bluuebunny/crossref_metadata_2025 huggingface dataset:
364 The Cycling Urologist: Effect on PSA, Haematuria, Pudendal Nerve Entrapment and Cyclists Nodules
Authors: Peacock J , Cobley J , Patel B
Published: October 2021

Aim

Cycle use has vastly increased over the last few years in the UK. The aim of this review was to evaluate the effect of cycling on the common conditions presenting to the urology clinic, in particular those of raised PSA, haematuria, soft tissue lesions (“cyclist nodules”) and pudendal nerve entrapment syndromes.

Method

A PUBMED search of the literature on cycling and genitourinary disorders was performed. The keywords included “Bicycling” AND “Prostate-specific antigen”, “Bicycling” AND “Haematuria”, “Bicycling” AND “Cyclist Nodules”, “Bicycling” AND “Pudendal Nerve Entrapment”.

Results

The literature suggests no significant change in total PSA levels after a bout of cycling, regardless of age. The type of cycling (mountain biking vs. road cycling) does not influence PSA levels. It is possible that the saddle used in cycling may displace the pressure across the perineal and gluteal region to effectively alleviate pressure on the prostate. Haematuria appears to be rare with cycling but has been described. Perineal nodular induration is a very rare - although possibly under diagnosed condition. It is thought to be caused by repetitive micro trauma from contact between the perineum and saddle. Pudendal nerve entrapment (PNE) represents the most common bicycling associated urogenital problem. Numbness in the perineum, penis, scrotum or the buttocks is the most common and most recognised symptom. Genital numbness may occur unrelated to erectile dysfunction (ED) although cycling related ED is invariably associated with genital numbness.

Conclusions

Urology Trainees and Consultants should be aware of how recreational and high-level cycling may result in presentation to the Urology clinic.
503 Top 100 Most Influential Manuscripts in Erectile Dysfunction: A Bibliometric Analysis
Authors: Minto T
Published: October 2021

Aim

Erectile dysfunction (ED) is a common condition encountered by an array of subspecialists and is the most cited research topic within the field of andrology. This bibliometric analysis aims to identify the most influential papers that inform current clinical practice and likely shape future research.

Method

The Thompson Reuters Web of Science citation database was interrogated using search terms to cover the breadth of erectile dysfunction. Results were ranked according to citation number with country of origin, journal, topic, year of publication, author, and institution also analysed.

Results

The search criteria matched 12,570 manuscripts. The top 100 highest citation ranged from 3013 to 161 (median 229.5). The most cited by Feldman et al, 1994 reports the prevalence and risk factors of ED within the Massachusetts Male Aging Study. The most manuscripts were published by the Journal of Urology (n = 15) with a total of 7913 citations. Institutions from the USA contributed the majority (n = 55) with the UK (n = 14) second. The most common theme represented was epidemiology (n = 46) followed by treatment (n = 27).

Conclusions

This analysis provides a list of the most influential manuscripts within ED and illustrates what can be considered a ‘highly citable’ paper. The most influential papers in Erectile Dysfunction remain seminal works from the end of the last century. The most cited manuscript (Feldman et al) has been cited 194 times in the last seventeen months showing its continued value. Only one paper published within the last decade has reached the top twenty exemplifying the relative lack of novel influential publications.
525 Minimally Invasive Surgical Treatment of Benign Prostatic Hyperplasia: A Systematic Review
Authors: Ting A , Shanmugathas N , Khoo C , Dasgupta R , El-Husseiny T , Abboudi H
Published: October 2021

Introduction

Minimally invasive surgical treatments (MISTs) of benign prostatic hyperplasia (BPH) have evolved to offer men daycase care with preservation of urinary continence and sexual function. This systematic review evaluates trends in minimally invasive BPH surgery over the last decade

Method

Systematic review (PRISMA) of Embase/MEDLINE databases (2010-2020). MISTs included Rezum, Urolift, Prostatic Artery Embolisation (PAE), Temporary Implantable Nitinol Device (TIND), Intraprostatic Injection, Transurethral Microwave Therapy (TUMT) and Transurethral Needle Ablation (TUNA). Primary outcome: urinary functional change (International Prostate Symptom Score (IPSS)/maximum flow (Qmax)). Secondary outcomes: sexual functional change (International Index of Erectile Function-5 (IIEF-5)), technical failures and complications.

Results

74 studies were included (total: 8,917 patients). Primary: all interventions offered improvement in IPSS and Qmax (intervention (no. studies): range IPSS change, range Qmax change, range months follow-up; Rezum (4): -46.7% to -62.7%, +17.6% to + 55.6%, 6-48; Urolift (11): -35.2% to -64.2%, +16.7% to + 89.6%, 1-60; PAE (36): -36.8% to -85.2%, +17.4% to + 155.2%, 3-38; TIND (2): -36.8% to -59.6%, +32.9% to + 95.9%, 12-36; Intraprostatic Injection (14): -24.3% to -62%, +8.7% to + 98.4%, 3-24; TUMT (4): -56.1% to -58.7%, +12.9% to + 60.2%, 6-60; TUNA (3): -17.6% to -63.2%, +3.9% to + 39%, 1-120). Secondary: 33 studies of all interventions bar TIND and TUMT reported IIEF-5 change; sexual function was largely preserved. Technical failures and Clavien-Dindo ≥3 complications were rare.

