bluuebunny/crossref_metadata_2025_split huggingface dataset:
1291 Is the Trauma Meeting a Thing of the Past?
Authors: Chow V , Butler K 
Published: August 2023

Abstract

Aim
This study explores the educational value of traditional trauma meetings and provides a unique solution to maximising the scholastic value for non-essential juniors.
In October 2022, surgical trainee-led small group teaching sessions were initiated twice a week in place of the traditional trauma meetings. For the other three days, trauma meetings were attended. The objective was to provide frequent teaching of orthopaedics for non-essential junior doctors via trauma meeting simulations but with smaller chunks of useful content and in a more relatable, slower paced, and approachable environment.

Method
A 6-item feedback form with Likert scales and free text responses was filled out after each teaching session from October to November 2022. Understanding of orthopaedic topics prior to these sessions and after were evaluated as well as confidence in their clinical roles.

Results
Twenty feedback responses were recorded and analysed. An improvement from 30% to 80% in their understanding of orthopaedic content was seen after teaching, along with an average rating of 80% for application of knowledge to their clinical work and an average rating of 75% was given to confidence and understanding of discussions in subsequent trauma meetings.

Conclusions
This study reveals the educational limitations gained in trauma meetings for non-essential juniors and aims to optimise learning by introducing a more approachable ‘alternative trauma meeting’. Making knowledge more accessible cultivates insight and interest and increases clinical confidence. This implementation also provides teaching experiences for registrars and core trainees as well as encourages team building between trainees and non-essential juniors.
1310 Association of Anterior Knee Pain in Suprapatellar vs Infrapatellar Tibial Nailing Techniques. a Retrospective Cohort Study
Authors: Waqas Ilyas M , Amer A Sh , Al-Kharouf K , Alaraj M , Vakil H , Zohaib S , Mitchell C 
Published: August 2023

Abstract

Aim
To assess whether there is a statistically significant difference between the incidence of anterior knee pain in supra-patellar vs infra-patellar tibial nailing techniques.

Method
Data were collected from a single major trauma Centre in the UK and included all patients with tibial fractures who underwent fixation using IM nail. Out of 312 patients identified, 206 were included in the final data set who fulfilled the inclusion criteria. Patients were divided into two cohorts: “Suprapatellar Nailing” and “Infrapatellar Nailing”, and clinical follow-up records were looked at thoroughly to identify the incidence of anterior knee pain. Statistical analysis was performed to test the null hypothesis, i.e., “Documented anterior knee pain is higher in infrapatellar nailing vs suprapatellar nailing”.

Results
Of 206 patients, 140 were males, and 66 were females, with a mean age of 43 years (Range 16-91). 60.2% (n = 124) were treated with infrapatellar nailing compared to suprapatellar nailing 39.8% (n = 82). Anterior knee pain was reported in 14.2% (n = 17) of the infrapatellar cohort compared to 14.6% (n = 12) in the suprapatellar cohort. The Chi-square statistic with yates’ correction is 0.0124, with a p-value of 0.91. The result is not significant (p &gt; 0.05).

Conclusions
The mean incidence of anterior knee pain in both cohorts is 14.4 % on the literature's lower spectrum of reported results. We acknowledge that the sample size needed to attain statistical significance is enormous; our study results suggest no significant difference in the incidence of anterior knee pain in infrapatellar vs suprapatellar nailing techniques and can give uncertain outcomes in well-trained hands.
140 Five Year Single-Unit Experience and Outcomes of Renal Decompression for Ureteral Obstruction: A Retrospective Analysis of 102 Kidney Units
Authors: Rahman K , Abdulmajed M 
Published: August 2023

Abstract

Aim
Renal decompression following ureteral obstruction is a common urological emergency. Malignant obstruction patients often have poor life-expectancy, and the impact of decompression on survival is questionable [1]. We herein review outcomes of ureteral obstruction management in a single unit.

Method
Records of nephrostomy requests in Ysbyty Gwynedd between January 2017 and December 2021 were retrospectively reviewed. Information on patient demographics, primary pathology, performance status (PS), change in renal function and outcomes were recorded.

