Urology

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Venous Thromboembolism After Radical Cystectomy: A Systematic Comparison of Open Versus Robotic Approaches (2003-2025)
(Springer Nature, 2025-10-10) Abdelrasheed, Ahmed; Higgi, Adnan; Elkomy, Abdelrahman; Ali, Mohammed; Elkomy, Abdelrahman; Medical and Dental
Radical cystectomy carries a substantial risk for venous thromboembolism (VTE), significantly impacting postoperative morbidity and mortality. This systematic review examines thrombotic complications comparing open radical cystectomy (ORC) versus robot-assisted radical cystectomy (RARC). Following PRISMA 2020 guidelines, we searched PubMed/MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science from January 2003 through September 2025. Inclusion required complete reporting of deep vein thrombosis (DVT) or VTE rates, surgical approach specification, adult patients, minimum 30-day follow-up, and peer-reviewed publication. Studies with any missing outcome data were excluded. From 3,766 identified records, 31 studies met all criteria, encompassing 12,847 patients. DVT rates ranged from 3.2-11.5% after open surgery versus 0-5.6% following robotic approaches. Meta-analysis revealed significantly higher thrombotic risk with open surgery (OR: 1.65, 95% CI: 1.23-2.21, P=0.001). Key predictors included prior VTE (OR: 8.73), COPD (OR: 3.24), advanced stage (OR: 2.73), and obesity (OR: 1.94). Extended 28-day prophylaxis reduced VTE incidence by 58% compared to in-hospital prophylaxis alone. Direct oral anticoagulants showed noninferior efficacy to low-molecular-weight heparin. Robotic cystectomy demonstrates significantly lower thrombotic risk, though appropriate prophylaxis remains essential regardless of surgical approach. Keywords: deep vein thrombosis (dvt); muscle-invasive bladder cancer (mibc); open radical cystectomy; pelvic surgery; robotic-assisted radical cystectomy.
A0680 - Complications of vasectomy: Results from a prospective audit of 94,000 procedures
(Elsevier, 2023-02-10) Peacock, Julian; Henderson, John; James, Gareth; Peacock, Julian; Henderson, John; James, Gareth; Medical and Dental
Introduction & Objectives: Vasectomy is an effective and safe form of male contraception. Over 11,000 vasectomies are performed per year in the UK, the majority in a primary care setting. It is important to counsel men about possible complications, however up-to-date data is scarce. The rate of troublesome chronic scrotal pain quoted in the BAUS patient information leaflet is 'up to 5%' which may discourage some patients. The Association of Surgeons of Primary Care (ASPC) has been collecting a large dataset on vasectomy over 15 years. The aim of this review was to provide up to date complication rates for vasectomy. Material(s) and Method(s): Data were collected prospectively between 2006 and March 2021. A patient questionnaire was completed on the day of surgery and 4 months post-op. Rates of early and late failure, infection, hospital readmission, haematoma and post-vasectomy pain syndrome (PVPS) were recorded. Result(s): Over the 15-year study period, data from 94,082 vasectomies was collected, performed by over 100 surgeons. In 2021, 96% of surgeons used one test to prove sterility. 66% of patients used a postal sperm test post vasectomy to confirm sterility. Failure rates were available for 70, 947 patients. Early failure occurred in 360 patients (0.5%); late failure occurred in 10 (0.014%). Post-operative infection was reported in 1007 cases (1.30%), haematoma in 1094 patients (1.40%). Post-vasectomy pain syndrome was reported in 89 patients (0.12%). Conclusion(s): Vasectomy remains a safe and reliable contraceptive method. The rates of complication were generally lower than those published by major urological organisations. This large, prospective audit provides accurate, contemporaneous complication rates which can form the basis for pre-vasectomy counselling.
