Subjects -> MEDICAL SCIENCES (Total: 8196 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (205 journals)
    - ANAESTHESIOLOGY (105 journals)
    - CARDIOVASCULAR DISEASES (334 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (19 journals)
    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (227 journals)
    - DENTISTRY (266 journals)
    - DERMATOLOGY AND VENEREOLOGY (162 journals)
    - EMERGENCY AND INTENSIVE CRITICAL CARE (121 journals)
    - ENDOCRINOLOGY (149 journals)
    - FORENSIC SCIENCES (43 journals)
    - GASTROENTEROLOGY AND HEPATOLOGY (178 journals)
    - GERONTOLOGY AND GERIATRICS (125 journals)
    - HEMATOLOGY (160 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (177 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (90 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (2241 journals)
    - NURSES AND NURSING (331 journals)
    - OBSTETRICS AND GYNECOLOGY (199 journals)
    - ONCOLOGY (355 journals)
    - OPHTHALMOLOGY AND OPTOMETRY (135 journals)
    - ORTHOPEDICS AND TRAUMATOLOGY (150 journals)
    - OTORHINOLARYNGOLOGY (76 journals)
    - PATHOLOGY (96 journals)
    - PEDIATRICS (254 journals)
    - PHYSICAL MEDICINE AND REHABILITATION (153 journals)
    - PSYCHIATRY AND NEUROLOGY (800 journals)
    - RADIOLOGY AND NUCLEAR MEDICINE (182 journals)
    - RESPIRATORY DISEASES (109 journals)
    - RHEUMATOLOGY (76 journals)
    - SPORTS MEDICINE (77 journals)
    - SURGERY (388 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (151 journals)

UROLOGY, NEPHROLOGY AND ANDROLOGY (151 journals)                     

Showing 1 - 144 of 144 Journals sorted alphabetically
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Advances in Chronic Kidney Disease     Hybrid Journal   (Followers: 15)
Advances in Urology     Open Access   (Followers: 13)
African Journal of Nephrology     Open Access   (Followers: 1)
African Journal of Urology     Open Access   (Followers: 7)
AJP Renal Physiology     Hybrid Journal   (Followers: 8)
Aktuelle Urologie     Hybrid Journal   (Followers: 4)
American Journal of Kidney Diseases     Hybrid Journal   (Followers: 53)
American Journal of Men's Health     Open Access   (Followers: 9)
American Journal of Nephrology     Full-text available via subscription   (Followers: 31)
Andrologia     Hybrid Journal   (Followers: 3)
Andrology     Hybrid Journal   (Followers: 5)
Andrology & Gynecology : Current Research     Hybrid Journal   (Followers: 4)
Andrology and Genital Surgery     Open Access   (Followers: 8)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 2)
Arab Journal of Urology     Open Access   (Followers: 7)
Archives of Clinical Nephrology     Open Access   (Followers: 2)
Archivio Italiano di Urologia e Andrologia     Open Access   (Followers: 1)
Archivos Españoles de Urología     Open Access   (Followers: 1)
Asian Journal of Andrology     Open Access   (Followers: 1)
Asian Journal of Urology     Open Access   (Followers: 3)
Asian Pediatric Nephrology Association     Open Access   (Followers: 3)
Bangladesh Journal of Urology     Open Access   (Followers: 5)
Basic and Clinical Andrology     Open Access  
BJU International     Hybrid Journal   (Followers: 19)
BJUI Compass     Open Access   (Followers: 1)
BMC Nephrology     Open Access   (Followers: 9)
BMC Urology     Open Access   (Followers: 13)
Canadian Journal of Kidney Health and Disease     Open Access   (Followers: 7)
Canadian Urological Association Journal     Open Access   (Followers: 1)
Cancer Urology     Open Access   (Followers: 1)
Cardiorenal Medicine     Full-text available via subscription   (Followers: 1)
Case Reports in Nephrology     Open Access   (Followers: 6)
Case Reports in Nephrology and Dialysis     Open Access   (Followers: 8)
Case Reports in Urology     Open Access   (Followers: 11)
Clinical and Experimental Nephrology     Hybrid Journal   (Followers: 5)
Clinical Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 24)
Clinical Kidney Journal     Open Access   (Followers: 5)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Nephrology     Full-text available via subscription   (Followers: 8)
Cuadernos de Cirugía     Open Access  
Current Opinion in Nephrology & Hypertension     Hybrid Journal   (Followers: 12)
Current Opinion in Urology     Hybrid Journal   (Followers: 11)
Current Urology     Open Access   (Followers: 10)
Current Urology Reports     Hybrid Journal   (Followers: 5)
Der Nephrologe     Hybrid Journal  
Der Urologe     Hybrid Journal   (Followers: 1)
Diabetic Nephropathy     Open Access  
EMC - Urología     Full-text available via subscription  
Enfermería Nefrológica     Open Access   (Followers: 1)
European Urology     Hybrid Journal   (Followers: 23)
European Urology Focus     Hybrid Journal   (Followers: 4)
European Urology Oncology     Hybrid Journal  
European Urology Open Science     Open Access   (Followers: 8)
Forum Nefrologiczne     Full-text available via subscription  
Geriatric Nephrology and Urology     Hybrid Journal   (Followers: 7)
Giornale di Clinica Nefrologica e Dialisi     Open Access  
Hellenic Urology     Open Access   (Followers: 4)
IJU Case Reports     Open Access  
Indian Journal of Nephrology     Open Access   (Followers: 2)
Indian Journal of Urology     Open Access   (Followers: 5)
International Brazilian Journal of Urology     Open Access   (Followers: 5)
International Journal of Nephrology     Open Access   (Followers: 2)
International Journal of Nephrology and Renovascular Disease     Open Access   (Followers: 2)
International Journal of Urology     Hybrid Journal   (Followers: 10)
International Urology and Nephrology     Hybrid Journal   (Followers: 6)
Journal für Urologie und Urogynäkologie/Österreich     Hybrid Journal  
Journal of Clinical Nephrology     Open Access   (Followers: 1)
Journal of Clinical Urology     Hybrid Journal   (Followers: 12)
Journal of Endoluminal Endourology     Open Access  
Journal of Endourology     Hybrid Journal   (Followers: 2)
Journal of Endourology Case Reports     Hybrid Journal  
Journal of Genital System & Disorders     Hybrid Journal   (Followers: 1)
Journal of Integrative Nephrology and Andrology     Open Access   (Followers: 2)
Journal of Kidney Cancer and VHL     Open Access  
Journal of Lower Genital Tract Disease     Hybrid Journal  
Journal of Nephrology     Hybrid Journal   (Followers: 5)
Journal of Nephrology Research     Open Access   (Followers: 2)
Journal of Pediatric Nephrology     Open Access   (Followers: 3)
Journal of Renal Care     Hybrid Journal   (Followers: 8)
Journal of Renal Nursing     Full-text available via subscription   (Followers: 8)
Journal of Renal Nutrition     Hybrid Journal   (Followers: 28)
Journal of Renal Nutrition and Metabolism     Open Access   (Followers: 2)
Journal of the American Society of Nephrology     Full-text available via subscription   (Followers: 38)
Journal of The Egyptian Society of Nephrology and Transplantation     Open Access  
Journal of Urology & Nephrology     Open Access  
Kidney Diseases     Open Access   (Followers: 3)
Kidney International     Hybrid Journal   (Followers: 52)
Kidney International Reports     Open Access   (Followers: 6)
Kidney Medicine     Open Access   (Followers: 1)
Kidney Research Journal     Open Access   (Followers: 6)
Kidneys (Počki)     Open Access  
Nature Reviews Nephrology     Full-text available via subscription   (Followers: 29)
Nature Reviews Urology     Full-text available via subscription   (Followers: 9)
Nefrología     Open Access  
Nefrología (English Edition)     Open Access  
Nephro-Urology Monthly     Open Access   (Followers: 1)
Nephrology     Hybrid Journal   (Followers: 13)
Nephrology Dialysis Transplantation     Hybrid Journal   (Followers: 26)
Nephron     Hybrid Journal   (Followers: 3)
Nephron Clinical Practice     Full-text available via subscription   (Followers: 3)
Nephron Experimental Nephrology     Full-text available via subscription   (Followers: 4)
Nephron Extra     Open Access   (Followers: 1)
Nephron Physiology     Full-text available via subscription   (Followers: 4)
Neurourology and Urodynamics     Hybrid Journal   (Followers: 1)
OA Nephrology     Open Access   (Followers: 2)
Open Access Journal of Urology     Open Access   (Followers: 6)
Open Journal of Nephrology     Open Access   (Followers: 4)
Open Journal of Urology     Open Access   (Followers: 6)
Open Urology & Nephrology Journal     Open Access  
Paediatric Nephrology Journal of Bangladesh     Open Access   (Followers: 4)
Portuguese Journal of Nephrology & Hypertension     Open Access   (Followers: 1)
Progrès en Urologie     Full-text available via subscription  
Progrès en Urologie - FMC     Full-text available via subscription  
Prostate Cancer and Prostatic Diseases     Hybrid Journal   (Followers: 4)
Renal Failure     Open Access   (Followers: 11)
Renal Replacement Therapy     Open Access   (Followers: 3)
Research and Reports in Urology     Open Access   (Followers: 4)
Revista de Nefrología, Diálisis y Trasplante     Open Access   (Followers: 1)
Revista Mexicana de Urología     Open Access  
Revista Urologia Colombiana     Open Access  
Scandinavian Journal of Urology     Hybrid Journal   (Followers: 6)
Seminars in Nephrology     Hybrid Journal   (Followers: 11)
The Prostate     Hybrid Journal   (Followers: 6)
Therapeutic Advances in Urology     Open Access   (Followers: 3)
Translational Research in Urology     Open Access   (Followers: 1)
Trends in Urology & Men's Health     Partially Free   (Followers: 1)
Urine     Open Access  
Uro-News     Hybrid Journal  
Urolithiasis     Hybrid Journal   (Followers: 1)
Urologia Internationalis     Full-text available via subscription   (Followers: 1)
Urologia Journal     Hybrid Journal  
Urologic Clinics of North America     Full-text available via subscription   (Followers: 3)
Urologic Nursing     Full-text available via subscription   (Followers: 3)
Urological Science     Open Access  
Urologicheskie Vedomosti     Open Access  
Urologie in der Praxis     Hybrid Journal  
Urology     Hybrid Journal   (Followers: 26)
Urology Case Reports     Open Access   (Followers: 3)
Urology Times     Free   (Followers: 3)
Urology Video Journal     Open Access  
World Journal of Nephrology and Urology     Open Access   (Followers: 5)
World Journal of Urology     Hybrid Journal   (Followers: 10)

