bluuebunny/crossref_metadata_2025_split huggingface dataset:
176 A Retrospective Analysis of Non-Muscle Invasive Bladder Cancer (NMIBC) Follow-Up Using Flexible Cystoscopy and the Role of the Charlson Co-Morbidity Index (CCI) in Improving Follow Up
Authors: Dickson S , Jones J , Clark R 
Published: November 2022

Abstract

Aim
1. A retrospective analysis of NMIBC follow-up using flexible cystoscopy during COVID-19.
2. Charlson Co-Morbidity Index (CCI) as a method of improving follow up.

Method
Online patient records were reviewed for 153 patients who attended Ayr University Hospital between 01/02/2020 and 01/05/ 2020 for check cystoscopy. We recorded the patients risk category and the number of months lapsed since their previous scope. Follow up schedules were compared with current NICE guidelines. CCI for each patient was calculated.

Results
The majority of the patients sampled had follow up adherent to NICE guidelines. Deviations were secondary to ‘allocation to an incorrect follow up schedule’, ‘late follow up’ and ‘non-compliance’. Incorrect allocation was due to both human error and clinical judgement. Clinical judgement included frail patients thought not to benefit from their current intensive schedule and patients with areas of suspicion warranting an earlier check. CCI scores ranged from 2–11. 25% of had a Charlson score of &gt;6 - this predicts a 0% 10-year survival.

Conclusions
We hypothesise that patients with a CCI &gt; 6 should be considered for less intensive follow up. Their co-morbid status makes them likely unsuitable for intervention if reoccurrence was identified.We are pleased with our current adherence to NICE guidelines. We recognise areas for improvement and have raised these at local meetings. We hope that the CCI can be used to ensure we practice realistic medicine and act in the best of the patient when deciding to follow up.
181 Service Evaluation of the Utilisation and Impact of PredictProstate on Clinical Decision-Making in a Prostate Cancer Specialist Multidisciplinary Service
Authors: Pandiaraja M , Pryle I , West L , Gardner L , Shallcross O , Tay J , Shah N , Gnanapragasam V , Lamb BW 
Published: November 2022

Abstract

Aim
Patients with low and intermediate risk prostate cancer must decide whether to undergo radical treatment. The PredictProstate tool uses patient characteristics to quantify the relative benefit of radical treatment. It has been introduced in our prostate cancer specialist multidisciplinary team meeting (pcSMDT) and in subsequent communication with patients to facilitate informed decision-making. The aim of this study was to assess the utilisation and utility of PredictProstate in informing treatment decisions for men referred to Cambridge University Hospitals (CUH) for consideration of radical prostatectomy (RARP).

Method
A retrospective chart review was conducted of patients referred to the CUH pcSMDT and robotic prostatectomy clinic (ROPD) between Sep 2019 and Aug 2021 for consideration of RARP. Data on patient characteristics, use of PredictProstate, and management decisions was collected from the EPIC EMR. A total of 841 patients were included in the analysis.

Results
The usage of PredictProstate in the pcSMDT increased in the second half of the study period (34.5% vs 23.8%, p&lt;0.001). The use of PredictProstate for men with low and intermediate risk prostate cancer was associated with an increased likelihood of attending ROPD (75% vs 61%, p&lt;0.001), but a reduced likelihood of RARP (41% vs 55%, p&lt;0.01). These effects were most pronounced for men of favourable intermediate risk (80% vs 63%, p&lt;0.004 and 34% vs 54%, p&lt;0.07 respectively).

Conclusions
PredictProstate provides personalised prognostic data for patients. Its increased use for men with low and intermediate risk prostate cancer is associated with increased attendance at specialist surgical clinic and a reduced chance of undergoing RARP.
202 Review of the Uro-Oncology MDT Performance Comparing Pre-Operative Radiological Staging with Surgical Outcomes for Localised Prostate Cancer
Authors: Oo KK , Cox A 
Published: November 2022

Abstract

Aim
Treatment decisions for prostate cancer (CaP) depend on accurate clinical parameters (PSA, DRE and Gleason grade). The ideal imaging utilisation is the topic of much controversy and is constantly evolving. Following an Ombudsman investigation where CaP staging and MDT processes were questioned, the performance of an MDT was appraised by comparing pathological outcomes with pre-operative staging.

Method
All radical prostatectomies (RP) (n=159) undertaken in ABUHB between June-2018 and January-2021 were retrospectively reviewed. Data were collected for preoperative risk stratification, MRI score (LIKERT/PIRADS) and pathological reports.