Urine Trouble: Using Education, Grab Bags and Wifi Trackers to Save Time Collecting Urology Equipment
(Oxford University Press, 2020-06-24) Wilson, Jacob; McMeekin, Faith; Wilson, Jacob; McMeekin, Faith; Medical and Dental
Introduction: Around 18% in the inpatient population is catheterised. It falls to junior doctors to perform difficult catheterisation when other staff members have failed, as well as initiating management for patients with haematuria. Standardised catheter packs are insufficient for difficult catheterisation and management of haematuria. We aim to reduce the time taken to locate the necessary equipment, thereby preventing delays to treatment. Method: 3 PDSA cycles were performed over 3 months following a baseline measurement, with the time taken to locate the appropriate equipment for two clinical scenarios measured. The interventions were: a teaching session, creating a Urology Grab Bag and equipping the Urology Grab Bag with a WiFi tracker. Result: The baseline average time taken to locate the appropriate equipment was 16m7s. Following a urology teaching session, there was an 80.61% reduction in average time taken to locate the equipment to 3m8s. A Urology Grab Bag containing appropriate equipment was crafted and reduced this time to 2m19s (a 25.82% reduction). Finally, a WiFi tracker was embedded into the grab bag reducing time taken to locate equipment by a further 66.39% to 47s. Conclusion: Education has the greatest effect in reducing time taken to locate equipment for difficult catheterisation and haematuria management.
Erectile Dysfunction Following Surgical Repair of Penile Fracture: A Literature Review of Incidence, Risk Factors, and Outcomes
(Springer, 2025-09-06) Abdelrasheed, Ahmed; Elkomy, Abdelrahman; Latham, Joseph; Ali, Mohammed; Elkomy, Abdelrahman; Medical and Dental
Penile fracture is a rare urological emergency that can lead to significant complications, particularly erectile dysfunction (ED). This systematic review aimed to evaluate the incidence of ED following penile fracture and assess management strategies. A comprehensive literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across multiple databases, including PubMed, EMBASE, Cochrane, SCOPUS, and Web of Science from inception to 2024. Studies reporting on ED incidence after penile fracture and comparing different management approaches were included. Quality assessment was performed using the QUADAS-2 tool. Studies with variable or insufficient data were excluded. Twenty-four studies involving 3,213 patients were included. The overall incidence of ED after penile fracture ranged from 0% to 52.9%, with immediate surgical repair showing significantly lower rates (6.6-16.5%) compared to conservative management (45.5-52.9%). Meta-analysis revealed that immediate surgical intervention (within 24-48 hours) was associated with lower ED rates (OR: 0.36, 95% CI: 0.15-0.89, P = 0.03) compared to delayed repair. Risk factors for post-operative ED included age >50 years (RR: 1.65, 95% CI: 1.14-2.39), bilateral corporal involvement, and concomitant urethral injury. Immediate surgical repair of penile fracture is associated with lower rates of ED compared to conservative management or delayed intervention. Early recognition and prompt surgical management within 24-48 hours are crucial for optimal functional outcomes.
CALIBER: a phase II randomized feasibility trial of chemoablation with mitomycin-C vs surgical management in low-risk non-muscle-invasive bladder cancer
(Wiley, 2020-04-03) Mostafid, Hugh; Porta, Nuria; Cresswell, Joanne; Griffiths, Thomas; Kelly, John; Penegar, Steven; Davenport, Kim; McGrath, John; Campain, Nicholas; Cooke, Peter; Masood, Shikohe; Knowles, Margaret; Feber, Andrew; Knight, Allen; Catto, James; Lewis, Rebecca; Hall, Emma; Davenport, Kim; Knight, Allen; Medical and Dental; Patient and Community Partners
Objectives: To evaluate the activity of intravesical mitomycin-C (MMC) to ablate recurrent low-risk non-muscle-invasive bladder cancer (NMIBC) and assess whether it may enable patients to avoid surgical intervention for treatment of recurrence. Patients and methods: CALIBER is a phase II feasibility study. Participants were randomized (2:1) to treatment with four once-weekly MMC 40-mg intravesical instillations (chemoablation arm) or to surgical management. The surgical group was included to assess the feasibility of randomization. The primary endpoint was complete response to intravesical MMC in the chemoablation arm at 3 months, reported with exact 95% confidence intervals (CIs). Secondary endpoints included time to subsequent recurrence, summarized by Kaplan-Meier methods. Results: Between February 2015 and August 2017, 82 patients with visual diagnosis of recurrent low-risk NMIBC were enrolled from 24 UK hospitals (chemoablation, n = 54; surgical management, n =28). The median follow-up was 24 months. Complete response at 3 months was 37.0% (20/54; 95% CI 24.3-51.3) with chemoablation and 80.8% (21/26; 95% CI 60.6-93.4) with surgical management. Amongst patients with complete response at 3 months, a similar proportion was recurrence-free by 12 months in both groups (84%). Amongst those with residual disease at 3 months, the 12-month recurrence-free proportion was lower in the surgical management group (40.0%) than in the chemoablation group (84%). Recruitment stopped early as chemoablation did not meet the prespecified threshold of 45% complete responses at 3 months. Conclusion: Intravesical chemoablation in low-risk NMIBC is feasible and safe, but did not demonstrate sufficient response in the present trial. After chemoablation there may be a reduction in recurrence rate, even in non-responders, that is greater than with surgery alone. Further research is required to investigate the role and optimal schedule of neoadjuvant intravesical chemotherapy prior to surgery for NMIBC.
Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected: A report from an International Continence Society consensus working group
(Wiley, 2020-08-04) Roy, Holly; Nettleton, Jeremy; Blain, Camilla; Dalton, Catherine; Farhan, Bilal; Fernandes, Ailton; Georgopoulos, Petros; Klepsch, Sabine; Lavelle, John; Martinelli, Evangelista; Panicker, Jalesh; Radoja, Ivan; Rapidi, Christina-Anastasia; Silva, Ricardo; Tudor, Katarina; Wagg, Adrian; Drake, Marcus; Nettleton, Jeremy; Medical and Dental
Aim: Lower urinary tract symptoms (LUTS) are a common urological referral, which sometimes can have a neurological basis in a patient with no formally diagnosed neurological disease ("occult neurology"). Early identification and specialist input is needed to avoid bad LUTS outcomes, and to initiate suitable neurological management. Methods: The International Continence Society established a neurological working group to consider: Which neurological conditions may include LUTS as an early feature? What diagnostic evaluations should be undertaken in the LUTS clinic? A shortlist of conditions was drawn up by expert consensus and discussed at the annual congress of the International Neurourology Society. A multidisciplinary working group then generated recommendations for identifying clinical features and management. Results: The relevant conditions are multiple sclerosis, multiple system atrophy, normal pressure hydrocephalus, early dementia, Parkinsonian syndromes (including early Parkinson's Disease and Multiple System Atrophy) and spinal cord disorders (including spina bifida occulta with tethered cord, and spinal stenosis). In LUTS clinics, the need is to identify additional atypical features; new onset severe LUTS (excluding infection), unusual aspects (eg, enuresis without chronic retention) or "suspicious" symptoms (eg, numbness, weakness, speech disturbance, gait disturbance, memory loss/cognitive impairment, and autonomic symptoms). Where occult neurology is suspected, healthcare professionals need to undertake early appropriate referral; central nervous system imaging booked from LUTS clinic is not recommended. Conclusions: Occult neurology is an uncommon underlying cause of LUTS, but it is essential to intervene promptly if suspected, and to establish suitable management pathways.
Reducing readmissions and improving patient experience following urological surgery, through early telephone follow-up
(BMJ Publishing Group, 2020-04-16) Nettleton, Jeremy; Jelski, Joseph; Ahmad, Adnan; Jelski, Joseph; Ahmad, Adnan; Medical and Dental
Readmission from urological surgery is common, with a readmission rate for day case surgery of 3.7% and 26% for robot-assisted cystectomy. Readmission to secondary care and representation to primary care are both expensive and preventable. This project aimed to reduce both and also enhance the care of patients following urological surgery in a large tertiary referral centre, within the National Health Service. A retrospective telephone follow-up (TFU) survey was set up in the early postoperatively period to measure reattendance and readmission rates and perception of care received. Patients were also asked to suggest how improvement could be made. Quality improvement tools were used to optimise and review the methods and timing of TFU. TFU was initiated as a strategy to enhance care and reduce readmission rates. Phone calls were targeted to occur between 48 and 72 hours following discharge. During the intervention period, 484 phone calls were attempted with 343 being successful. Reattendance rates were reduced by 13% and patient satisfaction improved by 19.6%, following TFU. This intervention also generated additional income for the organisation and enhanced patient satisfaction in the early postoperative period.