           

Similar Journals
Journal Cover
Journal of Clinical Urology
Journal Prestige (SJR): 0.15
Number of Followers: 12  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2051-4158 - ISSN (Online) 2051-4166
Published by Sage Publications Homepage  [1174 journals]
  • Editorial

    • Free pre-print version: Loading...

      Pages: 271 - 271
      Abstract: Journal of Clinical Urology, Volume 15, Issue 4, Page 271-271, July 2022.

      Citation: Journal of Clinical Urology
      PubDate: 2022-07-16T10:20:04Z
      DOI: 10.1177/20514158221113666
      Issue No: Vol. 15, No. 4 (2022)
       
  • Male factor infertility: A contemporary overview of investigation,
           diagnosis and management

    • Free pre-print version: Loading...

      Authors: Anil Krishan, Josip Vukina, Ian Pearce, Vaibhav Modgil
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Infertility, defined as the failure to achieve a clinical pregnancy after 1 year of regular, unprotected sexual intercourse, is a public health issue of global concern. It affects up to 12% of couples worldwide. While traditionally, research and treatment have focused on female causes of infertility, male factors contribute to up to 70% of cases and therefore deserve appropriate recognition. The purpose of this comprehensive review is to detail the diagnostic work-up, investigations and management of male factor infertility. We discuss much-debated pathologies, such as varicocele, and novel investigations, including sperm DNA fragmentation and reactive oxygen species.Level of evidence: Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-08-01T12:09:21Z
      DOI: 10.1177/20514158221078474
       
  • The negative impact of timed intercourse in infertile couples: A
           prospective cohort study

    • Free pre-print version: Loading...

      Authors: Sujoy Dasgupta, Leila CG Frodsham, Tet L Yap, Paramita Patra, Abhyuday Chanda
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To study the differences in sexual dysfunction and time to pregnancy (TTP) between infertile couples pursuing timed intercourse (TI – around the time of ovulation) and regular intercourse (RI – at least twice a week).Methods:In this prospective cohort study, we recruited all infertile couples presenting to the regional infertility clinics from January 2016 to December 2018, pursuing TI (n = 283) or RI (n = 88), and having no pre-existing sexual or psychiatric illness, and no medical contraindications to frequent intercourse. Sexual dysfunction was assessed using the Arizona Sexual Experience Scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The couples for whom natural conception was possible were followed up to determine TTP using Kaplan–Meier analysis.Results:TI significantly increased the risk of sexual dysfunction than RI for both males and females, even after adjusting for age, medical disorders, obesity, smoking, cause of infertility, and previous assisted reproductive techniques. TI increased the risk of erectile dysfunction, premature ejaculation, male hypoactive sexual dysfunction, female sexual interest-arousal disorder, and female orgasmic disorder. The TTP for natural conception was similar between them.Conclusion:TI increased the risk of sexual dysfunction without accelerating the time to achieve pregnancy, compared with RI.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-07-23T12:29:43Z
      DOI: 10.1177/20514158221113164
       
  • Effects of body fat components on early renal functions of individuals
           following kidney donation

    • Free pre-print version: Loading...

      Authors: Metin Yığman, Semih Tangal
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Obesity stands as a risk factor for the chronic kidney disease. The objective of this study was to investigate the relationship between early renal function following kidney donation and the measurements of body fat components.Methods:In total, 86 donors followed up for at least 6 months postoperatively were included. Height and weight measurements and results of laboratory analysis of all donors were recorded retrospectively. Visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), hepatic fat (HF), pancreatic fat (PF) and splenic fat (SF) measurements were performed, and pancreatic splenic fat fraction difference (P−S) and pancreatic splenic fat fraction ratio (P/S) were calculated by a radiologist using the records of preoperative computed tomography scans of donors.Results:The estimated glomerular filtration rate (eGFR), serum creatinine and spot urinary microalbumin/creatinine ratio values of the donors at the sixth month postoperatively were statistically different from those of the preoperative values (p < 0.001). In addition, the individuals were divided into two categories based on the postoperative eGFR: ⩾ 60 mL/min/1.73 m2 and < 60 mL/min/1.73 m2. Age, low-density lipoprotein (LDL) level and VAT/SAT ratio were lower in group eGFR: ⩾ 60 (p < 0.001, p = 0.03, p = 0.007, respectively). Age and VAT/SAT ratio were the parameters found to be affecting the eGFR significantly, and VAT/SAT ratio (0.729, 95% CI: 0.602–0.856, p = 0.007) had higher predictive value in receiver operating characteristic curve (ROC).Conclusion:Preoperative measurements of body fat components may provide significant information to predict postoperative renal functions of kidney donor candidates.Level of evidence:Not applicable.
      Citation: Journal of Clinical Urology
      PubDate: 2022-07-21T10:46:28Z
      DOI: 10.1177/20514158221109411
       
  • Ethnic and gender trends at the annual British Association of Urological
           Surgeons (BAUS) meeting: A review of BAUS programmes over a 13-year period
           (2009–2021)

    • Free pre-print version: Loading...

      Authors: Virginia Massella, Mriganka Sinha, Amelia Pietropaolo, Robert Geraghty, Miss Jo Cresswell, Joe Philip, Nitin Shrotri, Bhaskar K Somani
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:In this paper, we wanted to review the annual British Association of Urological Surgeons (BAUS) programme to analyse the female and ethnic minority (EM) representation and find out whether there is ethnic and gender disparity, and if it does reflect the reality of the workforce.Methods:To investigate gender and EM representation, we requested data for BAUS annual meetings over a 13-year period (2009–2021). All speakers and chairpersons for all four sub-sections including Endourology, Oncology, Andrology and Female, Neurological and Urodynamic urology (FNUU) were collated. We also looked at the geographic distribution of the speakers (London area, rest of England, Scotland, Northern Ireland and Wales). Data were analysed separately before and after the COVID-19 pandemic (cut-off March 2020), as in the latter 2 years, the meeting was held virtually.Results:A total of 2569 speakers (range: 135–323 speakers/year) were included in our analysis and 2187 (85%) speakers were from the United Kingdom. Of the UK speakers, more than three-quarters (76.6%, n = 1676) were males and females of White ethnicity and (23.4%, n = 511) were EM. The vast majority of speakers throughout the years were males (86%, n = 1891) with only 14% (n = 296) females regardless of their origin and ethnicity. The presence of EM females was only 1.9% (n = 43). The percentage of female representation rose consistently over time from 6.7% (n = 8) in 2009 to 21.1% (n = 44) in 2020, suggesting an upward trend. Regional distribution showed 31%, 63%, 3.6%, 1.6% and 0.2% from London, Rest of England, Scotland, Wales and Northern Ireland, respectively. Both gender and EM representation doubled in the last 2 years during the pandemic (p < 0.001).Conclusion:Annual BAUS meetings have seen a higher proportion of ethnic and gender representation in recent years. However, considering the workforce within urology, more needs to be done to address this historical disparity. Hopefully, the BAUS 10-point programme will provide a framework for addressing Equality, Diversity and Inclusion issues related to this bias.Level of evidence:Not applicable.
      Citation: Journal of Clinical Urology
      PubDate: 2022-07-16T05:24:14Z
      DOI: 10.1177/20514158221101760
       
  • Unresolving epididymo-orchitis: An atypical presentation of COVID-19

    • Free pre-print version: Loading...