Conclusions

MISTs for BPH are efficacious and safe. Randomised comparisons with long-term urinary and sexual follow-up are needed to guide choice; until then, patients should be carefully counselled based on individual priorities and circumstances.
647 Management of Malignant Upper Urinary Tract Obstruction
Authors: Lewis F , Neal N
Published: October 2021

Background

Malignant Upper Urinary Tract Obstruction (MUUTO) is a common emergency presentation. These are often complex patients and require multiple specialty input to make time-critical decisions. There are currently no national guidelines for the management of MUUTO, a review was conducted to assess the management and outcomes of MUUTO.

Aim

To agreed and review a pathway for patients with MUUTO in order to streamline patient care and to review the management.

Method

The pathway was devised by several consultants at Oxford University Hospital. Through retrospective data collection, the outcomes over six months were reviewed.

Results

Over the six-month period 49 interventions were performed for MUUTO; 44 Percutaneous Nephrostomy (PCN) and five cystoscopies with retrograde ureteric stents (RUS). Patients were admitted to urology in 45% of cases and oncology in 39%. The obstruction was located above the pelvis in 16 (33%) of the cases and within the pelvis in 25 (51%). The most common cancers causing obstruction were bladder cancer (41%), prostate (16%), and colorectal (14%). MDT advice was sought in 63% of cases. The mean time from diagnosis to the intervention was four days. Of the five retrograde inserted ureteric stents, four were unsuccessful and the patients proceeded to PCN. At the conclusion of data collection, 26 (53%) patients had died.

Discussion

The most striking findings were the high failure rate of RUS and the overall poor prognosis of MUUTO. As such this review suggests that more patients should proceed directly to PCN for decompression.
682 Pre-clinic mpMRI Prostate for Suspected Localised Significant Prostate Cancer – Incidental Findings and Outcomes
Authors: Berridge C T , Bhugalee S B N , Jothimuruga S , Khan M A
Published: October 2021

Aim

Two week wait pathways demand rapid investigation of patients with suspected prostate cancer. To facilitate this, mpMRI prostate imaging is now routinely organised for patients whom meet specific criteria, without prior physical review by an urologist. We sought to establish what incidental findings were amongst this patient group and whether management was affected.

Method

All patients referred between 1/4/2019 – 30/4/20 on a suspected prostate cancer pathway to the Leicester General Hospital were included with those coded to have had pre-clinic MRI selected.

Results

During this period 1487 patients were referred on the pathway of which 482 were coded as having has pre-clinic MRI. 8 patients were excluded due to incorrect coding leaving 474 to be analysed. 121 patients had incidental findings mentioned in the report, of these a higher proportion did not have prostate cancer (69%). There were just 11 (2%) significant findings that required further investigation or intervention. These included colorectal lesions, primary bone lesions, suspected bladder cancers and urinary tract calculi. Of this group 3 patients had prostate cancer. Of note 13% of these patients were noted to have diverticular disease and 6% had herniae noted although none required emergent treatment. In this series 32% of patients were confirmed to have prostate cancer with 67.1% of MRI scan reported as PIRADS 3-5.

Conclusions

Pre-clinic MRI prostate facilitates rapid investigation for suspected prostate cancer. There is a small chance of establishing a significant incidental finding which is slightly more common in the non-cancer group.
687 Timings of CT Scans in Suspected Renal Colic
Authors: Sabaratnam R , Callan R , Baptiste G , Miah T , Sharaf A , Chaudry A
Published: October 2021

Aim

Renal/ureteric colic is common; it has an annual incidence of 1-2 cases per 1000 people and has high recurrence rates. National Institute for Health and Care Excellence (NICE) guidelines recommend imaging within 24 hours of presentation for all patients with suspected renal or ureteric stones and, for most adults, a low-dose non-contrast computed tomography (CT) scan should be offered. We set out to assess adherence to this guidance within our centre.

Method

We reviewed the records of patients presenting with suspected renal colic from December 2019, up to and including March 2020, in a single centre. We assessed the proportion of adult patients who underwent a CT within 24 hours.

Results

The data from 95 patients aged 19-82 years was analysed. We found that 37(38.9%) patients did not receive a CT scan within 24 hours. 16(17%) patients waited over 1 week for a CT KUB.

Conclusions

Our findings show a considerable proportion of patients who did not receive a CT within the first 24 hours of presenting with suspected renal/ureteric colic. This has led to plans for a formal clinical pathway to be established within out trust.
891 Fasting Times in Trauma List Patients
Authors: Gabriels S , Goru P , Haque S , Hayat M
Published: October 2021

Introduction

To reduce the risk of regurgitation and aspiration of gastric contents, patients are to fast before anaesthesia. However, prolonged periods of fasting have been found to be unnecessary and potentially harmful. Our aim was to compare pre-operative fasting times in trauma patients against the AAGBI (Association of Anaesthetists of Great Britain and Ireland) guidelines and highlight areas for improvement. The AAGBI recommends minimum fasting periods of:

Method

50 patients were audited in each cycle. Data were collected prospectively using questionnaires in the initial audit and by interviewing patients in the re-audit. Patients in ITU and those with dementia were excluded. Questions included fasting instructions given, time of the last meal and drink (including kind of drink), IV fluids administration. Anaesthetic notes were checked for time of induction of anaesthesia.

Results

Average time fasted for food was 17.09 hours and 9.32 hours for water. In the re-audit, average time fasted was 16.43 hours for food and 5.27 hours for water. All the patients received information as to when they could eat or drink until. None of them was told ‘midnight’.