Results
Among 159 patients, 25 had upgraded ISUP scores in post-RP histology (15.7%). A threefold increase in MRI usage was observed over the last decade [852(2012–14) vs 2469(2018–20)]. 60% of low-risk and intermediate-risk patients were found to have higher pathological staging postoperatively compared to preoperative MRI. pT≥3 was observed in 68% of LIKERT/PIRADS V, 58% of DRE T2 and 67% of DRE T3.

Conclusions
Pathological upgrading was comparably lower than the national average supporting existing diagnostic pathways. Staging comparison of radiological with surgical outcomes remains challenging but MDT performance and recording were modified to reflect changes in usage of pre-op staging and reporting. Findings have led to new prospective audits to be updated annually.
263 Minimally Invasive Non-Radical Nephrectomy for Benign Renal Disease: A Single Centre Experience Comparing Two Surgical Approaches
Authors: Thomas A , Lokman U , Phan Y 
Published: November 2022

Abstract
In our high-volume tertiary centre for renal disease, we perform in excess of 150 nephrectomies for benign or malignant disease per annum. In this study we compare outcomes between laparoscopic and retroperitoneoscopic minimally invasive (MI) approaches.
We retrospectively reviewed our database of all patients who underwent MI non-radical nephrectomy over a 3-year period. Indication for surgery, conversion rate, operative time, blood loss, length of stay and post-operative complications were examined.
A total of 61 MI nephrectomies were performed by three experienced minimal access surgeons. Indications for surgery included chronic infection, stone disease, tuberculosis, and obstruction associated with pain. Mean age was 51 years (range 22–89), 72% were female. The approach was laparoscopic in 62% and retroperitoneoscopic in 38%. Median operative time 137 minutes. The overall conversion rate was 3% (2 patients). Median blood loss 50ml's with 1.5% transfusion rate. Median length of stay was 2 days (1–69). There was no significant change in the renal function (P=0.32). Four patients developed Clavien-Dindo grade 3 complication. There was no recorded mortality in our series.
We acknowledge this is a retrospective study that may be subject to selection bias, however our experience of this procedure in high volume centre with experienced operators shows that both laparoscopic and retroperitoneoscopic approaches are safe in performing MI non-radical nephrectomy with very low conversion rate.
425 Extra-Anatomical Detour Ureteric Stents: Our District General Hospital Experience of 50 Patients with a Minimum Follow Up of 6 Months
Authors: Rahman A , Quraishi MK , Mackie S , Watson G 
Published: November 2022

Abstract

Aim
Extra-Anatomical Detour Stents offer a viable modality of decompression particularly in the context of malignancies; with the absent need for changes of stents, cosmetically better than nephrostomies and fewer admissions associated with blockages/infections. Our aim was to assess the safety and feasibility of performing detour stents in a district general hospital.

Method
A review of prospectively collected data on all patients undergoing detour stents between 2016 and 2021 was undertaken. This enabled a possible follow up period of 6 months, provided the patients remained alive. A statistical package was utilised for the analysis of the collected data.

Results
Fifty patients were identified to have undergone detour stent insertion with malignancy being the indication in 90% of cases. Seven patients required a further eleven procedures with the most common being due to repositioning of the stent (36%) or change of stent due to infection (27%). Four patients passed away within 60 days of their procedure. Four patients had their stents eventually replaced with nephrostomies and a patient no longer required the detour stent due to resolution of their obstructive pathology. Nine patients are currently being followed up and thirty-six patients from the original cohort passed away with functional detour stents. Their median survival time post-procedure was 164 days.

Conclusions
Extra-Anatomical Detour Stents offers patients with obstructing renal tract secondary to malignancy a better quality of life when compared with nephrostomy. Continued caseload and refinement of surgical technique would lead to further optimised surgical outcomes.
426 Conservative Management of Bilateral Undescended Testes in an Adult
Authors: Langman F , Rahman A , Quraishi MK , Plail R 
Published: November 2022