      Authors: Thomas Thompson, Gage Rosimus, Ian Pearce, Vaibhav Modgil
      Abstract: Journal of Clinical Urology, Ahead of Print.

      Citation: Journal of Clinical Urology
      PubDate: 2022-07-11T11:29:51Z
      DOI: 10.1177/20514158221081390
       
  • Young-Dees bladder neck reconstruction: An effective alternative in the
           treatment of urinary incontinence following urethroplasty for pelvic
           fracture urethral injury

    • Free pre-print version: Loading...

      Authors: Bobby Viswaroop Sistla, Ganesh Gopalakrishnan
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Introduction:We review our experience of Young-Dees bladder neck reconstruction (BNR) in treatment of urinary incontinence following anastomotic urethroplasty for pelvic fracture urethral injury (PFUI).Material and methods:Between January 2009 and June 2015, 11 patients presented with urinary incontinence following urethroplasty for PFUI. After evaluation with voiding cystourethrogram, urodynamics and cystoscopy, seven were found to be having genuine stress urinary incontinence. All seven underwent Young-Dees BNR. We also looked at whether there were any predictors of either poor or good outcome following surgical correction based on radiographic, endoscopic and urodynamic findings.Results:Of the seven patients who had undergone Young-Dees BNR, four had urethroplasty at our centre (4/89, 4.4%). Median age was 23 years (range = 14–31 years), and median time to definitive treatment was 15 months (range = 9–126 months). Age at injury 15 years in five. Four (56%) had pubic diastases, in three, it was secondary to the injury, and in one, it was consequent to facilitating urethroplasty via a formal transpubic approach. There were no consistent radiographic findings on the pre-operative studies which could predict whether the configuration of the bladder neck or the degree of bladder descent might result in incontinence. The number of prior attempts at urethroplasty when compared to a similar cohort was also non-contributory. At urodynamics, all bladders were stable on filling and there were no issues related to compliance with the bladder neck being occluded. The detrusor pressure generated during voiding and with the bladder neck occluded did help us to counsel patients regarding the outcome of surgery and if there would be a need for clean intermittent self-catheterisation following surgery. All patients are voiding via naturalis without the need for clean intermittent self-catheterisation and are socially continent.Conclusion:Young-Dees BNR may be a forgotten procedure but is worth revisiting in patients with stress urinary incontinence following successful urethroplasty for PFUI. It is cost-effective and can be done without the Leadbetter modification.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-07-06T11:06:47Z
      DOI: 10.1177/20514158221081312
       
  • Paraganglioma (pheochromocytoma) of the urinary bladder: A systematic
           review with a diagnostic, management and treatment algorithm

    • Free pre-print version: Loading...

      Authors: Ali Hooshyari, Matthew Tyson, Michael Rice
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Introduction:Paraganglioma of the urinary bladder is a rare but well-documented tumour. Herein, we provide the largest, comprehensive systematic review of the literature and aim to increase familiarity with this rare but significant neoplasm.Methods:A systematic review of the literature was conducted on the NCBI PubMed database. The search criteria were not limited to any specific years or languages. There were 418 articles between January 1953 and August 2020, of which 255 case reports were selected.Results:Paragangliomas of the urinary bladder most commonly occurred in Caucasians in the fifth decade of life, most commonly presenting with haematuria and variations of ‘micturition attacks’. Eighty percent of tumours were functionally active. The mucosa was normal in 91% of patients. In all, 25% of tumours were treated with transurethral resection alone, 65% had partial cystectomy and 5% had radical cystectomy. Alpha-blockers were administered pre-operatively in 38% of patients and the risk of intra-operative hypertensive crisis was over three times greater in those who did not receive an alpha-blocker. The tumour was confined to the bladder in 75% of cases. Metastasis occurred in 20% of cases, most commonly to iliac nodes. The mean follow-up time was 26.5 months. In cases that documented follow-up, 18.6% had recurrence, most commonly in lymph nodes and bone.Conclusion:All patients presenting with micturition attacks or haematuria with a computed tomography showing an enhancing, well-defined submucosal bladder lesion and/or cystoscopy showing a lesion with normal overlying mucosa should be worked up for a possible paraganglioma of the urinary bladder.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-29T11:51:48Z
      DOI: 10.1177/20514158221090329
       
  • Telehealth: A new paradigm' Paediatric surgical subspecialty
           telemedicine survey in the COVID-19 Pandemic at a tertiary care centre

    • Free pre-print version: Loading...

      Authors: Yu Jin Shin, Amrita Mohanty, Audry Kang, Clark E Judge, Fuad M Baroody, Andrea Shogan, Sarah H Rodriguez, Russell R Reid, David Frim, Nikunj K Chokshi, Grace Mak, Mark B Slidell, Thomas K Lee, Jessica Kandel, Amber Truehart, Mohan S Gundeti
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:Although the technology has been available and several pilot studies have shown success, use of telemedicine has previously been limited in the United States, especially among surgeons. This study aimed to investigate the benefits and obstacles for successful implementation of telemedicine visits in paediatric surgical subspecialties amid the COVID-19 pandemic.Methods:We analysed survey data from telemedicine visits with paediatric surgical subspecialists from May 1 through June 30, 2020 at our paediatric surgery subspecialty clinics. Univariate logistic regression was used to determine associations in survey responses and various demographic factors.Results:There were 164 respondents to the survey. The most frequently cited barrier to care was ability to get time off work (46.3%). Overall satisfaction with the telemedicine visit was 93.8%, and 55.6% responded that they would choose video telemedicine rather than an in-person or telephone visit. Those living at least 25 miles from the hospital had increased odds of indicating interest in using telemedicine for future visits (OR = 2.56, 95% CI = 1.12–5.86, p = 0.026). The average respondent saved between 30 minutes and 1 hour, and 45 minutes using telemedicine.Conclusions:The implementation of telemedicine at our institution in the paediatric surgical subspecialties has proven to be effective and well-received. Given the benefits of time and money saved for families, paired with high satisfaction rates and continued interest, paediatric surgical subspecialists should work to incorporate virtual visits into regular patient care, even well after the COVID-19 pandemic.Level of Evidence:Level IV
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-29T06:55:12Z
      DOI: 10.1177/20514158221086137
       
  • Venous thromboembolism (VTE) prophylaxis following transurethral resection
           of the prostate (TURP): An audit of practice in Scotland

    • Free pre-print version: Loading...

      Authors: Robert Peter Small, Jaimin Bhatt
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objectives:To establish the current practice of urologists in Scotland with regard to venous thromboembolism (VTE) prophylaxis following transurethral resection of the prostate (TURP).Methods:An electronic survey was distributed to all practicing urology consultants and trainees in Scotland. Participants were asked questions regarding their current practice with regard to peri-operative VTE prophylaxis and were offered free-text responses. Findings were compared with a previous UK-wide study from 2002, and with current European Association of Urology (EAU) guidelines.Results:56/113 (49.6%) of urologists responded to the survey. Overall, 71.4% of responding urologists prescribed pharmacological VTE prophylaxis following TURP. No urologists routinely prescribe VTE prophylaxis on discharge. 94.6% of responding urologists utilise mechanical prophylaxis in the form of thromboembolic deterrent (TED) stockings, with 35.7% of urologists discharging patients with TED stockings. No urologists reported a death from uncontrollable bleeding after TURP in the previous 10 years, whereas 10% of respondents had a patient whom had suffered a death or serious complication from a thromboembolic event following TURP in the past 10 years. A range of free-text responses were given.Conclusion:Our national audit has identified a wide variation between practice and current published guidance. These results contrast dramatically with a previous UK wide audit from 2002, which found 14% of urologists utilised pharmacological prophylaxis, 50% utilised mechanical prophylaxis only and 23% used no thromboprophylaxis at all. Recent guidance from the EAU recommends against using pharmacological prophylaxis due to the increased bleeding risk. Given that current practice does not marry with published recommendations; we believe that further research is required in this area for stronger evidence-based guidelines to be developed.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-09T01:26:35Z
      DOI: 10.1177/20514158221089413
       
  • Determining risk factors for symptomatic urinary tract infection following
           trial of void: A retrospective analysis

    • Free pre-print version: Loading...