Conclusions

Although there was an improvement, this was still beyond the guidelines. The results highlighted the importance of regularly reviewing the fasting status throughout the day in order to achieve the standard.
714 An Evaluation of The Discontinuation of Tamsulosin and Finasteride Post Transurethral Resection of The Prostate (TURP) At UHL
Authors: Bahri S , Malcomson B , Ball K , Bhrambhatt D , Beatty J
Published: October 2021

Aim

A significant proportion of men suffer from lower urinary tract symptoms (LUTS) secondary to prostatic enlargement. If medical management of BPH fails surgical transurethral resection of the prostate maybe required. The continuation of pharmacological therapy post operatively is redundant, however it was noted that several patients remained on these medications post TURP. The aim of this project was to identify if patients following surgical intervention were discontinued from preexisting medications that became redundant post operatively.

Method

A retrospective analysis was performed of patients who underwent TURPs between July- December 2019 within the University Hospitals of Leicester NHS trust to assess if patients preexisting medications used for the treatment of LUTS were discontinued post operatively.

Results

In the above time frame, 104 TURPs were performed in the trust. Out of these, 89 men were already on 5-alpha reductase inhibitors and/or alpha blocker, predominantly tamsulosin and finasteride. Of the 89 men, only 46 were given a clear instruction to stop these drugs on discharge.

Conclusions

Continuation of the above medication is unnecessary post TURPs with potentially avoidable side effects for patients and an unnecessary expense. A series of changes were implemented to improve practice. These will be reevaluated on the recommencement of TURPs following the covid-19 pandemic.
733 Long-Term Outcomes of Outpatient Laser Ablation for Recurrent Non-Muscle Invasive Bladder Cancer: A Retrospective Cohort Study
Authors: Grover S , Raj S , Russell B , Thomas K , Nair R , Thurairaja R , Khan M S , Malde S
Published: October 2021

Aim

Non-muscle-invasive bladder cancer (NMIBC) is the most prevalent form of bladder cancer, predominantly affecting the elderly population. The most common treatment for recurrent NMIBC is transurethral resection of the bladder tumour (TURBT), which carries a risk of perioperative morbidity and mortality in this often-co-morbid population. Outpatient laser ablation of low-grade NMIBC recurrences is a minimally invasive treatment option, but long-term efficacy is poorly reported.

Method

We retrospectively reviewed the case notes of all patients treated with Holmium:YAG laser ablation from 2008-2016. Data regarding patient demographics, original histology, dates of procedures, follow-up time, recurrence, progression, and complications were recorded.

Results

A total of 199 procedures were performed on 97 patients (mean age of 83.56), 73 (75.3%) of which originally had low-grade (G1 or G2) tumours. Overall, 55 (56.7%) patients developed tumour recurrence at long-term follow-up (mean 5.36 years), and only 9 (9.3%) patients had tumour progression to a higher stage or grade, but there was no progression to muscle-invasive disease. The median recurrence-free, progression-free and overall survival times were 1.69 years (95% CI 1.20-2.25), 5.70 years (95% CI 4.10-7.60) and 7.60 years (95% CI 4.90-8.70), respectively. No patients required emergency inpatient admission after laser ablation for any associated complications.

Conclusions

Office-based Holmium: YAG laser ablation is an oncologically-safe method of managing recurrent low-grade non-muscle-invasive bladder cancer in the long-term, with no patients progressing to muscle-invasive disease. Furthermore, the procedure is safe, and no significant complications were seen in this elderly and co-morbid population.
742 Transurethral LASER Ablation (TULA): A Safe and Well Tolerated Procedure for The Treatment of Bladder Tumours Up To 4cm In Diameter in An Outpatient Setting
Authors: Siddiqui Z , Morland L , Speakman S , Birley R , Hughes K
Published: October 2021

Aim

Traditionally the management of recurrent non-muscle invasive bladder cancer (NMIBC) involves rigid cystoscopy and bladder biopsies/tumour resection under general/regional anaesthesia. As a result, many frail patients endure frequent anaesthetics and therefore are at increased risk of adverse outcomes including cognitive decline. Discontinuation of anti-platelet/anti-coagulation is not required for TULA. An outpatient TULA service was recently started at our trust. We present a case series of our first 4 months data.

Method

All TULA cases (n = 39) performed between Aug-Dec 2020 were included. Data was gathered prospectively including patient demographics, co-morbidities, initial cancer diagnosis and number of subsequent recurrences, post-procedural complications, and patient procedural satisfaction.

Results

Median age was 82 years (range 34-96) and median number of co-morbidities were 4 (range 0-10). Previous bladder cancer diagnosis was present for 85% with the most common initial stage G2pTa (n = 11). Median number of recurrences was 1 (range 1-5). Median patient perceived pain score was 3 (range 1-7) with 100% of patients preferring TULA over TURBT. Reasons included reduced procedural time (n = 18) and enhanced recovery (n = 15). Only 1 patient was readmitted post-procedure due to haematuria, however urine was clear after catheterisation and the patient was discharged.

Conclusions

TULA is safe for all low risk NMIBC, particularly for frail patients. It is well tolerated and facilitates improved patient experience. It also alleviates demand on theatre capacity and inpatient beds which has a positive effect on surgical waiting lists. Further audit of clinical outcomes should continue as recommended by NICE.
746 Single-Centre Experience with Three Metallic Ureteric Stents (Allium URS, Memokath-051 and Resonance) for Chronic Ureteric Obstruction
Authors: Ho C , Palaniappan V , Ting A , Khoo C , Forster L , Kondjin-Smith M , Abboudi H , Hanna M , El-Husseiny T , Dasgupta R
Published: October 2021

Aim

To evaluate efficacy of Allium URS, Memokath 051 and Resonance metallic ureteric stents as an alternative to polymer stents/nephrostomy in managing chronic ureteric obstruction (CUO).