Abstract
Bilateral undescended testes are an uncommon finding in children and even a rarer phenomenon in adults. Undescent of the testes (UDT) has important consequences on fertility, testicular injury, hormonal concerns, testicular torsion, and testicular cancer risk, as well as psychological health.
We present the case of a then 21-year-old native caucasian who was referred to the urology clinic with an ‘empty scrotum’ in 2009. On examination, he had secondary sexual characteristics with expected pubertal transformation. Testes were palpated as small smooth ovoid masses in each groin with the inability to be reduced into the scrotum. The basic hormonal screen was within the normal range. Ultrasound of the scrotum and groins identified testes in the left and right inguinal canal, respectively. Semen analysis showed azoospermia.
Treatment wise no pharmacological therapies were warranted in view of normal hormonal function. The patient opted for conservative options for fertility in view of likely low success rates in atrophic testes including sperm extraction techniques After detailed discussions around the dilemmas of Bilateral UDT, a decision for a tailored surveillance regimen including ultrasound and self-examination was taken. Psychological counselling was declined by the patient as felt unwarranted. He continues to remain well in himself to date with his wife and adopted children.
Greater awareness of testicular self-examination amongst young men should be advocated. With established neonatal screening availability, UDT in adults is seldom heard of but it is a primary risk factor for testicular cancer. Proper counselling advice and prosthesis should be offered proactively.
455 The Changing Trends of Image Guided Biopsy of Small Renal Masses Before Intervention- an Analysis of European Multinational Prospective EuRECA Registry
Authors: Chan VWS , Keeley F , Lagerveld B , Breen D , King A , Nielsen T , van Strijen M , Garnon J , Alcorn D , Graumann O , de Kerviler E , Zondervan P , Walkden M , Lughezzani G , Wah TM 
Published: November 2022

Abstract

Aim
To evaluate the use of pre-cryoablation biopsy for small renal masses (SRMs) and the effects of increasing up take on histological results of treated SMRs.

Method
From 2015 to 2019, patients with sporadic T1N0M0 SRMs undergoing percutaneous, laparoscopic or open cryoablation from 14 European institutions within the European Registry For Renal Cryoablation (EuRECA) were included for the retrospective analysis. Univariate and multivariate logistic models were used to evaluate the trends, histological results and the factors influencing use of pre-cryoablation biopsy.

Results
871 patients (Median [IQR] age, 69[14], 298 women) undergoing cryoablation were evaluated. The use of pre-cryoablation biopsy has significantly increased from 42% (65/156) in 2015 to 72% (88/122) in 2019 (p&lt;0.001). Patients treated for a benign histology are significantly more likely to have presented later in the trend, where pre-cryoablation biopsy is more prevalent (OR: 0.64, 95% CI 0.51–0.81, p&lt;0.001). Patients treated for undiagnosed histology are also significantly less likely to have presented in 2018 compared to 2016 (OR 0.31, 95% CI 0.10–0.97, p=0.044). Patients aged 70+ are less likely to be biopsies pre-cryoablation (p&lt;0.05). R.E.N.A.L. nephrometry score of 10+ and a Charlson Comorbidity Index &gt;1 are factors associated with lower likelihood to not have received a pre-cryoablation biopsy (p&lt;0.05).

Conclusion
An increased use of pre-cryoablation biopsy was observed and cryoablation patients treated with a benign histology is more likely to have presented in periods where pre-cryoablation biopsy is not as prevalent. Comparative studies are needed to draw definitive conclusions on the effect of pre-cryoablation biopsy on SRM treatments.
456 Ten-Year Outcomes of Image-Guided Ablation and Partial Nephrectomy for T1 Renal Cell Carcinoma
Authors: Chan VWS , Osman FH , Cartledge J , Gregory W , Kimuli M , Vasudev N , Ralph C , Jagdev S , Bhattarai S , Smith J , Lenton J , Wah TM 
Published: November 2022

Abstract

Objective
This is the first study to compare 10-year oncological outcomes and peri-operative outcomes of IGA and PN in patients with confirmed small renal cell carcinomas (RCC).

Method
This is a retrospective cohort study of localised RCC (T1a/bN0M0) patients undergoing cryoablation (CRYO), radio-frequency ablation (RFA) or laparoscopic PN at our institution from 2003 to 2016. Oncological outcomes were compared using Cox regression and log-rank analysis. eGFR changes were compared using Kruskal-Wallis and Wilcoxon-rank tests.