Results
Over 60 months, 102 nephrostomies were performed. Benign obstructions constituted 30.4% (n = 31) of cases. Of 71 cancer cases, 9 were re-insertions due to complications. Cancer group was associated with high and early deaths (11.3%, 64.5% and 85.5% at 3, 12 and 60 months, respectively) with only 1 in 5 kidney units illustrating improvement in renal function following decompression. All cancer patients were frail, with performance status of 2 (63%) and 3 (37%). Following nephrostomy insertion, 69.3% of kidney units developed urinary infection and/or sepsis requiring treatment. Only about 1 in 2 (53%) cancer patients received further oncological treatment (chemo- and /or radiotherapy). Though ante grade ureteric stenting was attempted in 23 kidney units following nephrostomy insertion for cancer, only 21 were successful and 2 of those blocked within 14 days.

Conclusions
Decompression of malignant ureteral obstruction may not improve survival and can involve multiple interventions with quality-of-life implication. Hence, the decision to decompress should not be the default and would therefore need to be individualized, adopting a multidisciplinary approach.
324 The Learning Curves of Major Laparoscopic and Robotic Procedures in Urology: A Systematic Review
Authors: Chahal B , Aydin A , Amin M S A , Khan A , Khan M S , Ahmed K , Dasgupta P 
Published: August 2023

Abstract

Aim
Urology has been at the forefront of adopting laparoscopic and robot-assisted techniques to improve patient outcomes. Defining the learning curves for these procedures enables assessment of trainee performances relative to expected progress and has important implications in research. This systematic review aimed to examine the literature relating to the learning curves of major urological robotic and laparoscopic procedures.

Method
In accordance with PRISMA guidelines, a systematic literature search strategy was employed across PubMed, EMBASE, and the Cochrane Library from inception to December 2021 for eligible studies alongside a search of the grey literature. Two independent reviewers completed the article screening and data extraction stages, using the Newcastle-Ottawa Scale (NOS) to then undertake quality assessment of the included articles. The review was reported in accordance with AMSTAR guidelines.

Results
Of 3702 records identified, 97 eligible studies were included for narrative synthesis. 39 studies evaluated robot-assisted laparoscopic prostatectomy (RALP) with the learning curve identified as 10-250 cases for operative time and 250-300 for potency. The shortest learning curve was reported for hand-assisted laparoscopic nephrectomy, involving 4-10 cases. There was considerable variation in the study designs, outcome measures and prior experience of surgeons, with all studies scoring either 5 or 6 on the NOS.

Conclusions
Standardised reporting of outcomes and performance measures is required to reduce heterogeneity and enable the undertaking of a meta-analysis. Future studies should use multiple surgeons and large sample sizes of cases to identify the currently undefined learning curves for laparoscopic radical cystectomy and for robotic and laparoscopic retroperitoneal lymph node dissection.
325 Antegrade Sclerotherapy: A Viable Option for the Treatment of Varicocele in the United Kingdom? a Single Centre Perspective
Authors: Chuah C T , Jones R , Patel C , Seipp C 
Published: August 2023

Abstract

Aim
Antegrade sclerotherapy has been used for the treatment of varicoceles since the 1970s. Despite its efficacy, minimally invasive technique, and short learning curve it is not routinely used in the United Kingdom. With the prospect of an increase in varicocele operations, with the European and American Associations of Urology now advocating for treatment in sub-fertile men with clinical varicoceles, we aim to look at the experiences of this procedure in a UK urology unit.

Method
A retrospective review of antegrade sclerotherapy for varicoceles within a single centre in North Wales. The primary outcome being clinical recurrence and secondary outcomes of fertility and radiation exposure.

Results
37 patients with a median age of 28 (range 14-65) were included. 35 out of 37 patients had a reported pre-operative scrotal ultrasound showing a left sided varicocele. The most common indication for procedure was pain (70.3%) followed by subfertility (21.6%). 45.9% were exposed to only 1 shot of radiation during the procedure. The median follow up was 3 months and only 2 patients had clinical recurrence and there were no significant complications (Clavien-Dindo &gt; 3). 3 of 8 patients with subfertility had successful paternity. Another 4 patients had semen analysis, all of them had improved sperm count, motility, morphology postoperatively.