      Authors: Michael Kwok, William Yaxley, Sachinka Ranasinghe, Leanne Morton, Sachin Perera, Kreyen Ponen, Anita Pelecanos, Sumudu Britton, Patrick NA Harris, David L Paterson, Rachel Esler, David Hussey, John W Yaxley, Matthew J Roberts
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To investigate the incidence and risk factors for symptomatic urinary tract infection (UTI) following trial of void (TOV) to guide patient selection for antibiotic prophylaxis.Methods:A retrospective study considered all patients who underwent successful TOV across two separate 12-month periods at a tertiary hospital. Routine prophylactic antibiotics were not administered.Results:The 183 patients included were mostly men (91.3%) aged ⩾ 65 years (78.7%). Thirty-seven (20.3%) had recent urological surgery. The incidence of UTI following TOV was 12.6% (23/183); median duration of onset was 3 days (interquartile range = 2–9). Cystitis was most common (17/183; 9.3%), while four patients (2.2%) suffered urosepsis. There were no singular statistically significant risk factors for increasing the risk of UTI following TOV, however, ⩾ 2 risk factors showed numerically higher odds of UTI compared to ⩽ 1 risk factor (15.6% vs 4.2%; odds ratio = 4.24, 95% confidence interval = 0.96–18.80, p = 0.058). Atypical organisms resistant to most oral antibiotics were predominantly cultured, however, 89% sensitivity to ciprofloxacin was observed.Conclusion:The incidence of UTI following TOV was higher than anticipated. Reliable identification of at-risk patients for antibiotic prophylaxis is likely to be complicated. Further research is needed to confirm patient selection prior to confirmatory trials.Level of evidence:2b
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-09T01:23:52Z
      DOI: 10.1177/20514158221099856
       
  • Antimicrobial resistance profiles for bacteria isolated from rectal swabs
           in patients candidate for prostate biopsy

    • Free pre-print version: Loading...

      Authors: Solmaz Ohadian Moghadam, Ali Nowroozi, Seyed Ali Momeni, Mohammad Reza Nowroozi, Siamak Heidarzadeh, Ashkan Poorabhari
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Infection is one of the common complications of post-prostate biopsy. Therefore, prophylaxis with fluoroquinolones and/or cephalosporins is recommended. We aimed to evaluate the prevalence of antibiotic-resistant bacteria isolated from rectal swabs in candidates for transrectal ultrasound-guided (TRUS) biopsy. The possible patient’s related risk factors attributing to resistance to antibiotics were also assessed.Methods:This cross-sectional study was performed on 126 male patients who were candidates for TRUS biopsy. Rectal swabs were collected and the samples were transferred to the laboratory in Amies transport medium during 2 hours and cultured on MacConkey agar with ciprofloxacin 1 mg/L and ciprofloxacin-resistant strains were identified. Kirby-Bauer disc diffusion method was used to determine the antibiotic susceptibility of the isolates.Results:In total, 59 bacterial isolates were obtained, which were Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, respectively, in terms of frequency. They showed the lowest resistance to levofloxacin. Smoking was associated with positive culture results. Age was a factor with a significant effect on carrying ciprofloxacin-resistant strains.Conclusion:Ciprofloxacin resistance was high in almost all strains, but post-biopsy infectious complications were very low.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-09T01:12:40Z
      DOI: 10.1177/20514158221097557
       
  • Scrotal exploration for acute testicular pain: A contemporary UK series
           from a tertiary centre

    • Free pre-print version: Loading...

      Authors: William Maynard, Nimlan Shanmugathas, Alexandra Mundell, Mussab Yassin, Mariana Bertoncelli-Tanaka, Roland Morley, Suks Minhas
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objectives:The objective of this study was to assess the evaluation and operative outcomes of patients attending a single urology centre with acute testicular pain (ATP) who underwent scrotal exploration. We sought to determine adherence to the Royal College of Surgeons England (RCS) commissioning guide on testicular torsion, clinical and radiological features predictive of torsion, time-dependent salvage rates and surgical technique in a contemporary cohort.Patients and Methods:A single-centre retrospective review was carried out from 2015 to 2020. All patients presenting with acute testicular pain undergoing surgical exploration were included.Results:140 patients were identified, median age 16 years, 40 had testicular torsion (TT) (30%) where nausea (positive predictive value (PPV) 51.7%, p = 0.009) and abnormal testis lie (PPV 50%, p = 0.008) were more frequent. TT was the most common diagnosis if presenting
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-07T06:27:11Z
      DOI: 10.1177/20514158221099390
       
  • Is lower urinary tract surgery without upper pole heminephrectomy safe and
           effective in the long-term treatment of duplex system ureterocele'

    • Free pre-print version: Loading...

      Authors: Ayşe Başak Uçan, Arzu Şencan, Zehra Günyüz Temir, Özkan Okur, Gökçe Sönmez, Merve Öztürk
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:The study aimed to retrospectively evaluate postoperative results of patients with duplex system ureterocele (DSU) who underwent endoscopic ureterocele incision (UI), lower urinary tract reconstruction (LUTR) or both, and investigate the necessity of upper pole heminephrectomy (UPH) in ureterocele treatment.Patients and methods:In total, 44 patients with DSU who were operated on in December 2005 and December 2018 were evaluated for patient characteristics, ureterocele location, differential renal function (DRF), vesicoureteral reflux (VUR), postoperative incontinence, proteinuria, hypertension and urinary tract infection (UTI).Results:UI was performed in 27 of 44 cases (61.3%) as the first-line treatment. Ten of them (37%) had no urinary infection or renal function loss at a mean of 3 years (1.5–7 years). LUTR was needed in 17 patients after UI due to VUR in 14 patients and bladder outlet obstruction (BOO) in 3 patients. In total, 34 patients who underwent LUTR, proteinuria or incontinence were not detected in the mean 6 years’ follow-up. Thirty-three patients (97%) had identical renal scans and similar DRF before and after the operation. No patient underwent UPH.Conclusion:UI must be considered the first-line treatment in DSU in infancy. In older patients, especially with VUR, LUTR is effective and safe and UPH mostly is not necessary.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-07T06:24:03Z
      DOI: 10.1177/20514158221099384
       
  • Overcoming barriers for women entering the urology workforce in the United
           Kingdom

    • Free pre-print version: Loading...

      Authors: Sarah Khan-Ruf, Hannah Warren, Lizzie DhaRocca, Kamran Ahmed
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:Urology has considerable gender disparity with just 10.3% of UK consultant posts held by women and lower than the 13.2% average across all surgical specialties. Medicine is no longer a male-dominated vocation, with women making up the majority of medical graduates for almost 30 years. To recruit the highest calibre doctors, urology needs to appeal and be accessible to all talented individuals.Objective:In this paper we explore barriers to workforce diversity and propose solutions to the current problems.Methods:A literature review was conducted and authors’ opinions explored.Results:Reasons for women avoiding a career in urology include perceptions of urology as a ‘male’ specialty, lack of female role models, less mentoring and sponsorship of female medical students and trainees, and the use of derogatory and devaluing language. We suggest solutions to overcome these barriers for the benefit of profession.Conclusions:While there is a way to go to reach gender parity, there are reasons to be optimistic. We propose to see more women supported through mentoring programmes, more female representation on panels and in leadership positions to raise the profile of women in urology. We need to create a workplace culture and flexible working patterns that encourages all genders to excel.
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-07T06:21:17Z
      DOI: 10.1177/20514158221089418
       
  • Complex case of granulomatosis with polyangiitis involving the urethra and
           prostate causing outflow obstruction and ano-urethral fistula

    • Free pre-print version: Loading...

      Authors: Mustafa Rashid, Adam Cox
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Granulomatosis with polyangiitis (GPA) is an autoimmune small to medium vessel inflammatory vasculitis that can affect multiple organ systems, with predominantly pulmonary, renal and musculoskeletal manifestations. Rarely, there have been cases involving the genitourinary system, particularly causing urethritis and prostatitis. In some incidences, this may mimic prostate abscess or malignancy. We present a case of a 36-year-old man with refractory urinary retention secondary to prostate abscess due to GPA. This case necessitated transurethral resection of the prostate (TURP) and supra-pubic catheterisation, later complicated by a peri-anal abscess and severe urethritis. A potential recto-urethral fistula was noted on magnetic resonance imaging (MRI) and cystourethroscopy, which was managed conservatively with long-term catheter drainage until resolution. The patient ultimately displayed many severe clinical manifestations of a systemic vasculitis and this case report emphasises the importance of considering autoimmune vasculitis conditions as a differential diagnosis when managing inflammatory genitourinary conditions. This case report highlights the importance of obtaining sufficient tissue to make a timely diagnosis in order to initiate immunosuppressant therapy and disease-modifying anti-rheumatic drugs (DMARDs).
      Citation: Journal of Clinical Urology
      PubDate: 2022-06-03T12:07:30Z
      DOI: 10.1177/20514158211073438
       
  • First-line therapy for metastatic renal cell carcinoma

    • Free pre-print version: Loading...