Method

Retrospective analysis of consecutive patients with CUO managed with Allium URS, Memokath-051 or Resonance (September 2015/July 2020). Baseline patient variables (age, gender, underlying aetiology, ASA) and stricture characteristics (length, level, continuity) were recorded. Intra- and post-operative clinical and radiological follow-up assessments at 6 weeks, 3 months and then every 6 months, as well as any emergency attendances, were reviewed for placement success, stent complications, serum creatinine, and mortality. Outcomes included placement success rate, functional stent survival, and mean renal function.

Results

Overall, 129 stent insertion episodes (SIEs) (Allium URS: 23, Memokath 051: 48, Resonance: 58) occurred in 76 patients (Allium URS: 16; Memokath-051: 31; Resonance: 29). Placement success was high (Allium URS: 95.7%; Memokath-051 and Resonance: both 100%). Median functional stent survival was 11.4 months for Allium URS, 5.5 months for Memokath-051 and 11.7 months for Resonance. 47.8% of Allium URS SIEs (11/23), 64.6% of Memokath-051 SIEs (31/48) and 19% of Resonance SIEs (11/58) experienced complication (most frequently obstruction followed by migration and infection). There were no complications for Resonance SIEs for benign indication. In the first year following SIE, serum creatinine ranged from +21.3% to + 46.7% for Allium URS, -7.8% to + 8.9% for Memokath-051, and -9.4% to + 27.3% for Resonance.

Conclusions

Allium URS, Memokath 051 and Resonance metallic ureteric stents are all viable management options of CUO. Resonance was particularly efficacious for patients with benign aetiology.
884 Improving the Analgesia Prescribing Compliance to NICE Guidelines (NG118) In Suspected Renal Colic Patients Using a Proforma
Authors: Marques S D B , Cheah W , Smith C , Kailasa A , Alexandrou K
Published: October 2021

Aim

To improve analgesia prescribing for patients admitted with suspected renal colic in line with NICE guidelines (NG118) in an acute district general hospital using a proforma.

Method

In the first cycle, a retrospective review of 16 patients who presented with renal colic to the emergency department or surgical assessment unit was performed and the analgesia prescribing was recorded. A unique analgesia prescribing proforma was then developed using NICE guidelines (NG118) including the use of NSAIDS as first-line when there are no contra-indications, intravenous paracetamol, opioid analgesics and omitting antispasmodics. Following implementation of the proforma, a prospective review of 18 patients were included in the second cycle and the prescribing compliance were compared.

Results

Study included 34 patients who presented with suspected renal colic over a 3-month period. In the first cycle, 19% of patients had appropriate analgesia prescribed which were compliant with NICE guidelines. In cycle 2, 89% of patients had appropriate analgesia prescribed. In particular, the inappropriate prescription of antispasmodics has improved significantly (38 % in cycle 1 vs 0 % in cycle 2).

Conclusions

A proforma can serve as a useful ‘checklist’ for analgesia prescribing and improve the symptomatic relief for patients presenting with suspected renal colic in line with NICE quality standards.
1202 Urinary Continence and Oncological Outcomes in Robotic-Assisted Radical Prostatectomy Patients According to Nerve Spare Technique
Authors: Ghazal-Aswad K , Kum F , Brown C
Published: October 2021

Aim

To assess the effects of nerve sparing (NS) on recovery of urinary continence, oncological outcome, and positive surgical margin (PSM) rates in patients undergoing robotic-assisted radical prostatectomy (RARP).

Method

Retrospective analysis of patients who underwent RARP between January-December 2017 at a single high- volume centre was undertaken. Urinary continence and symptoms according to different NS types (Non-NS, Unilateral, Bilateral) at 2, 6, 12, and 24 months were collated. COX proportional hazards model and Kaplan-Meier were used to correlate NS type with achievement of a dry-state; pad-free state; and oncological outcome defined by biochemical (PSA) recurrence (BCR), over 2 years follow-up. PSM occurrence was compared in non-nerve spared versus nerve spared prostate lobes.

Results

241 patients underwent full analysis, Non-NS = 30 (12%), Unilateral = 84 (35%), Bilateral = 127 (53%). Comparing each NS cohort, there was no significant difference in the Mean (±SD) number of pads used per day, or rates-of-dryness at all time points during follow-up. Both COX-regression and Kaplan-Meier analyses found no significant association between any NS-type and biochemical recurrence or final achievement of continence. There was no significant risk association between NS-type and PSM rate, or significant difference in the rate of PSM between lobes that were nerve spared or not.

Conclusions

The degree of nerve sparing does not appear to enhance post-RARP continence recovery and is not associated with worse oncological outcomes, studied as positive surgical margin rates and biochemical recurrence at all time points up to 2 years of follow-up.
1299 Observational Study of The Use of Spinal Anaesthesia As an Alternative to General Anaesthetic For Ureteroscopy During The COVID-19 Pandemic
Authors: Longshaw A , Gallagher W , Dickinson A
Published: October 2021

Introduction

General anaesthetic has traditionally been felt to be more appropriate than spinal anaesthesia for patients undergoing ureteroscopy as it is difficult to achieve a suitably high block. During the COVID-19 pandemic, our centre moved elective operating to an alternative day-case surgical environment where the anaesthetic team performed predominantly spinal anaesthesia and were therefore very experienced with this modality. In view of concerns of COVID-19 transmission by aerosolisation during the intubation and extubation phases of general anaesthetic, spinal anaesthesia as an alternative first line modality was trialled with the option of converting to general anaesthesia if surgery could not be achieved safely and comfortably for the patient.

