bluuebunny/crossref_metadata_2025_split huggingface dataset:
697 Day Case Trans-Urethral Resection of Bladder Tumour (TURBT) Without a Day Surgery Unit. Making Most of the Available Resources
Authors: Olaniyi P , Botham J , Birch E , Pearsall J , Warren K , Burden H 
Published: August 2023

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

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

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

Abstract

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

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

Results
With the Trilogy™, calcium oxalate monohydrate (COM) (15:3) stone phantoms had an average stone clearance rate of 498.40 mm3/min, calcium phosphate (CaP) (15:4) had an average clearance rate of 493.60 mm3/min, uric acid (UA) (15:5) were cleared at a rate of 1267.61 mm3/min and struvite (15:6) cleared with a rate of 1299.64 mm3/min.
Using TFL, COM had an average clearance rate of 40.74 mm3/min, CaP were cleared at 39.65 mm3/min, UA at 39.5mm3/min and struvite were cleared at an average rate of 56.41 mm3/min.

Conclusions
The Trilogy™ had statistically significantly faster stone clearance rates across all 4 stone types (p = 0.03).