bluuebunny/crossref_metadata_2025_split huggingface dataset:
219 Have New National Guidelines Changed Practice in Referrals with Suspected Ureteric Colic?
Authors: Boyle C , Young J 
Published: October 2021

Abstract

Aim
To assess how many patients had a non-contrast CT as first-line investigation for suspected renal colic, and how this was affected by the release of the 2019 NICE guidelines. A secondary aim was to assess the proportion of patients who had CT KUBs that demonstrated a ureteric calculus.

Method
CT KUB scans performed over two separate 3 month periods were identified. These reflected periods of time before and after the new NICE guidelines. Electronic records were used to assess if the patients had an ultrasound performed as the initial diagnostic investigation, instead of a CT scan. The results of the scans were reviewed to identify if a ureteric or renal calculus had been positively identified.

Results
In the period before the new guidelines, 61 patients were scanned. 4 had an ultrasound to assess for a stone prior to a CT. All of these patients were medical inpatients. None of the ultrasounds diagnosed a stone. 22/61 patients had CT-proven stones (36%) In the period after the new guidelines, 79 patients were scanned. 12 had an ultrasound to assess for a stone prior to a CT. 8 were medical patients, 3 were surgical and 1 was gynaecological. 1 ultrasound diagnosed a stone. 28/79 patients had CT-proven stones (35.4%)

Conclusions
The release of new guidelines did not improved compliance with suggested imaging pathways. This clearly demonstrates an area for improvement. It is also worth noting that only 1/3 of referrals with suspected renal colic did actually have a stone, which has implications for specialty referral pathways.
323 Association of Increased Body Mass Index and Waist to Hip Ratio with Kidney Stone Disease: a Prospective Analysis of 493,410 UK Biobank participants
Authors: Lovegrove C , Littlejohns T , Allen N , Howles S , Turney B 
Published: October 2021

Abstract

Aim
To investigate the relationship between measures of adiposity and risk of incident kidney stone disease.

Method
The UK Biobank is a prospective cohort study of ∼500,000 participants whose height, weight, BMI, waist circumference, hip circumference, waist:hip ratio (WHR), total fat mass, fat-free mass, body-fat percentage, and percentage truncal fat were measured at enrolment with linkage to medical records. ICD-10 and OPCS codes identified individuals with a new diagnosis of nephrolithiasis from 2006-2010. Individuals with a history of kidney stones or incomplete data were excluded. Multivariate Cox-proportional hazard models were used to assess associations between anthropometric measures and incident kidney stones.

Results
From the UK Biobank, 493,410 individuals were identified for inclusion; 3,466 developed a kidney stone during the study period. Increasing weight, BMI, waist, and hip circumferences, WHR, and body and truncal fat were all associated with increased risk of incident kidney stone disease. However, after adjustment for BMI, only waist circumference and WHR remained significantly associated with risk of nephrolithiasis. In overweight patients, high (men 94-102cm, women 80-88cm) waist circumference or WHR (men &gt;0.9, women &gt;0.85) conferred &gt;40% increased risk of stone formation.

Conclusions
This study indicates that android fat distribution is independently associated with increased risk of developing nephrolithiasis. Kidney stone disease is known to be associated with hypertension, cardiovascular disease, and diabetes, all of which have been linked to android body shape. Our findings provide insight into anthropometric risk factors for stone disease, will facilitate identification of patients at greatest risk of stone recurrence, and will inform prevention strategies.
364 The Cycling Urologist: Effect on PSA, Haematuria, Pudendal Nerve Entrapment and Cyclists Nodules
Authors: Peacock J , Cobley J , Patel B 
Published: October 2021

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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

Abstract

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.