Method

During a three-month period, unless contraindicated, spinal anaesthesia was used as the first line anaesthetic for ureteroscopy cases. A retrospective study of outcomes was then undertaken.

Results

44 patients were treated with a conversion rate to general anaesthetic of 9% (n = 4). There was a complication rate of 20% (n = 9); 4 partial procedures, 4 readmissions with symptomatic residual fragments or sepsis and 1 patient required post-operative overnight stay due to anaesthetic. Spinal anaesthetic time averaged 25minutes.

Conclusions

The global COVID-19 pandemic has led to change in practice and we have demonstrated that spinal anaesthesia is a valuable alternative to general anaesthetic in the majority of ureteroscopy cases. When undertaken by an experienced anaesthetic team, using this method does not significantly add to procedure time.
1473 Urology Consent Forms at a District General Hospital – a Quality Improvement Project
Authors: Bernstein D , West A , Preston E , Premakumaran P , Suleyman N , Undre S
Published: October 2021

Aim

Consent is a core component of interaction between patients and healthcare professionals. Prior to surgery, forms are completed to record patient consent. As well as containing risks and benefits of the procedure, the consent form, as per guidelines1,2, must be legible and suitable to a patient’s capacity. To evaluate compliance with local and national guidelines, a quality improvement project was undertaken at a district general hospital.

Method

Over a three-week period 30 urology consent forms were selected to assess adherence to local and national guidelines. The appropriateness of consent form, patient signature, legibility, acronym use and whether the patient was offered a carbon copy were assessed. After initial data collection, all urology staff consenting patients were notified of the findings and how best to improve guideline adherence. A further three-week data collection was undertaken, though the sample set was small due to Coronavirus and Christmas.

Results

The results confirmed that patients had appropriate consent forms filled out and were signed appropriately. After intervention, there was clear improvement in legibility, with no low legibility consent forms, and 100% vs 83% high or moderate legibility between data sets. Intervention also resulted in significant reduction of acronym use; 33% vs 60%. More patients were also offered to retain a carbon copy; 89% vs 40%.

Conclusions

Through this intervention of highlighting local and national guidance as compared to current practice, compliance drastically improved. As the pandemic subsides, we hope regular emails to surgical teams will improve consent form completion to better patient care.
1532 Strict Trifecta Outcomes of Robotic-Assisted Partial Nephrectomy inT1a and T1b Renal Tumours
Authors: Abdalla O , Alzouebi I , Kumar M , Nambi Rajan T
Published: October 2021

Aim

To evaluate and compare strict Trifecta outcomes of robotic assisted partial nephrectomy (RAPN) in patients with T1a and T1b renal tumours.

Method

A retrospective analysis of 146 consecutive patients undergoing a robotic assisted partial nephrectomy for T1a and T1b renal tumours from 2014-2019. Patient demographics, tumour characteristics, strict trifecta measures including warm ischaemia time, minimal renal function change (≤15% postoperative eGFR decrease), complications, and surgical margin positivity were collected, as well as intra-operative and oncological outcomes.

Results

In total 146 patients underwent RAPN. 113 patients had T1a tumours, 30 had T1b with a mean tumour size of 2.5cm (0.8-3.9cm) and 4.5cm (4.1-7cm) respectively, and 3 patients had T2a tumours. The nephrometry score was higher in stage T1b patients, however all other variables were similar between the two stage groups. Overall strict Trifecta was 75.5% with 77.9% in T1a group compared to 66.7% in T1b group (p = 0.21). Postoperative renal function was preserved in 102 patients in T1a vs 26 patients in T1b. Approximately 9 patients with T1a had positive surgical margin compared to 3 patients in T1b cohort. Post-operatively 3 patients in T1b (10%) group developed a Clavien Dindo score of 3 complications, compared to none in the T1a group (p 0.009). These were due to pseudoaneurysm and bleeding. No statistical difference in Fuhrman score and tumour types in the two groups. No cancer recurrences were observed during the 30 months follow up period in both T1a and T1b groups.

Conclusions

RAPN is a feasible treatment choice in selected T1b renal tumours.
190 Evaluating the Management of Cephalic Arch Stenosis in A North London Hospital
Authors: Hammad A , Al Midani A
Published: October 2021

Aim

Brachiocephalic fistulas (BCFs) are the most commonly used arteriovenous fistulas (AVFs). They are commonly associated with cephalic arch stenosis (CAS), a leading cause of dysfunction and failure. The 2018 European Society of Vascular Surgery guidelines recommend the consideration of stent grafts for managing CAS. In this study, we sought to evaluate the management of CAS in a North London hospital.

Method

We carried out a retrospective study of patients who had undergone a fistulogram/fistuloplasty for CAS between May 2014 and May 2020. We extracted demographic data, information about their access, and information regarding surgical management of CAS, from the patients’ records on VitalData. We extracted data about recurrence of CAS from their Cerner records.