Individualised Predictions of the Survival Benefit Due to Adjuvant Therapy in a Randomised Trial of Sorafenib after Nephrectomy for Localised Renal Cell Carcinoma
(SAGE Publications, 2020-12-12) Lawrence, Nicola; Martin, Andrew; Davis, Ian; Troon, Simon; Sengupta, Shomik; Hovey, Elizabeth; Coskinas, Xanthi; Kaplan, Richard; Smith, Benjamin; Ritchie, Alastair; Meade, Angela; Ritchie, Alastair; Medical and Dental
BACKGROUND: Little has been published regarding how doctors think and talk about prognosis and the potential benefits of adjuvant therapy. OBJECTIVE: We sought predictions of survival rates and survival times, for patients with and without adjuvant therapy, from the clinicians of patients participating in a randomised trial of adjuvant sorafenib after nephrectomy for renal cell carcinoma. METHODS: A subset of medical oncologists and urologists in the SORCE trial completed questionnaires eliciting their predictions of survival rates and survival times, with and without adjuvant sorafenib, for each of their participating patients. To compare predictions elicited as survival times versus survival rates, we transformed survival times to survival rates. To compare predicted benefits elicited as absolute improvements in rates and times, we transformed them into hazard ratios (HR), a measure of relative benefit. We postulated that a plausible benefit in overall survival (OS) should be smaller than that hypothesized for disease–free survival (DFS) in the trials original sample size justification (i.e. HR for OS should be ≥ 0.75). RESULTS: Sixty–one medical oncologists and 17 urologists completed questionnaires on 216 patients between 2007 and 2013. Predictions of survival without adjuvant sorafenib were similar whether elicited as survival rates or survival times (median 5–year survival rate of 61% vs 60%, p = 0.6). Predicted benefits of sorafenib were larger when elicited as improvements in survival rates than survival times (median HR 0.76 vs 0.83, p < 0.0001). The proportion of HR for predicted OS with sorafenib that reflected a plausible benefit (smaller effect of sorafenib on OS than hypothesized on DFS, i.e. HR ≥ 0.75) was 51% for survival rates, and 65% for survival times. CONCLUSIONS: The predicted benefits of adjuvant sorafenib were larger when elicited as improvements in survival rates than as survival times, and were often larger than the sample size justification for the trial. These potential biases should be considered when thinking and talking about individual patients in clinical practice, and when designing clinical trials.
P6-10 Ocular Radiation Exposure in Endourology
(Sage Publications, 2021-06-21) Peacock, Julian; Henderson, John; Peacock, Julian; Henderson, John; Medical and Dental
Introduction: There is widespread recognition of the risk of laser and splash injury to the eye during endourological procedures. Despite the lens being one the most radiosensitive tissues, the risk of radiation induced cataract is not widely recognised. The aim of this study was to evaluate ocular radiation exposure to the Endourologist, during routine endourological surgery. Patients and Methods: A prospective study was performed over an 8-month period at a single large District General Hospital. Three procedures were included – ureteric stent insertion, ureteroscopy, and percutaneous nephrolithotomy. Each surgeon was issued a dosimeter, worn on the glabella. Fluoroscopy Time (FT) and Dose Area Product (DAP) were recorded for each case. Results: A total of 404 procedures were included (247 ureteroscopies (URS), 150 ureteric stent insertions and 7 percutaneous nephrolithotomy (PCNL)). Dosimeters were worn by 10 surgeons. Mean fluoroscopy times (URS 20.56 s; ureteric stent 18.96 s; PCNL 360.67 s) and mean DAP (URS 100.82 cGy.m2, ureteric stent 119.82 cGy.m2 and PCNL 1121.62 cGy.m2) were identified with large inter-surgeon variability. No surgeon had a total dosimeter dose >0.00mSv. Conclusions: The International Commission on Radiological Protection (ICRP) recently reduced the yearly eye dose limit from 150 to 20 mSv. Cataractogenesis is no longer considered a typical deterministic effect, with a threshold level below which no effect occurs. Even in higher volume centres, these annual limits are unlikely to be reached. Lead glasses may be considered for surgeons and radiologists with the highest exposure, but for the majority, ocular radiation exposure is negligible.