Results
296 (238 T1a, 58 T1b) patients were identified, 103, 100 and 93 patients underwent CRYO, RFA and PN, respectively. Median follow-up time was 75, 98 and 71 months, respectively. Patients undergoing PN are significantly younger and have fewer complex tumours than those undergoing CRYO or RFA (p&lt;0.001). On univariate analysis, all oncological outcomes were comparable amongst CRYO, RFA and PN (p&gt;0.05). On multivariate analysis, T1a patients undergoing RFA had improved local-recurrence-free survival (LRFS) (HR 0.002, 95%CI 0.00–0.11, p=0.003) and metastasis-free survival (HR 0.002, 95%CI 0.00–0.52, p=0.029) compared to PN. In T1a and T1b patients combined, both CRYO (HR 0.07, 95%CI 0.01–0.73, p=0.026) and RFA (HR 0.04, 95%CI 0.03–0.48, p=0.011) had improved LRFS rates. Patients undergoing CRYO and RFA had a significantly smaller median decrease in eGFR post-operatively compared to PN (T1a: p&lt;0.001; T1b: p=0.047). Limitations include retrospective design and limited statistical power.

Conclusions
IGA is potentially as good as PN in oncological durability. IGA preserves kidney function significantly better than PN. More studies with larger sample size should be performed to establish IGA as a first-line treatment alongside PN.
460 Prostate Biopsy Sepsis Rates – Are We Meeting National Average Levels?
Authors: Arang H , Mehta A , Roberts R , Mehta A , Beknazirov K , Ahmed I , Lynch M 
Published: November 2022

Abstract

Aim
To identify the prevalence of sepsis following trans rectal ultrasound (TRUS) biopsy of the prostate at our unit and identify potential causes for this, and to implement change to reduce the sepsis rate.

Method
A retrospective observational audit was performed between 01/10/19–17/01/20 for TRUS biopsy, followed by two re-audits between 05/03/20–28/05/20 and 06/08/20–17/09/2020 for trans perineal (TP) biopsy. A descriptive statistical analysis was performed on the data as well as an N-1 Chi-squared test on the data with a p&lt;0.05 set as statistically significant. We compared our procedure to the BAUS guideline and NICE guideline for TRUS and TP biopsy.

Results
A total of 202 patients had TRUS biopsies between 01/10/19 to 17/01/20. 7.9% of patients presented with sepsis following their biopsy. Following our recommendation, between 05/03/20 to 28/05/20, a total of 19 patients had TP biopsy at our unit with 0 developing sepsis. A re-audit of 44 patients who underwent TP biopsy between 06/08/20 to 17/09/2020 showed no patients developing sepsis, indicating sustained improvement.

Conclusion
The rate of TRUS biopsy sepsis was four times higher than average levels at our department. There were zero patients who became septic following their TP biopsy. Over a 3-month period our TRUS biopsy audit showed 69 days of sepsis related admission, this is greater than £30,000 in costs. TP biopsy therefore leads to improved patient experiences with their care and also a significant cost saving to the trust.
569 Trial Without Catheter – Are We Performing the Procedure Correctly?
Authors: Mehta A , Arang H , Anyomih T , Arsanious N 
Published: November 2022

Abstract

Aim
To assess the trial without catheter (TWOC) practice at our unit by ensuring there is accurate recording of data onto electronic records and factors affecting successful TWOC are being addressed.

Method
2 months of retrospective data on TWOC practice was collected between 01/07/2019–30/08/2019. The Guy's and St Thomas’ TWOC guideline was used as the standard to compare to. Factors that could affect TWOC outcomes were checked on our electronic patient records. A re-audit was performed between 31/07/2020–30/08/2020.

Results
55 sets of data were collected with 16 (42%) patients having no documentation of post void residual volume (PVR). There were 6 adverse outcomes following TWOC, 3 patients returned in acute urinary retention (AUR) and 3 had delayed discharges. 3/6 of these adverse outcomes were linked to poor TWOC practice. 4/5 patients who failed TWOC were not on Tamsulosin and 0/5 were on laxatives. Following our implemented changes the re-audit showed no adverse outcomes, and only 2 patients without PVR documented.

Conclusions
Our first audit demonstrated significant adverse outcomes from poor TWOC practices at our unit. We implemented changes including writing an official TWOC guideline for the trust and regional teaching from our catheter workshop that included correct TWOC practice. Following these changes, the rates of adverse outcomes following TWOC were significantly reduced.
642 Racial Disparities in Uric Acid Stones - a Tertiary Centre Cohort Study
Authors: Hoq MN , Ahmed MD , Al-Jadir B , Subramonian K 
Published: November 2022

Abstract

Aim
The prevalence of urolithiasis has been increasing over decades with uric acid stones accounting for 10% of all urinary tract stones. While hyperuricosuria states have been well recognised as risk factors in the pathogenesis of uric acid stones; its association with ethnic variations is poorly understood. We followed up on our single-centre cohort study to analyse and understand the patient characteristics in uric acid stones and differences between racial groups.