Results

Seventy patients were included. 54.3% were still alive at the time of data collection. The average age of those still alive was 65.8±14.1 years. 78.6% had a left BCF. 66% had previous access. 4.29% underwent stenting for CAS. The rest had fistulopasties alone. 90% required multiple fistulopaslties (mean=3.44±1.51). Median interval between access creation and first fistuloplasty was 1.90 years. 34.3% of patients underwent surgical repair of their AVF. AVF failure rate was 34.3%. Median interval between access creation and failure was 3.05 years. Median interval between first fistuloplasty and access failure was 1.34 years.

Conclusions

Our data demonstrate a high rate of access failure in patients with CAS treated at our centre. Few of our patients had stent grafts inserted. The majority had fistuloplasties without stenting, which was associated with a high recurrence rate.
488 An Evaluation of Pain Related Outcomes Following Nerve Sheath Catheter Insertion after Major Lower Limb Amputations
Authors: Vincenti C , Bhattacharya V , Kansal N
Published: October 2021

Aim

Limb amputations have many post-op complications, including pain. The evidence supporting the use of nerve sheath catheters (NSC) to manage post-op pain is mixed. Current literature suggests NSC reduces post-op opioid requirements but does not reduce pain score, phantom limb pain or chronic stump pain. This study compared post-op pain in those with and without NSC after above knee amputations (AKA) and below knee amputations (BKA).

Method

Retrospective data from April 2014 – March 2017 was reviewed. Information regarding indication, anaesthetic, morphine requirement at 72 hours, phantom limb, chronic limb pain and a pain scale (1-10) at 24, 48 and 72 hours were collected.

Results

32 patients were involved in the study. 11 had NSC for pain control. Of those patients without NSC, 43% experienced no pain. In comparison, 33% of those with NSC experienced no post-op pain. Phantom limb pain was experienced in a higher proportion of patients with NSC (18%) and in those with AKA (11%). 18% of patients with NSC experienced chronic limb pain, compared to 33% without NSC. 62% of patients with NSC required morphine at 72 hours and at higher dosages compared to those without. However, two patients used large amounts of morphine potentially giving spurious results.

Conclusions

Though limited by small patient group, patients with NSC were more likely to require morphine at 72 hours and at higher dosages but were less likely to experience chronic limb pain thus proving the role of NSC in post-op pain control.
652 Fate of The Contralateral Limb Following Major Lower Limb Amputation in Patients with Peripheral Arterial Disease And/Or Diabetes: Case Series from Two Regional Vascular Centres
Authors: Siddle H , Bonner R , Leighton P , McGinnis E , Rahma S , Stubbs N , Hinchcliff R , Wright-Hughes A , Nixon J , Richards S , Russell D
Published: October 2021

Introduction

This is the first clinical case series to report time to ulceration, minor and major amputation of the contralateral limb (CLL) in the first 12 months following major lower limb amputation (LLA) in patients with peripheral arterial disease (PAD) and/or diabetes.

Method

Consecutive patient samples at two regional UK vascular centres were included; from 2010 to 2017 (site 1) and 2014 to 2016 (site 2). Data were extracted from electronic records for 12 months following index major LLA. Survival analyses are presented for the event of mortality in the total study population, plus major amputation-free survival, and complication-free survival in site 1 only; results are stratified by diabetes status.

Results

Of 381 patients reviewed (n = 197 site 1; n = 184 site 2), 208 (54.6%) were diagnosed with diabetes at the time of their index major LLA. The mean survival time of patients was lower in those without diabetes (HR: 0.64 [95% CI, 0.43 to 0.95], p=.03). The mean time to major amputation of the CLL or death in patients was lower in those without diabetes (HR: 0.65 [95% CI, 224 0.40 to 1.06]; p=.08). The median time to any complication of the CLL or death was greater in those without diabetes (HR: 1.25 [95% CI, 227 0.88 to 1.78]; p=.21).

Conclusions

Death rates were higher in patients without diabetes, whilst those with diabetes had high levels of CLL complications. Optimisation of care to protect the CLL following major LLA and guidance for carers, patients, and clinicians is required.
926 Evaluating VTE Prophylaxis in Nephrectomy in Two Merseyside Hospitals
Authors: Farmer T , Calmuc A , Wong K , Starmer B , Venugopal S
Published: October 2021

Aim

The primary aim was to review current venous thromboembolism (VTE) prophylaxis prescribing against national and European guidelines at two hospitals in northwest England. A secondary aim was to standardise VTE prescribing practices.

Method

3 standards were identified (NICE, BAUS and EUA) for VTE prophylaxis in nephrectomy. All simple and radical nephrectomies and nephroureterectomies were included. Open and laparoscopic cases were included. Data was collected from Royal Liverpool University Hospital (RLUH) and Arrowe Park Hospital (APH). Cases from surgical diaries between January 2019 to January 2020 were identified and compared to the 3 standards. 49 cases were identified at RLUH and 83 at APH

Results

At APH, 77/83 (92.7%) cases received inpatient LMWH. The remaining 6 were already on a DOAC. 98.7% received inpatient mechanical VTE prophylaxis. 85.5% of patients received extended VTE prophylaxis with no documented indication, and only 20% of open nephrectomies received 28 days LMWH. At RLUH 44/49 cases (89.7%) received inpatient LMWH. All 5 patients who did not had a documented reason why. 100% of inpatients at received inpatient mechanical VTE prophylaxis. 4 patients underwent open nephrectomy, however none of these received 28-day extended LMWH prophylaxis.