Current process and outcomes of the surgical management of LUTS due to benign prostatic enlargement: how consistent are we? – results from the multi-institutional audit of surgical management of BPE (AuSuM BPE) in the United Kingdom
(SAGE Publications, 2021-01-17) Joshi, Hrishi; Sali, Gaurav; Paramore, Louise; Jones, Richard; Lazarowicz, Henry; Kujawa, Magda; Pandit, Amol; David, Rotimi; Wilson, Katherine; Bates, Christopher; Shergill, Iqbal; Gan, Christine; El-Husseiny, Tamer; Mukhtar, Bashir; Appanna, Timson; Veeratterapillay, Rajan; Harding, Christopher; Crockett, Matthew; Dawson, Christopher; Simpson, Richard; Zelhof, Bachar; Starmer, Benjamin; Crockett, Matthew; Medical and Dental
Objective In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. Materials and method A multi-institutional snapshot audit was conducted for patients undergoing interventions for LUTS/BPE over 8-week period. Using Delphi process two-part proforma was designed to capture data. Results 529 patients were included across 20 NHS trusts in England and Wales. Median age was 73 years. Indications for surgery were acute retention (47%) and LUTS (45%). 80% of patients had prior medical therapy. TURP formed the commonest procedure. 27% patients had <23 hour hospital stay. Immediate (21%) and delayed (18%) complications were Clavien-Dindo <2 category. High proportion of patients reported residual symptoms. Type and indication of surgery were significant predictor of complications, length of stay and failure of TWOC outcomes, on multivariate analyses. There were variations in departmental processes, 50% centres used PROMs. Conclusion Monopolar TURP still remains the commonest intervention for BPE. Most departments are adopting newer technologies. The audit identified opportunities for development of consistent, effective and patient centric practices as well as need for large-scale focused studies.
Myeloid Sarcoma of the Bladder in a Patient with Chronic myelomonocytic Leukaemia: A Case report and Literature Review
(University of Toronto Press, 2022-01-22) Smith, Rebecca; Mohamed, Bashir; Nettleton, Jeremy; Smith, Rebecca; Mohamed, Bashir; Nettleton, Jeremy; Medical and Dental
Background Myeloid sarcoma is a rare extramedullary tumour of immature granulocytes, most commonly involving the skin, bone, lymph nodes, and soft tissue. It is usually associated with a diagnosis of relapsed or de novo acute myeloid leukaemia, acute lymphoblastic transformation of a myelodysplastic/myeloproliferative neoplasm, or can occur as isolated myeloid sarcoma. Case report A 66-year-old female with a 7-year history of stable chronic myelomonocytic leukaemia presents with urgency, frequency, dysuria symptoms, and without new constitutional symptoms. She is found to have atypical, multifocal lesions on the right posterolateral wall of the bladder with associated hydronephrosis. Pathology reveals the diagnosis as myeloid sarcoma; surprisingly, bone marrow evaluation does not show evidence of acute leukaemic transformation. Conclusions Myeloid sarcoma occurring in patients with chronic myelomonocytic leukaemia is extremely rare, and there are no cases reported in the English literature of these patients developing lesions in the bladder. The urological manifestations of an underlying haematological malignancy are best managed with a combination of systemic chemotherapy and allogeneic stem cell transplant, and in this case, the only surgical intervention required was ureteric stenting and tissue biopsy. Although rare, it is essential to consider alternative diagnoses when confronted with an atypical bladder tumour; failure to do so may result in patient harm by exposure to unnecessary intervention and delay to potentially curative treatment.
Urinary tract obstruction
(Sage, 2022-03-02) Wilson, Jacob; Farrow, Emily; Holden, Charles; Farrow, Emily; Medical and Dental
An obstruction may occur anywhere along the urinary tract from the kidney to the urethral meatus. There is a wide range of causes, from benign to malignant, and the ensuing obstruction may develop acutely or more insidiously over weeks to months. Given this variability, symptoms and signs alter depending on the underlying disease process. Knowledge of the anatomy and pathophysiology of the disease process enables prompt recognition and management of common conditions that result in urinary tract obstruction.
