bluuebunny/crossref_metadata_2025_split huggingface dataset:
1048 Patient and Clinician Satisfaction with Urology Telephone Consultations During the Covid-19 Pandemic
Authors: Colemeadow J , Pandian S K 
Published: October 2021

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

Introduction
Upper tract urothelial carcinomas (UTUC) account for 5-10% of urothelial malignancies. Rapid diagnosis is essential as 60% are invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines recommend CT urography (CTU) for initial diagnosis and staging of UTUCs. Diagnostic ureteroscopy (URS) is used second line where diagnosis is unclear. The COVID-19 pandemic has limited theatre access and may delay diagnosis of suspected UTUC. Our aim was to evaluate specific CTU findings in predicting UTUC to aid prompt diagnosis and risk stratification in a tertiary centre.

Method
A retrospective analysis was performed on 122 patients who underwent CTU with diagnostic URS over two years from 2018-2019 for possible UTUC. Data including demographics, imaging and histology were collected from our electronic database.

Results
57 patients had confirmed UTUC, all had CT changes. CTU had an overall positive predictive value (PPV) of 45%. CT findings were divided into: hydronephrosis; filling defect/lesion; urothelial thickening; normal; or other. The PPV was highest for filling defects/lesions at 60%, hydronephrosis was 38%, urothelial thickening was 30%, and other was 33%. Of those with high-grade histology, 61% had evidence of filling defects/lesions and 24% had hydronephrosis.

Conclusions
A specific CTU finding of filling defect/lesion in combination with cytology can aid diagnosis and risk stratification of UTUC. This may enable us to reduce use of diagnostic URS, as well as associated risks of intravesical seeding, necessary in the COVID-19 pandemic. With other CTU findings of hydronephrosis or urothelial thickening, a diagnostic URS may be required.
1234 Emergency Urology Procedures During COVID-19 Pandemic: A 2 Monthly Prospective Study
Authors: Georgiou M , Ridzuan-Allen A , Chamsin A , Tolofari S , Ejikeme C , Jones R , Siddiqui Z , Napier-Hemy T , Rotas S , Hughes K E , Khattak A Q , McCabe J E , Omar A M , Mistry R , Samsudin A , Gana H.BY , Floyd M.S. 
Published: October 2021

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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