Conclusions

Comparing guidelines with local data reveals that prescribing practice for both in- and outpatient LMWH is variable and often is based on personal preferences. The above results have been presented locally at each institution and practice standardised with re-audit ongoing.
1031 A Mixed Methods Feasibility Study of Extracorporeal Shockwave Therapy for Diabetic Foot Ulcers
Authors: Hitchman L , Totty J , Lathan R , Sidapra M , Smith G , Carradice D , Chetter I
Published: October 2021

Aim

The purpose of this mixed methods feasibility study was to assess the feasibility of delivering ESWT to patients with DFUs. It also aimed to explore any potential clinical effect of ESWT on wound healing and investigate whether ESWT may offer any patient reported benefits.

Method

A single centre mixed methods feasibility study. Patients with a DFU who met the eligibility criteria underwent ESWT 3 times in over 7 days. Primary outcome was feasibility of delivering the intervention. Secondary outcomes included wound size, number of DFU healed at 12 weeks and quality of life. Semi-structured interviews explored participants experience of undergoing ESWT.

Results

22.6% (24/106) of patients screened were recruited. The mean attendance to clinic was 90.9% and 65.1% to follow up. The mean score for acceptability and tolerability was 9.86 (SD 0.48, 95% CI 9.62-10.01) and 9.15 (SD 2.57, 95% CI 7.87-10.42) respectively. There were no serious adverse events or side effects. 45.5% of DFU healed during follow up and quality of life scores improved until 8 weeks. Key themes identified from the qualitative interviews were desire for the fast healing, improved quality of life, new treatments must be flexible and accessible on transport.

Conclusions

This study has shown it is possible to recruit and retain patents into this research. This study supports development of a large randomised control trial to determine the clinical and cost effectiveness of ESWT for DFU healing.
1430 Mid-Term Outcomes After Endovascular Repair of Popliteal Artery Aneurysms Demonstrate Satisfactory Patency Rates and Safety of Stent-Grafts
Authors: Stupalkowska W , Badawy A , Chaudhuri A
Published: October 2021

Aim

Popliteal artery aneurysms (PAAs) are increasingly treated via an endovascular approach. We present mid-term outcomes of popliteal endovascular aneurysm repair (PEVAR) from a single centre.

Method

A retrospective analysis of a prospective database of consecutive patients who underwent either elective or emergency PEVAR in a single regional vascular centre from January 2010 to August 2020. The patients underwent placement of a heparin-bonded stent-graft (Viabahn Endoprosthesis, WL Gore and Associates, Flagstaff, USA) for PAA >20mm or complications: thromboembolism, rupture or popliteal vein thrombosis. Patency and stent-graft related complications were assessed.

Results

A total of 64 PAAs (mean size 36.8±13.4mm) were treated in 56 patients (mean age 75±10.7 years, 54 (96%) male). Median follow-up was 29.5 months (IQR 36.75). 30-day mortality was 0%. Technical success rate of stent-graft insertion was 100%. 1-year and 5-year primary patency was 83% and 67% respectively; primary-assisted patency at these time points was 86% and 72%, and the corresponding secondary patency was 89% and 75%. 61 out of 64 treated limbs had >1 vessel runoff. The most frequently occurring complication was stent-graft occlusion which affected 11 (17%) limbs. Stent-graft fracture occurred in 1 patient, resulting in endoleak.

Conclusions

Viabahn Endoprosthesis can be used successfully in treatment of PAA with acceptable short- and mid-term patency rates. One in five patients in this cohort required a reintervention, with most complications occurring in the first year postoperatively. Stent-graft fracture occurred only in one patient demonstrating that PEVAR is a safe option for PAA management in the intermediate term.
935 Identification and Management of Electrolyte Abnormalities in Surgical Patients Requiring Total Parenteral Nutrition: An Audit of Current Practice at A University Hospital
Authors: Thorpe C , Liokati I , Boyle E , Mohan H , Bates N , Martin S , Kennelly R , Hanly A , Winter D , Carrington E V
Published: October 2021

Aim

Electrolyte abnormalities are a common and serious consequence of nutritional deficiencies when patients are nil-by-mouth. Timely intervention with a multidisciplinary approach is known to improve outcome. This audit aimed to assess adequacy of initial electrolyte management and timing of dietetics referral in acute surgical patients requiring total parenteral nutrition in a university hospital.

Method

A retrospective audit of all general surgery patients referred to dietetics for total parenteral nutrition between January-December 2019 was performed. The following audit standards (from the time following admission) were applied: monitoring of electrolytes every 48-hours, treatment of electrolyte abnormalities within 24-hours of discovery; and referral to the dietetics service within 48-hours of nil-by-mouth being commenced.

Results

Data from 52 patients (27 females, median age 66) were analysed. Fifty-one (98%) had electrolytes measured every 48-hours, however magnesium, phosphate and/or calcium were not measured prior to dietetics input in 9 (17%). Forty electrolyte abnormalities requiring treatment were found in 28 patients (54%), though only 18 (64%) commenced treatment within 24-hours. The most common electrolyte abnormalities not corrected within 24-hours were phosphate and calcium (50%). 46% of patients were referred to dietetics after 48-hours of nil-by-mouth status.

Conclusions

In our unit, we found that basic electrolytes were frequently monitored in patients placed nil-by-mouth, however calcium, phosphate and magnesium were often omitted prior to dietetics input, and correction of abnormalities was sometimes delayed. Introduction of a local protocol-based approach for electrolyte monitoring with streamlined dietetics referrals is likely to improve adherence to best practice.
187 A Rare Case of Colovesical Fistula in A Patient with Situs Inversus
Authors: Ben Hmida R , Sheikh O
Published: October 2021

A 47 year old man with no past medical history presented to the urology clinic with recurrent urinary tract infections caused by E.Coli. He subsequently had a number of investigations including imaging and cystoscopy which showed a high possibility for a colovesical fistula and incidentally demonstrated subdiaphragmatic Situs inversus. The sigmoid colon was inflamed and adherent to the posterior wall of the bladder.