      Authors: Paramvir Sawhney, Suyanto Suyanto, Agnieszka Michael, Hardev Pandha
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objectives:To evaluate current first-line treatment strategies in advanced or metastatic renal cell carcinoma (RCC), and to review other promising treatments under investigations.Materials and methods:We reviewed all relevant pivotal first-line systemic therapy trials, and studies investigating the role of cytoreductive nephrectomy, metastectomy, and ablative radiotherapy in advanced or metastatic RCC.Results:In total we identified 21 relevant studies, investigating both systemic and non-systemic therapies, including treatments under investigations.Conclusion:Metastatic RCC (mRCC) is a highly heterogeneous disease that is notoriously difficult to treat, however, the discovery of novel targeted therapies over the past decade have revolutionised its management. The International mRCC Database Consortium (IMDC) is a prognostic model that is commonly used in both clinical trials and routine clinical care to risk-stratify patients with mRCC, which has helped with therapy selection for mRCC patients over the past decade. However, with an improved understanding of tumour biology and genetics, this has prompted a shift from cytokine therapy to receptor tyrosine kinase inhibitors, and now to Immune Checkpoint Inhibitors (ICIs). Recent promising results from clinical studies with ICI combination treatments have transformed the treatment landscape for the management of intermediate- and poor- risk clear cell RCC, however, further research is still needed for favourable-risk, and non-clear cell patients.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-25T12:38:25Z
      DOI: 10.1177/20514158221092949
       
  • The ‘Emergency Stone Clinic’ – improving patient care: A
           collaborative, hospital-based quality improvement project

    • Free pre-print version: Loading...

      Authors: Edward Balai, Samuel Folkard, Tony Tien, Kerem Atalar, Brendan Berry, Shelina Runa, Christopher Bastianpillai, Stuart Graham, James Green, Pallavi Pal
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Introduction & Aims:There is a current drive nationally to improve the management of acute ureteric colic. Management targets set by the British Association of Urological Surgeons (BAUS) include a 4-week target for the time from diagnosis-to-definitive management, or to clinic review in patients managed expectantly. The motivation to review our acute stone service stemmed from concerns that we did not have the capacity to consistently offer primary definitive treatment or timely clinic review to patients. We aimed to restructure our service using Plan-Do-Study-Act (PDSA) cycles to achieve the BAUS targets.Method:All patients diagnosed with a ureteric stone between March and September 2017 were reviewed as a baseline. Our strategy for improvement involved implementing an emergency stone clinic (ESC) model. This was developed through collaboration between the key stakeholders and centred on a weekly consultant-led specialist clinic designed to review and make early management decisions for all patients referred with a ureteric stone meeting pre-agreed criteria. Post-intervention data were collected between June 2018 and January 2019. To assess whether we were able to meet these targets during the COVID-19 pandemic, data were also collected between January 2020 and October 2020.Results:Time from CT diagnosis to clinic review reduced from 77 to 9 days. Patients seen within 4 weeks of diagnosis improved from 2.9% to 90.5%. Of those requiring a procedure, the percentage receiving a primary intervention increased to 72.1%. Emergency stent insertion was reduced from 69% to 27.9%. The rate of patient re-presentation to A&E reduced from 3.0 to 1.6 episodes/month. The percentage receiving their definitive procedure within 4 weeks improved from 26.2% to 51.2% in the first post-intervention cycle and remained at 54.5% during the pandemic period.Conclusions:Implementing the ESC model led to substantial improvements in patient care and significant progress towards achieving the BAUS management targets while reducing the burden on our Emergency Department.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-21T10:26:51Z
      DOI: 10.1177/20514158221095486
       
  • Robotic pyeloplasty in a horseshoe kidney: A case report

    • Free pre-print version: Loading...

      Authors: Grace Bennett, Bachar Zelhof
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To deliver a case report showing that robotic pyeloplasty in a patient with a horseshoe kidney is not only successful but also potentially superior to laparoscopic surgery. To the best of our knowledge, this is the first case report of its kind in the United Kingdom.Method:PubMed was used to do a literature search. We have excluded papers that were written in foreign languages, or were paediatric case studies.Results:Horseshoe kidneys are the commonest congenital abnormality of the renal and are often associated with pelvic-ureteric junction obstruction (PUJO) – in the order of 30%. Minimally invasive surgery is the gold standard for management of PUJO. With the advancement of the Da Vinci robot, this case report presents a patient undergoing pyeloplasty in a horseshoe kidney with PUJO on the left side, using a robotic technique. We performed a robotic pyeloplasty on a 32-year-old woman, with a horseshoe kidney. We felt this is a case worth discussion, giving the alteration in the surgical technique in conjunction with the anatomical abnormalities, and the lack of similar reported cases in the literature. We propose that in some cases, the robotic operative technique is superior to standard laparoscopic technique. Although there is an increased cost when using the Da Vinci robot, this may be offset by the 3D visualisation, enhanced dexterity, tremor filtering and movement scaling, increased range of motion, as well as the reduction of operative time, hospital stay, blood loss, complications, and indeed patient satisfaction. In addition to the benefits of robotic surgery itself, we demonstrate that robotic surgery in this particular case was preferable to other techniques, given the anatomical exclusivity of a horseshoe kidney.Conclusion:We propose that in some cases, the robotic operative technique is superior to other minimal access techniques in urological surgery.Level of Evidence: 4
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-21T10:19:51Z
      DOI: 10.1177/20514158221089113
       
  • Group practice in Urology: A cross-sectional analysis over 8 years
           (2014–2021)

    • Free pre-print version: Loading...

      Authors: Thomas Cwalina, Michael Callegari, Brandon Piyevsky, Anood Alfahmy, Andrew Drozd, Erin Jesse, Megan Prunty, Ramy Abou-Ghayda, Michael Zell, Jason Jankowski
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Purpose:Physician and medical practices have undergone significant consolidation over the last decade. This has been in response to federal and financial changes to health care delivery within the United States. As per the 2021 AUA annual census, the percentage of employed practicing urologists (not in solo or partnership practice) increased from 51.3% to 64.4% between 2015 and 2020 (AUA Census 2021). Our objective was to further examine the changing trends among provider groups within Urology between 2014 and 2021.Methods:Publicly available information from within Medicare Physician Compare, published by the US Centres for Medicare and Medicaid Services (CMS) was used. Practice size data were pulled from 1 month each year between 2014 and 2021 and filtered by physicians listing ‘Urology’ as their primary specialty. Practices were divided into categories based on size. Statistical calculations were conducted using R (version 4.0.2).Results:Solo or partnership practice declined by 15.9% compared to larger practice groups which increased by an average of 5.1%. Providers within the Northeast US illustrated the largest migration to larger practices with 101%, 162% and 232% growth among practices with 25–99, 100–499 and over 500 providers, respectively.Conclusion:Urologists have been moving increasingly towards larger group practice since 2014. An emphasis on value-based healthcare, integration of electronic records and an increase in administrative workload are only some of the influencing factors likely responsible for this trend. Further studies are needed to examine the effect practice consolidation has on patient outcomes and cost of care.
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-21T10:17:05Z
      DOI: 10.1177/20514158221086419
       
  • Standardised nurse-led protocol of radiolucent renal and proximal ureteric
           stones using sodium bicarbonate oral dissolution therapy

    • Free pre-print version: Loading...

      Authors: Michelle Carey, Ahmad O Khalifa, Rui Pinto-Lopes, Soumendra Datta, Gerald Rix, Zafar Maan
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Oral dissolution therapy is a recognised treatment option for radiolucent kidney stones. A standardised nurse-led protocol was developed. Efficacy and compliance was audited and results reviewed.Methods:Twenty-two patients with radiolucent stones were prescribed oral sodium bicarbonate. Patients monitored their urinary pH and the Urology Nurse Practitioner checked compliance. Follow-up with non-contrast computerised tomography of the kidneys, ureters and bladder (CT KUB) was evaluated at 6 weeks.Results:Twenty patients with radiolucent stones completed treatment. Mean stone size was 8 mm (2–23 mm). Nine patients (45%) had complete dissolution, three (15%) had partial dissolution and eight (40%) had no visible response on follow-up CT KUB. The Hounsfield unit (HU) average was 464 (116–1285). Those patients with complete dissolution had HU of less than 605. Three patients with encrusted ureteric stents underwent complete dissolution.Conclusions:Utilisation of a nurse-led sodium bicarbonate dissolution therapy protocol for the treatment of radiolucent stones is effective and acceptable to patients in carefully selected cases. Orally dissolution therapy (ODT) is a suitable option in patients with multiple co-morbidities and high anaesthetic risk. In our series, ODT was also highly effective in treating radiolucent stent encrustation.
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-19T07:16:04Z
      DOI: 10.1177/20514158221091066
       
  • Prevalence of asymptomatic bacteriuria among pregnant women and changes in
           antibiotic resistance: a 6-year retrospective study

    • Free pre-print version: Loading...