Urological issues in cyclists
(Sage, 2020-11-02) Peacock, Julian; Cobley, Jonathan; Patel, Biral; Peacock, Julian; Cobley, Jonathan; Patel, Biral; Medical and Dental
Cycle use has grown rapidly over the last few years in the UK. British Cycling membership has increased threefold since the 2012 Olympic and Paralympic Games, and this is likely to rise in the wake of the Coronavirus pandemic. As urologists, day-to-day encounters with cyclists are commonplace, who may present with acute traumatic injuries or chronic overuse injuries. The aim of this literature review was to evaluate the effect of cycling on conditions presenting to the urology clinic, in particular those of raised prostate-specific antigen (PSA), haematuria and soft-tissue lesions (‘cyclist nodules’). Furthermore, the review aimed to summarize the relationship between cycling and pudendal nerve entrapment (PNE) syndromes. A PubMed search of the literature on cycling and genitourinary disorders was performed. The literature suggests no significant change in PSA levels after a bout of cycling. Age appears to have no effect on the change in PSA experienced following a bout of cycling, in particular when comparing those <50 years of age to those >50 years of age. Haematuria appears to be rare with cycling but has been described, even with stationary bike riding. It is imperative to exclude coexisting urinary-tract pathological conditions, and cycling-induced haematuria should always be considered a diagnosis of exclusion. Perineal nodular induration (‘cyclist nodules’) is a rare condition, related to pressure and repetitive micro-trauma between the perineum and saddle. Pudendal Nerve Entrapment (PNE) represents the most common bicycling-associated urogenital complaint. Numbness in the perineum, penis, scrotum or buttocks—‘genital numbness’—is the most common and most recognized symptom of pudendal compression. Despite several studies demonstrating a link between elite cyclists and erectile dysfunction, for the average cyclist riding may actually have a protective effect on sexual function.
The development of the Cystectomy-Pathway Assessment Tool (C-PAT): a concise tool to assess the quality of care in the cystectomy pathway
(Wiley, 2021-07-27) Uren, Alan; Cotterill, Nikki; Abrams, Paul; Catto, James; Patel, Biral; McGrath, John; Ahmed, Iram; Rowe, Edward; Patel, Biral; Medical and Dental
Objectives: To develop and test the psychometric properties of a concise, patient-reported questionnaire, designed to assess key aspects of the radical cystectomy (RC) patient pathway that are important to both patients and clinicians. Patients and methods: Draft items were developed by a consultation with a 13-member expert clinical panel, and the in-depth qualitative analysis of 14 semi-structured interviews with patients who had received RC within the previous 18 months. A further nine cognitive interviews with patients refined the items and ensured they were easy to complete. Pilot testing in 122 patients recruited from five hospitals in England tested the properties of validity and reliability of the resulting 17-item questionnaire. Results: Patients and clinicians identified the following aspects as important for the delivery of quality patient care. These included timely referral and initial test results; an explanation of risk/benefits of treatment; access to a cancer nurse specialist; training and support in stoma management; timely surgery, surgical complications, and timely follow-up. Pilot testing showed missing data was low (≤3% for all items), and between 73% and 89% of the responses to items were the most positive about their care (indicating ceiling effects). Five items were identified using factor analysis as being statistically related (Cronbach's α 0.76, intraclass correlation coefficient test-retest reliability of 0.95) and formed the scored part of the tool 'care and support', scored 0-16. There was insufficient evidence at this stage to show the tool was capable of measuring differences between cancer centres. Conclusion: We have developed a questionnaire that captures aspects of quality of care within the RC patient pathway. The results support the validity and reliability of the 17-item Cystectomy-Pathway Assessment Tool (C-PAT). We envisage the tool can be the basis for audit of the patient reported assessment of the quality of care for individual cancer centres.
Surgery for pathological T3a, T3b and lymph node positive, prostate cancer: surgical, functional and oncological outcomes
(SAGE Publications, 2020-09-20) Gilliland, Niall; Vennam, Sarath; Geraghty, Robert; Peacock, Julian; Crockett, Matthew; Kearley, Samantha; Oxley, Jon; Porter, Tim; Waine, Elizabeth; Aning, Jonathan; Rowe, Edward; Koupparis, Anthony; Crockett, Matthew; Medical and Dental
Objective: To investigate and document the surgical, functional and oncological outcomes following surgery for high-risk prostate cancer patients. Patients and methods: Patients with pathological T3a, T3b and N1 disease were extracted from our prospectively updated institutional database. Data include demographics, preoperative cancer parameters, short and long-term complications and functional results. Details of biochemical recurrence, type and oncological outcome of salvage treatments, cancer-specific and overall survival were also obtained. Results: A total of 669 patients were included; 58.9% had T3a disease, 35.9% had pT3b and 11.4% N1 disease. With a median follow-up of 66 months (8–129), overall survival was 94.3%, cancer-specific survival was 98.7% and biochemical recurrence was 45.6%. Average inpatient stay was 1 day and the overall complication rate was 9.1%; 54.2% experienced a biochemical recurrence and 90.3% went on to have one or more salvage treatments, which were varied. Significant predictors of biochemical recurrence included pathological stage, any positive margin and patient age (P<0.005). A total of 44.9% had an immediate biochemical recurrence, with 90% receiving subsequent treatment and 20.5% having a durable response. None of the patients receiving prostate bed radiotherapy alone had a durable response. 54% had a delayed biochemical recurrence, with 63.5% receiving subsequent treatment and 44% having a durable response. Conclusions: Surgery is associated with encouraging surgical and functional outcomes, cancer-specific survival and overall survival rates in these patients. Pathological stage is a significant predictor of biochemical recurrence. The present analysis shows that long-term observation for certain patients with biochemical recurrence is appropriate and questions the effectiveness of further local salvage treatments in patients with an immediate biochemical recurrence postoperatively.