Surgical management following a multi-disciplinary decision resulted in an elective Ureteric stent insertion followed by laparotomy with sigmoid colectomy and primary anastomosis. The bladder wall defect caused by fistula formation was repaired.

We report an extremely rare case of colovesical fistula in the setting of subdiaphragmatic situs inversus in a relatively young patient.

This would likely be seen in older patients with more severe diverticulitis and usually in an acute setting. Anatomical variation resulted in more severe diverticular disease and predisposed to fistula formation.
735 An Unusual Case of Cervical Potts Disease in A Pediatric Patient
Authors: Pandya B , Shogan A
Published: October 2021

Pott’s disease is a form of extrapulmonary tuberculosis (TB) affecting the spine. Approximately 10% of individuals with extrapulmonary TB will have skeletal manifestations with the most common area affected being the spine, followed by the hip and knee. Within the spine, Pott’s disease has a predilection for affecting the thoraco-lumbar region, with the cervical spine being the least affected. Here, we report a case of cervical Pott’s disease in a 16-year-old child, with no risk factors for TB, presenting with neck pain and stiffness. Initial blood results were unremarkable, but a CT scan showed a C5 vertebral body fracture and mild canal stenosis. A sagittal MRI scan demonstrated canal stenosis and a pathologic compression fracture of the C5 vertebrae, a soft tissue mass extending into the epidural and prevertebral spaces and associated cervical cord compression. A trans-oral biopsy confirmed TB and a diagnosis of Pott’s disease. She underwent HALO placement and needed further fusion surgery. She was started on anti-tuberculous therapy and made a good recovery post-operatively.
1658 Duodenal Stricture Secondary to Chronic Pancreatitis; A Case Report
Authors: Heer B
Published: October 2021

The complications of chronic pancreatitis are well established; however, the incidence of duodenal strictures in the context of previous necrotising pancreas is uncommon.

I herein report the case of a 30-year Caucasian woman who presents with reduced oral intake, vomiting and profound cachexia. Medical history of note includes necrotising pancreatitis and umbilical hernia repair. Computed tomography scan revealed multiple cystic collections in the anterior pararenal space. Oesophagogastroduodenoscopy (OGD) revealed a duodenal stricture, which was histologically benign. Endoscopic insertion of a percutaneous jejunostomy (PEJ) unfortunately failed.

Upon counselling with the patient, the decision was made to perform a laparotomy with loop gastrojejunostomy and jejunostomy tube insertion. The patient was subsequently able to be fed, initially with the aid of dieticians, and trained for independent care at home.

This case highlights the uncommon complication of duodenal stricture in the context of chronic pancreatitis, and the importance of timely diagnosis and management.
1423 Quality and Efficacy of Multidisciplinary Team (MDT) Discussion Quality Assessment Tools and Checklists: A Systematic Review
Authors: Brown G , Young A , Rymell R
Published: October 2021

Aim

MDT discussion is the gold standard for cancer care in the UK. With the cancer incidence and complexity of treatments both increasing, demand for MDT discussion is growing. The need for efficiency, whilst maintaining high standards, is therefore clear. Paper-based MDT quality assessment tools and discussion checklists may represent a practical method of monitoring and improving MDT practice. This review aims to describe and appraise these tools, as well as consider their value to quality improvement.

Method

MEDLINE, Embase and PsycInfo were searched using pre-defined terms. PRISMA methodology was followed throughout. Studies were included if they described the development of a relevant tool/checklist, or if an element of the methodology further informed tool quality assessment. To investigate efficacy, studies using a tool as a method of quality improvement in MDT practice were also included. Study quality was appraised using the COSMIN risk of bias checklist or the Newcastle-Ottawa scale, depending on study type.

Results

The search returned 6888 results. 17 studies were included, and 6 different tools were identified. Overall, methodological quality in tool development was adequate to very good for assessed aspects of validity and reliability. Clinician feedback was positive. In one study, the introduction of a discussion checklist improved MDT ability to reach a decision from 82.2% to 92.7%. Improvement was also noted in the quality of information presented and the quality of teamwork.

Conclusions

Several tools for assessing and guiding MDT discussions are available. Although limited, current evidence indicates sufficient rigour in their development and their potential for quality improvement.
A welfare analysis of Norway’s export promotion programme for whitefish
Authors: Kinnucan Henry W , Das Abhipsita , Pettersen Ingrid Kristine
Published: October 2021

Norway recently increased the effective levy used to fund its export promotion programme for whitefish by 21 per cent. Study results suggest the intensified programme is welfare increasing. The net social gain, defined as the difference between the increase in economic surplus associated with the increased advertising and the decrease in economic surplus associated with the increased effective levy, is estimated at between $20 million and $136 million per year, for a best-bet estimate $60 million. The associated benefit–cost ratio (BCR), defined as the ratio of the aforementioned changes in economic surplus, is estimated at between 11 and 71, for a best-bet estimate of 32. The BCR is invariant to the supply elasticity. The invariance property is useful as it implies that the BCR can be estimated using strictly demand-side information; there is no need to estimate the supply side of the market. The current levy of 0.75 per cent appears to be well below the levy that would maximise producer welfare.