      Authors: Erin Cotton, Robert Geraghty, Sameer Umranikar, Kordo Saeed, Bhaskar Somani
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Asymptomatic bacteriuria (ASB) during pregnancy is a risk factor for development of urinary tract infections and pyelonephritis, which can lead to maternal and foetal consequences. This study aimed to determine the prevalence of ASB during pregnancy, the most common causative pathogens and their resistance patterns.Methods:A retrospective analysis was performed using microbiology laboratory data from urine sample cultures from pregnant women collected at our University hospital over a 6-year period (2014–2019). Identification and susceptibility testing were performed using standard microbiology procedures based on British Society of Antimicrobial Chemotherapy and European Committee on Antimicrobial Susceptibility Testing.Results:From a total of 18,938 urine samples, 1522 (8.04%) were positive for bacteriuria, the most common isolates were Escherichia coli and Coliform (lactose fermenters) (n = 1171, 76.9%), followed by Enterococcus faecalis and other enterococci (n = 191, 12.5%). In 2019, the resistance of E. coli was 56.8%, 25.3% and 4.7% to amoxicillin, trimethoprim and gentamicin, respectively, with an increasing pattern of resistance to trimethoprim and gentamicin from 2014 to 2019. The resistance rates to nitrofurantoin were 1% and 5.5% for E. coli and Group B Streptococcus, respectively.Conclusion:Our study shows the trends of antimicrobial resistance in this vulnerable group and will help confirm treatment effectiveness and direct guideline recommendations locally and internationally.Level of Evidence:2b
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-16T07:08:19Z
      DOI: 10.1177/20514158221095672
       
  • Evaluating the incidence, management, and recurrence of inguinal hernia
           during robotic prostatectomy: A literature review

    • Free pre-print version: Loading...

      Authors: Mia Ivos, Christopher Wilhelm, Pranav Sharma
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objectives:Robotic radical prostatectomy (RARP) is a well-established treatment for localised prostate adenocarcinoma. The benefits of this minimally invasive technique include shortened operative time and improved patient recovery. However, the development of inguinal hernia (IH) before, during, and following RARP has been reported. The aim of this study is to evaluate the incidence, management, and recurrence of IHs in patients undergoing RARP for prostate cancer.Methods:A literature search was conducted using the PubMed database from August 2007 to October 2020 using the keywords ‘robotic prostatectomy’ and ‘inguinal hernia’. Studies evaluating the incidence and recurrence of IH in patients undergoing RARP were identified and included. The initial search identified 77 articles. After excluding one duplicate, six case reports, three editorial comments, four articles not in English, eight review articles, and 14 studies that did not mention hernia incidence, 41 studies were included in our final literature review.Results:Concomitant IH repair (IHR) during RARP resulted in decreased symptomatic hernia recurrence during the follow-up period. When compared to patients who had not undergone hernia repair, the patients who underwent IHR during RARP did not experience greater complications in the postoperative period.Conclusions:Patients that undergo an intraoperative IHR during RARP did not experience significant adverse postoperative complications. Although operative time can slightly increase compared to RARP alone, we recommend a thorough preoperative physical examination in all patients scheduled to undergo RARP to evaluate for IH in addition to a thorough discussion with the patient of the risks and benefits of intraoperative repair.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-16T07:06:09Z
      DOI: 10.1177/20514158221095662
       
  • Are neutrophil–lymphocyte and platelet–lymphocyte ratios useful for
           determining active phase of Peyronie’s disease'

    • Free pre-print version: Loading...

      Authors: Jacob W Greenberg, Joseph Kim, Joshua Pincus, Maxwell L Sandberg, Brian Dick, Rachel M Greenberg, Omer Raheem, Wayne JG Hellstrom
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:Management options for Peyronie’s disease (PD) are determined by the phase of the condition. Experts counsel against surgical intervention during the active phase of PD. Patients with chronic phase of PD are offered either collagenase injections or surgical intervention. Accurately characterising a patient’s phase of PD is crucial in determining the appropriate treatment option.Objective:To investigate neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) as possible predictors for the determination of acute or chronic phase of PD.Methods:This study retrospectively queried all patients who presented for initial diagnosis of PD from 2016 to 2020 and had complete blood count (CBC) laboratory values before initial therapy. PD phase was defined per the American Urological Association guidelines. The active phase of PD was defined as a changing penile curvature and/or growing palpable plaque. The chronic phase of PD was defined as a stabilised penile curvature. All statistical analyses were two-tailed, using a significance level of 0.05.Results:One hundred nine patients met inclusion: 27 (25%) active phase and 82 (75%) chronic phase patients. Demographic and erectile characteristics were not statistically different between the two groups. NLR and PLR values between active and chronic phase patients were comparable (p> 0.05). A linear regression evaluated correlations between the duration of PD and either NLR or PLR. Neither NLR nor PLR was correlated with PD duration on Spearman, Pearson, or Kandall tests. In addition, NLR and PLR were not noted to be predictors of PD phase on multiple logistic regression. Finally, a receiver operator characteristic curve was generated. NLR and PLR yielded an area under curve of 58% and 57.8%, respectively.Conclusions:Two recent studies suggested NLR and PLR could be used to predict the phases of PD. However, after evaluating a cohort of 109 men from our institution, our data do not support the use of peripheral blood PLR or NLR to determine the phase of PD.
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-16T07:04:48Z
      DOI: 10.1177/20514158221094636
       
  • Twenty-four hour urine parameters in nephrolithiasis patients with
           obstructive sleep apnea syndrome

    • Free pre-print version: Loading...

      Authors: Mohammed Shahait, Amihay Nevo, Jose M El-Asmar, Nalyn Siripong, Nazih Khater, Jordan Denk, Stephen Jackman, Timothy Averch, Michelle Semins
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To study 24-hour urine metabolic abnormalities in patients with obstructive sleep apnea syndrome (OSAS), diagnosed by polysomnography. The purpose was to identify whether OSAS is independently associated with a distinctive set of 24-hour urine studies in a cohort of stone formers.Patients and Methods:Using our institutional stone database (2013–2017), 1132 consecutive patients with 24-hour urine collections were identified. After applying our exclusion criteria, the final cohort consisted of 376 patients of which 45 patients had OSAS. Descriptive statistics were used to compare 24-hour urine parameters between patients with and without OSAS. Logistic regression models were used to assess the association between OSAS and 24-hour urine parameters.Results:On univariate analysis, patients with OSAS were older (57.7 versus 48.2, p < 0.001) with a higher body mass index (BMI) (35 versus 27.8, p < 0.001), and higher likelihood of diabetes mellitus (DM) (57.8 versus 10.6%, p < 0.001) and hypertension (HTN) (60% versus 23.9%, p < 0.001). Patients with OSAS had higher 24-hour total amount of urine volume (2018 versus 1818 ml, p = 0.03), calcium (279.7 versus 208 mg, p = 0.02), oxalate (41.6 versus 31.3 mg, p < 0.001), yet lower 24-hour urine pH (5.75 versus 6.03, p = 0.001). On multivariable linear regression analysis, OSAS did not affect any of the 24-hour urinary parameters.Conclusion:OSAS is a prevalent comorbidity among nephrolithiasis patients. We found no major differences in 24-hour urine parameters between nephrolithiasis patients with OSAS and those without OSAS. Further study is needed to determine whether the severity of OSAS and compliance with treatment play a role in the pathogenesis of stone formation.Level of evidence:2b
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-16T07:02:21Z
      DOI: 10.1177/20514158221088683
       
  • Comparison of long-term results following ureteroscopic stone
           fragmentation with removal versus stone dusting without removal

    • Free pre-print version: Loading...