The baby pacifier sign: Bilateral ureteric obstruction secondary to prostate cancer
(SAGE Publications, 2020-05-26) Kass-iliyya, Antoine; Okeke, Aloysius; Gibson, Maurice; Kass-iliyya, Antoine; Okeke, Aloysius; Gibson, Maurice; Medical and Dental
No abstract available
A urological urgent assessment unit service evaluation in a United Kingdom hospital
(Wiley, 2023-09-04) White, Emma; White, Emma; Nursing and Midwifery Registered
What are the experiences, evaluations and satisfaction levels of service users requiring ambulatory, urgent and emergency urological care who attended a newly implemented urology assessment unit (UAU) in a National Health Service (NHS) hospital in the United Kingdom (UK)? A UAU within an acute care setting was set up for ambulatory, emergency and urgent urological care. The objectives of the unit was to improve patient satisfaction, divert patients from the emergency department, provide an area for early specialist review, allow earlier discharge from hospital and prevent unnecessary admissions to hospital. The aim of this service evaluation (SE) was to evaluate the service user experience and satisfaction when attending this unit. Surgical assessment units are well-supported in terms of reducing admissions and diverting patients from emergency departments, however, there is little published research regarding units specifically for urology. Important sources involved in urological care delivery and services advocate their implementation but there remains very little published evidence to support this. Opinion pieces and short case studies have yielded positive results. No research was found that has looked into patient satisfaction, experience and feedback of these units in any detail. A SE was conducted involving sending a postal questionnaire to a random selection of 150 patients who attended the UAU. The questionnaire contained a set of 13 Likert-style questions with additional free text open-ended questions for provision of further clarification and service user expression. Questions around age, reason for admission and accessibility to the UAU were also included. The Likert-style and demographic questions were analysed by quantifying responses to percentages and the open-ended responses were analysed thematically. The questionnaire response rate of 51% was seen from 76 respondents and these were most commonly over 71 years old (47%). The most common reasons for attending were urinary retention, infection and post-operative urological problems. Of these, 22% did not need to see a doctor and were treated and discharged by the urology nurse practitioner. The care on the UAU was rated highly and generally found to be preferable over the care provided by emergency departments (ED) and general practitioners (GP) family doctors and patients were grateful to avoid being admitted to hospital. Patients appreciated easy access to specialist care and knowledge. Good levels of communication were highlighted as important. Open-ended response themes included; nursing, doctors, environment, access, communication, specialist access, preventing ED attendances and hospital admissions. Participants rated the care from the nurses and doctors highly; there was a focus on appreciating seeing a specialist directly and avoiding admission to hospital. They were satisfied with being able to avoid attending their GP or ED, and generally preferred the unit over these routes of care. There are multiple areas within emergency and urgent urological care that require further research.
