was 16±2.5F. Successful haemostasis was achieved in 91.1% (222 in Group A and 119 in Group B). 8.8% needed a rescue operation (21 in Group A and 12 in Group B, p = 0.86). Pseudoaneurysms developed in 4.8% (n = 18) and were more frequent in Grade 2 haemostasis (11 Group A and 2 Group B, p = 0.058).

Conclusions

The overall success rate was comparable between the two groups. However, ProGlide deployments required more adjuncts to achieve haemostasis. Pseudoaneurysm formation was more frequent with adjuncts.