      Authors: Dor Golomb, Asaf Shvero, Hamad Mahajna, Oleg Levi, Hanan Goldberg, Shlomi Tapiero, Yariv Stabholz, Paz Lotan, Abd-Elhalim Darawsha, Yaron Ehrlich, Nir Kleinmann, Vadim Khasminsky, Dorit Zilberman, Harry Winkler, David Lifshitz
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Purpose:To compare long-term results following ureteroscopic stone fragmentation and removal versus stone dusting.Methods:We conducted a retrospective analysis of patients who underwent ureteroscopy for renal calculi at two high-volume tertiary centres between 2012 and 2013, therefore allowing long-term follow-up. The surgeons differed in their technique, some performing dusting for the most part and the others fragmentation. Inclusion criteria were stone free at the first follow-up and the sole use of laser lithotripsy is either by dusting or by fragmentation. Operative and post-operative data as well as re-treatment rates were compared between the groups. Stone-free rates and long-term stone recurrence rates were analysed by a single radiologist blinded to the treatment technique.Results:Between 2012 and 2013, 669 ureteroscopies were performed at both centres. The study group included 100 patients, which met the inclusion criteria, equally distributed between dusting and fragmentation. The cumulative stone diameter in patients treated with dusting was significantly larger (12.7 mm versus 17 mm, p = 0.006). Operative time was shorter in patients treated with dusting (56 minutes versus 47.2 minutes, p = 0.6). The mean follow-up was 58.9 (standard deviation (SD) 17.2) and 69.4 (SD 13.8) months for the fragmentation and dusting-treated patients, respectively(p = 0.06). The long-term recurrence rate in the fragmentation group was 22% compared to 38% in the dusting group (p = 0 .08). Most of the patients in the dusting group required a repeat ureteroscopy during their follow-up (28% versus 6%, p = 0.003). A multivariable logistic regression analysis revealed that the fragmentation was not associated with a lower stone recurrence rate when compared to dusting (OR 0.6, 95% CI 0.199-1.810, p = 0.3).Conclusions:The recurrence rate of renal stones was not significantly influenced by the choice of surgical techniques. However, dusting was associated with a greater need for repeat ureteroscopy than fragmentation with removal.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-13T10:55:46Z
      DOI: 10.1177/20514158221088452
       
  • ADXBladder molecular urine testing to risk stratify and prioritise
           management of suspected and known bladder cancers during the COVID-19
           pandemic

    • Free pre-print version: Loading...

      Authors: Joseph Santiapillai, Luke Foster, Paula Allchorne, James S. A. Green, Haboon Mohamud, Ahmad Almushatat, Prasad Patki, Hussain Nawaz, Michael Stevens, Prabhakar Rajan
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:COVID-19 has challenged diagnostic and surveillance pathways for suspected and known bladder transitional cell cancer (TCC). Exclusion of high-grade/invasive TCC by molecular urine testing could risk stratify patients for priority flexible cystoscopy and transurethral resection (TUR). We evaluated ADXBladder (ArquerDx), which has a high negative predictive value (NPV) for high-grade and ⩾ pT1 TCC.Patients and methods:Prospective cohort study of patients referred with haematuria for diagnostics or on TCC surveillance (Dec 2020–Feb 2021). Patients underwent ADXBladder testing, flexible cystoscopy and imaging (for haematuria), followed by TUR/biopsy as necessary. Clinico-radiological/pathology findings were compared with ADXBladder results.Results:Of 117 eligible patients, 39 and 78 had positive and negative ADXBladder tests, respectively. Of 15 suspected TCC on cystoscopy, eight were confirmed on TUR/biopsy. Overall ADXBladder NPV was 96.2% (CI: 91.0–98.4). NPV for high-grade and ⩾pT1 TCC was 97.4% (CI: 94.4–98.8) and 98.7% (CI: 95.0–99.7), respectively.Conclusions:Our ‘real world’ evaluation confirmed a high NPV for high grade and ⩾pT1 TCC using ADXBladder. Further larger studies are required to determine whether a negative ADXBladder test combined with negative imaging and patient risk factors may justify patient downgrading on timed diagnostic pathways.Level of evidence:IV
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-13T10:53:03Z
      DOI: 10.1177/20514158221086692
       
  • Fusion versus cognitive MRI-guided prostate biopsies in diagnosing
           clinically significant prostate cancer

    • Free pre-print version: Loading...

      Authors: Kathleen Lockhart, Jarad Martin, Martin White, Avi Raman, Alexander Grant, Peter Chong
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:This study assesses whether fusion or cognitive magnetic resonance imaging (MRI)-guided prostate targeted and systematic transperineal biopsies (TPB) increase detection of clinically significant prostate cancer (csPCa).Materials and Methods:A retrospective analysis was completed of patients (2018–2020) undergoing 3-Tesla multiparametric prostate MRI informing targeted (either cognitive or MIM software fusion approach) and systematic TPB. ISUP (International Society of Urological Pathology) grade group ⩾ 2 was considered csPCa.Results:A total of 355 cases from 4 urologists were included; 131 were fusion and 224 were cognitive MRI-guided biopsies. Of all csPCa found, 86.8% (n = 171) of cases were confirmed to be at the MRI-indicated location and 11.6% were found as part of active surveillance. In all, 45.0% of the fusion group were found to have csPCa, compared to 62.05% (n = 139) in the cognitive group (p = 0.002). csPCa detection rates varied between urologists (41% to 78%, p < 0.001), so a subgroup analysis was performed on Urologist A; 45.0% of fusion and 41.3% of cognitive biopsies had csPCa (p = 0.644). Multinomial logistic regression analysis showed that biopsy type, being on active surveillance, number of biopsy cores, iPSA (initial Prostate Specific Antigen) value or PIRADS (Prostate Imaging-Reporting and Data System) score made no significant difference in whether csPCa was found.Conclusion:Cognitive and fusion targeting had similar csPCa detection rates. Further prospective studies would be beneficial to validate these findings.Level of evidence:2b (according to Oxford Centre for Evidence-Based Medicine)
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-13T10:50:35Z
      DOI: 10.1177/20514158221085081
       
  • Seminal vesicle abscess: A case report and review of the literature

    • Free pre-print version: Loading...

      Authors: Finín Cotter, Niranjan Sathianathen, Gowribahan Thevarajah, Hong Kuan Kok, Catherine Temelcos, Owen Niall, Sudheshan Sundaralingam
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Seminal vesicle abscess (SVA) is a rare pathology. We review the literature and present the case of a 54-year-old presenting with an SVA treated successfully with percutaneous transgluteal drainage and subsequently, transrectal ultrasound (TRUS)-guided transrectal drainage.Level of evidence: 4
      Citation: Journal of Clinical Urology
      PubDate: 2022-05-02T02:07:20Z
      DOI: 10.1177/20514158211058062
       
  • Upper tract CT urogram for the surveillance of high-risk non-muscle
           invasive bladder cancer–are we over-screening patients'

    • Free pre-print version: Loading...

      Authors: Jennifer K Martin, Naomi Fenton, Paul Carruthers, Katherine S Warren, Janice Ash-Miles, Helena P Burden
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:The European Association of Urology (EAU) recommends annual upper tract imaging for high-risk (HR), non-muscle invasive bladder cancer (NMIBC). We evaluated the incidence of upper tract recurrence found during imaging surveillance for HR NMIBC and appraised our imaging strategy and patient radiation exposure.Subjects/patients (or materials) and methods:Two hundred and eighty-six patients between 2014 and 2019 with HR NMIBC (G3 tumour or T1 tumour or CIS, as per National Institute for Clinical Excellence (NICE) guidelines), were included in the study. The total number of computed tomography (CT) scans performed, the average radiation dose administered and the incidence rate of upper tract disease for each patient were recorded and analysed using a Microsoft Excel database.Results:The incidence rate of upper tract recurrence diagnosed during CT follow-up was 4/286 (1.4%). Three had a successful laparoscopic nephroureterectomy, the fourth was medically unfit for surgery. In total, 2.8% (8/286) were found to have other urological diagnoses. Patients received a CT scan on average every 13 months, with a mean radiation dose of 11.5 mSv.Conclusion:This study found that patients with HR NMIBC have a lower risk of upper tract recurrence than previously reported, which might support a guideline change to eliminate unnecessary radiation exposure during follow-up.Level of evidence:Not applicable for this multi-centre audit
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-30T04:56:35Z
      DOI: 10.1177/20514158221088681
       
  • Sexual and urinary function after organ sparing surgery for penile cancer:
           A questionnaire study of consecutive patients over a 3-year period in a
           single region

    • Free pre-print version: Loading...