BAUS 10-point plan for widening participation: Are principles of Equality, Diversity and Inclusion (EDI) framework being addressed – Evidence from annual BAUS meeting programmes
(SAGE Publications, 2023-05-10) Massella, Virginia; Cresswell, Jo; Willis, Susan; Gbolahan, Olayinka; Sinha, Mriganka Mani; Pietropaolo, Amelia; Shrotri, Nitin; Phillip, Joe; Pearce, Ian; Somani, Bhaskar; Sinha, Mriganka Mani; Medical and Dental
Introduction: In response to the Kennedy Report and to widen participation, BAUS implemented a 10-point action plan in 2021, with one of the pillars being inclusivity and non-diverse panels for conferences. We compared the ethnic and gender trends of speakers at BAUS annual meetings to review and analyse changing trends Methods: Data for BAUS annual meetings over a 14-year period(2009-2022) were obtained for 4 sub-sections including Endourology, Oncology, Andrology and Female, Neurological and Urodynamic urology(FNUU). This was then compared for gender and ethnic diversity(ED) for period 1(2009-2020) and period 2(2021 and 2022), representing pre and post 10 point action plan development. Results: A total of 2476 speakers were involved, with 1903(76.9%) and 573(23.1%) in periods 1 and 2 respectively. The proportion of white males reduced from 67%) to 39.1%) during periods 1 and 2, while this increased for ED males (19.6% to 30.3%), white females (11.3% to 20%) and ED females (1.5% to 10.4%) during the same period. Conclusions: Annual BAUS meetings have seen a higher proportion of ethnic minority and gender representation in recent years, with BAUS becoming a more progressively inclusive association reflecting the demographic of its membership clearly demonstrating early success for the 10 point action plan.
Flexible Ureteroscopy: Global User Experience Using Disposable Devices
(Springer, 2023-10-07) Kasmani, Zain; Ravindraanandan, Manoj; Mahmalji, Wasim; Kasmani, Zain; Medical and Dental
Introduction: Renal stone treatment through flexible ureteroscopy is widely established and successful. Ureteroscopes can broadly be classified into reusable and single-use disposable devices, each with their own advantages. Disposable scopes are cheaper to buy, maintain, and dispose of but may have a greater environmental impact and long-term cost. To establish the collective views of urologists, we conducted a multicentre, global study to demonstrate users’ experience with single-use flexible ureteroscopes. Methods: An online nine-question survey was distributed to urologists globally through email and social media platforms. Questions focused on user grade, experience, location, general opinion, advantages, disadvantages, and estimated cost of a single-use flexible ureteroscope. All responses were collated over a three-day period and analysed using descriptive statistics. Results: A total of 69 responses were received; the majority of responses were from the UK (75%), and most were consultants (64%). Two-thirds of those surveyed had used a single-use scope on a patient, and 95% of them stated they enjoyed using it, citing excellent vision and reduced need for maintenance. The majority (52%) stated that widespread adoption of disposable scopes was limited due to their prohibitive expense, with an average, sterling-converted responder-estimated cost of £991 (£100-£6000) per reusable scope. Conclusion: Most urologists enjoyed using disposable scopes, finding them comparable or better than reusable devices. However, the initial cost can be prohibitive in certain centres. The potential environmental impact is a further concern as this remains largely unknown for now. In the meantime, it is likely that stone units will continue to use a combination of single-use and reusable scopes, considering their individual needs and budgets as well as local availability and price.
Technical Aspects and Clinical Outcomes of Robotic Ureteroscopy: Is It Ready for Primetime?
(Springer Nature, 2023-06-01) Sinha, Mriganka Mani; Gauhar, Vineet; Tzelves, Lazaros; Tefik, Tzevat; Ergul, Rifat Burak; Juliebø-Jones, Patrick; Somani, Bhaskar; Sinha, Mriganka Mani; Medical and Dental
Purpose of review: Robotic surgery in urology has already been widely employed in robotic-assisted laparoscopic surgery for minimally invasive procedures (MIS). We wanted to analyse rapidly developing robotic ureteroscopy (RoboURS) for the treatment of renal stone disease. Recent findings: A comprehensive literature review was performed for technical aspects and clinical outcomes of RoboURS. RoboURS has made significant breakthroughs with each model proving that this technology improves ergonomics and supports surgeon and instrument longevity while minimising musculoskeletal issues in retrograde intra-renal surgery (RIRS). Further randomised controlled trials are required to compare the efficacy of RoboURS vs manual flexible ureteroscopy (FURS). The cost-effectiveness will also need to be assessed prior to widespread acceptance into urological infrastructure and mainstream practice. RoboURS continues to evolve despite the limitations of infrastructure and cost-effectiveness. It holds the promise of a better future for surgeon longevity, reduced peri-operative morbidity and better workplace environment.

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