Method
We conducted retrospective analysis of 487 patients with stone analysis results treated at a single tertiary centre. Patients with Uric acid stones were identified and data on Age, BMI, Serum Uric acid level and Urine pH were compared amongst different patient populations using STATA.

Results
Out of 487 stone analysis results, 63 were identified as uric acid stones as either major (n=42) or minor (n=21) component and were included in our analysis. 71.43% (n=45) of these patients were Caucasian while 28.57% (n=18) were Asian. Male gender predominance was also noted (n=46). Of the diverse aetiologies, metabolic disorders were the most prevalent and include aciduria, diabetes mellitus, metabolic syndrome, and obesity. Amongst the Asian population, there was a significant propensity to lower age, lower BMI, higher uric acid level and higher urine pH.

Conclusion
Our study shows that Asians suffer from uric acid stones at a younger age, have relatively lower BMI, higher uric acid levels and relatively higher urine pH. We have previously done this analysis with a smaller population and our repeat analysis shows the same trend which strengthens our findings.
685 Management of Patients Presenting Acutely with Suspected Ureteric Colic
Authors: Sturgess G , Elmussareh M 
Published: November 2022

Abstract

Aim
To assess how patients presenting with suspected ureteric colic are managed compared to NICE guidance (renal and ureteric stones, QS195 July 2020). Also, to review the incidence of ureteric stones occurring in all referrals received in a hospital where patients are referred prior to imaging confirmation of stones.

Method
The dataset was formed by retrospective handover screening during a three-month period in 2019 prior to the impact of COVID-19 with any patient included who was referred to urology with a suspected ureteric calculus, generating 149 cases. Demographic information, imaging modality and treatment were recorded as well as comparisons to five NICE quality statements on the management of ureteric stones.

Results
Of the 149 referrals 88 were male with a median age of 45 years. Ureteric stones were found in 61/149 of referrals with 99/149 receiving CT scan first line whilst the remainder were initially imaged using ultrasound. Forty referrals were received for women under the age of 50 with only 3/40 having a ureteric stone. Pick-up rate of ureteric stones was higher in older and male patients. CT within 24 hours of referral was achieved in 82.8% and 69.9% were given appropriate analgesia. In patients in which it was necessary primary treatment occurred within 48 hours in 45.4% of patients.

Conclusions
Less than half of referrals received had a ureteric stone with particularly low pick-up rates in young women. A large proportion of patients having ultrasound first line had subsequent CT imaging. Adherence to NICE quality standards was comparable to other centres.
719 2WW Prostate Cancer Referrals - Are We Over Investigating Patients with Normal PSA Results?
Authors: Ravindraanandan M , Willard K , Cotton R , Dawson S , Nair B , Pankaj P , Luscombe C , Gommersall L 
Published: November 2022

Abstract

Aim
Nationally, men are referred by GPs to urologists for suspected prostate cancer using a cancer pathway proforma for an appointment within two weeks. Criteria include a PSA level above the age-specific range, or an abnormal DRE regardless of PSA result. In this study, we look at the number of cancers detected from patients referred with abnormal DREs and a normal PSA.

Method
In a single major tertiary urological centre, data on patients referred with suspected prostate cancer were retrospectively collected over a 12-month period. Variables focussed on included those referred with a normal PSA, but abnormal DRE, and analysed using descriptive statistics.

Results
Over a 12-month period, 935 referrals were made by GPs for suspected prostate cancer. Of those, 15.3% (n=143) were referred due to an abnormal DRE but a normal PSA. The median age of our cohort was 73 (38–92, mean 70.15) with a median PIRADS score of 2, and a median PSA density of 0.04 (0.01–0.19, mean 0.05).
From our cohort, 6.3% of men (n=9) had malignant histology. From those with malignant histology, 2.1% (n=3) had clinically significant prostate cancer with a mean age of 79. None of the three men were suitable for radical treatment. Only one man with non-clinically significant prostate cancer went on to have radical treatment.

Conclusions
Significant time and resources are used for those referred with abnormal DREs and normal PSA results, who for the overwhelming majority do not require any treatment. There may be scope to streamline referral criteria to reduce burden on services.