Conclusions
Antegrade sclerotherapy shows favourable outcome of only 5.4% recurrence accompanied with low dose of radiation. 37.5% of sub fertile patient managed to achieve paternity. This is another viable treatment option for consideration in the treatment of varicoceles.
371 A Single-Centre Impact Assessment of Delayed Imaging in Suspected Ureteric Colic
Authors: Beder D , Hassan M , Khan T , Ragge N , Abioye A , Pushkaran A 
Published: August 2023

Abstract

Introduction
Ureteric colic accounts for a quarter of emergency Urology presentations (Talreja et al, 2015). The British Association of Urological Surgeons (BAUS) recommends a CT of the urinary tract within 14 hours of presentation. However, District General Hospitals frequently lack access to cross-sectional imaging overnight for the purpose of investigating suspected ureteric colic. With the ever-increasing pressure on bed spaces, we report on the delay in discharge of appropriate patients with suspected ureteric colic due to delayed access to imaging.

Method
We performed a retrospective review of admissions for ureteric colic from October 2021 to March 2022. We determined the time from presentaon to performance of CT. Assessment of suitability for discharge was based on the BAUS consensus document. Factors contributing to delayed discharge were determined through case note review.

Results and Conclusions
Of 140 patients included, almost half (47%) were admitted overnight. 64% of admissions were avoidable by adherence to the BAUS guidelines on safe discharge. 54 patients were not discharged the same day: 57% due to delay in obtaining CT imaging, 17% due to sepsis, 13% due to AKI, and 13% due to reasons not specified. The mean discharge delay due to imaging was 1 day (0-3). Notably, only 60% of referrals with suspected ureteric colic had a ureteric stone present. We therefore conclude that imaging at the point of presentation of suspected ureteric colic can prevent unnecessary admission and direct safe patient discharge. These results have led to local introduction of a patient pathway to improve management.
372 Is the Mixing of Local Anaesthetic Agents for Perineal Block in TP Prostate Biopsy Patients Advantageous? a Comparative Study of Local Anaesthetic Efficacy
Authors: Bhopal K , Allat O A , Noureldin M , Gubby C , Firth E , Craggs J , Heybourne A , Mehnaj Noor M , Rajkumar G , Emara A , Hindley R 
Published: August 2023

Abstract

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

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

Results
The two groups were matched in their demographics including age, PSA and prostate volume.
The pain threshold was similar in both groups during administration of the perineal block. The difference in pain threshold between the ‘mixed’ vs ‘non-mix’ group was statistically significant during the biopsy sampling i.e., 4(std 2) for the ‘mixed’ and 2(std1) for the ‘non-mix’ group.
84.8% of the ‘mixed’ group vs 97.7% of the ‘non-mix’ group said they would recommend the procedure. The response was the same when asked whether they would repeat the procedure if required (84.4% in ‘mixed’ vs 97.7% in ‘non-mix’). The cancer detection rate had no statistical difference between the 2 groups although core-length’s taken from target lesions were shorter in ‘mixed’ vs ‘non-mixed’ group (mean 7mm vs 9.5mm).

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

Abstract

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

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

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

Results
Total 335 patients presented with acute scrotum required exploration between 2018-2022 and divided into 2 categories:
[category 1] prior to the start of covid-19 pandemic and [category 2] after the pandemic “≥2020”. The analyses revealed a 13% increase in the number of presentations, though this was not statistically significant [P = 0.09].
The sub-analysis of category 2 looked at the relationship of covid-19 status at the time of presentation with acute pain. This showed a significant correlation between covid-19 +ve status and pain with negative exploration [P = 0.0263].
Table 1: Sub-analysis of the covid-19 status at the time of presentation after 2019. Fisher exact test.
Analyzing the data found to be statistically significant of value of 0.0263 where the result is significant at P&lt;0.05.

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

Abstract

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

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

Results
The total 250 patients underwent TPBx. 10 patients were already known to have prostate cancer. The mean age was 69 years. The average PSA value was PSA: 8.41 ng/ml with an average PSA density of 0.23.
43 patients underwent previous transrectal ultrasound-guided prostate (TRUS) biopsy while 207 patients were biopsy naïve.
The overall cancer detection rate was 76 %. In 25 % of patients, there were some discrepancies between the mpMRI lesion site and histology results.
Majority of the histology results were ISUP grade group 2, 30 % of the case, grade group 3 in 22 % of the cases, grade group 4 in 14 % of the cases, grade group 1 in 6% of the cases grade group 5 in 2 % of the cases.

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

Conclusions
Compared with OPN and RPN, LPN demonstrated a lower EBL. All other perioperative outcomes demonstrated similar results between the three treatment modalities. Future large-scale, prospective, randomised studies is necessary to draw a definitive conclusion from this analysis.