      Authors: Eleanor F Zimmermann, Ysabelle Embury-Young, David Dickerson, Aditya Manjunath
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:The European Association of Urology recommends organ-sparing surgery (OSS) for localised penile cancer. We aimed to assess the impact of OSS including glans reconstruction on erectile, sexual and urinary function.Method:Local ethics approval was obtained. Patients coded for glans resurfacing, glansectomy and partial penectomy from 2015 to 2018 were identified across two trusts. Background characteristics, histology, staging and follow-up were recorded. Two questionnaires were used to assess function: a custom questionnaire on patient reported outcomes and the International Index of Erectile Function (IIEF) Questionnaire. Anonymised questionnaires were sent to each patient with prepaid return envelopes included.Results:A total of 28/64 (44%) questionnaires were returned complete. The mean age of participants was 71(35–93) and body mass index (BMI) 28(20–38). There was 1 glans resurfacing, 1 circumcision and wide local excision, 8 glansectomy and 18 partial-penectomy patients (of which 4 and 13 declined reconstruction, respectively). Sexual satisfaction (SS) and erectile function (EF) declined postoperatively while sexual desire was preserved. Subjective glans sensitivity reduced independent of technique. Glans reconstruction reduced the impact on IIEF in glansectomy (13.5 versus 25.3, p < 0.05) but not partial-penectomy (13.4 versus 13.8). SS was worse in partial-penectomy patients undergoing glans reconstruction on patient-reported outcome measures (PROM) (SS change: −4.0/10 with reconstruction versus −0.9/10 without, p < 0.05). Urinary symptoms appear limited to spraying and change of flow of urine, with some patients reporting the need to pass urine sitting down.Conclusion:Sexual and erectile function is impaired post-OSS in penile cancer while sexual desire is preserved. Simultaneous glans reconstruction appears to minimise this impact in glansectomy patients when assessed by IIEF. A validated PROM questionnaire could improve preoperative counselling, and guide postoperative sexual recovery.
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-30T04:55:04Z
      DOI: 10.1177/20514158221081320
       
  • Diagnostic value of the abnormal digital rectal examination in the modern
           MRI-based prostate cancer diagnostic pathway

    • Free pre-print version: Loading...

      Authors: Wasiq Sajjad, Vineetha Thankappannair, Syed Shah, Adham Ahmed, Kasra Saeb-Parsy, Christof Kastner, Benjamin Lamb, Vincent J Gnanapragasam
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Currently the National Institute for Health and Care Excellence (NICE) recommends an abnormal digital rectal examination (DRE) as a standalone referral criterion for suspected prostate cancer. Unlike referrals for a raised prostate-specific antigen (PSA) which are triaged directly to magnetic resonance imaging (MRI), an abnormal DRE requires re-examination in a secondary clinic first. Here, we investigated the ongoing value of the abnormal DRE as a referral criterion.Methods:This study is a retrospective review of patients referred to secondary care for suspected prostate cancer based on an abnormal DRE over a 15-month period at a single UK hospital (n = 158). Age, PSA, primary and repeat DRE findings and eventual diagnosis were collated.Results:A concurrent raised PSA was present in 65/158 (41%). Concordance between primary and secondary care DRE was only 72/158 (46%). The overall and significant cancer detection rate was 26/158 (16%) and 22/158 (14%), respectively. Among men with a concurrent raised PSA, 19/65 (29%) had significant cancer found, whereas with an abnormal primary care DRE and normal PSA (n = 93), only 3/93 (3%) had a significant cancer. Mandating a PSA before referral for an abnormal DRE would have redirected 65/158 (41%) of men to MRI first, negating the need for a repeat DRE (p < 0.0001). This finding was recapitulated in a second prospective validation cohort (n = 30) with 9/30 (30%) redirected to MRI first.Conclusions:This is one of the first studies to investigate the value of the DRE in contemporary practice. We propose that PSA is used to triage men with an abnormal DRE to MRI without needing a repeat DRE. If the PSA is normal, the diagnostic yield is low but may still warrant a repeat DRE to assess the need for further investigations. Additional multi-centre studies are required to further validate our findings.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-27T12:04:32Z
      DOI: 10.1177/20514158221091402
       
  • Tertiary experience of managing young bladder cancer patients

    • Free pre-print version: Loading...

      Authors: Andrew Brown, Claudia Burton, Sarah Ives, Isabel Elkington, Maria Hussain, Alex Murigu, Ben Shear, Katherine Warren, Helena Burden
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Bladder cancer is rare in young patients and some authors have concluded that this group have a favourable outcome. We aimed to analyse our experience with such patients.Patients and Methods:Patients aged 50 years or younger were identified via a retrospective review of pathology samples between 2016 and 2020. Data regarding demographics, symptoms, stage, grade, size and multifocality at initial transurethral resection, recurrence rate and progression were analysed.Results:60 patients with an average age of 42 were identified. The majority of patients presented with intermediate-risk non-muscle invasive bladder cancer (NMIBC). Four patients presented with muscle invasive and three with metastatic disease. There were seven deaths. Forty-nine patients with NMIBC were followed-up for an average of 5 years and 2 months. 41% of our cohort did not have a recurrence and only four moved up the risk stratification. No patients under 40 presented with muscle invasive disease and the majority had intermediate risk NMIBC.Conclusion:Young patients typically present with intermediate-risk NMIBC which rarely progresses. Very high-risk disease and aggressive variants do occur and may benefit from upfront cystectomy. The rate of muscle-invasive disease increases with age and rarely occurs under 40. Until more data is readily available, the management of this cohort of patients should follow the well-established guidelines.Level of evidence:4 (case series)
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-27T12:02:22Z
      DOI: 10.1177/20514158221089411
       
  • Microscopic testicular sperm extraction (micro-TESE) for azoospermia at a
           large tertiary referral centre: Male and female factors and outcomes

    • Free pre-print version: Loading...

      Authors: Mohamed Abu Yousif, Abigail Kwok, Richard Jones, Daphne Chong, Richard Russell, Andrew Drakeley, Andrew Baird, Marc Lucky
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objectives:To report on the outcomes and demographics of azoospermic couples undergoing microscopic testicular sperm extraction (micro-TESE) in a large tertiary referral centre.Subjects and methods:A retrospective study of patients undergoing micro-TESE in a tertiary referral centre from March 2015 to August 2019 was undertaken. Histopathology, patient demographics, comorbidities, patient factors and live birth outcomes were evaluated.Results:A total of 102 micro-TESEs were performed with a sperm retrieval rate (SRR) of 30.3%. The successful group had a mean age of 32.7 years and a mean body mass index (BMI) of 26.8 kg/m2. Female partners in the successful group had a mean age of 32.2 years. Twenty percent of female partners had infertility factors, 86.7% had no previous pregnancy and 13.3% had a previous miscarriage. The successful group had 15 live births (50%), while 20% had frozen their sperm. 93.3% achieved live birth from single embryo transfer and currently have unutilised embryos in cryostorage to possibly create siblings in the future. Twenty percent had more than one live birth from a single micro-TESE. Sertoli cell-only syndrome (SCOS) was identified in 57.5% of all cases. This was bilateral in 80% of these cases (four cases only sampled unilaterally due to previous orchidectomies). Of the SCOS group, six men went on to have successful sperm extraction (10%). The presence of previous urologic history/surgery increased the risk of azoospermia by 13%.Conclusion:Men with previous urological conditions have an increased risk of azoospermia. SCOS was identified in 57.5% of cases making it the most common histopathological diagnosis in azoospermic men. Based on our cohort, micro-TESE offers potential sperm retrieval in azoospermic men with SCOS. Successful sperm extraction in patients was associated with 50% live births and appeared to be unaffected by the presence of male/female factors. The number of live births could be higher as 20% had frozen their sperm. Concurrent female issues did not appear to affect successful outcome after micro-TESE, although numbers are small.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-27T12:01:32Z
      DOI: 10.1177/20514158221089409
       
  • The impact of the COVID-19 pandemic on the primary definitive management
           of ureteric stones

    • Free pre-print version: Loading...

      Authors: Charlotte Lee, Alisha Masani, Lily Whitehurst, Graham Watson, Simon Mackie
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To assess the management pathways of ureteric stones within our department and any impact on this as a result of the pandemic.Patients and methods:Retrospective data were collected at two different time points defined as ‘pre-COVID-19’, during April and May 2019, and ‘peri-COVID-19’, during April and May 2020 of all patients with ureteric stones.Results:Similar patient numbers presented with ureteric stones pre-COVID-19 (63) and during the pandemic (75). Pre-COVID-19, 31 patients were admitted, of which 48% had primary ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL). The average time to theatre was 1.2 days. During the pandemic, there were 34 admissions with 56% of these patients receiving primary URS/PCNL. The average time to theatre was 1.5 days. Of the patients referred to the virtual stone clinic, pre-COVID-19, 38% were listed for urgent-elective surgery which was performed at an average of 62 days. During the pandemic, 49% were listed for surgery, waiting 144 days for their procedure.Conclusion:Patients who underwent primary surgery during their first admission had their definitive treatment quicker during the pandemic. However, patients listed for elective procedures waited longer in the peri-COVID-19 period.Level of evidence:(Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009)): 2c
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-23T10:29:44Z
      DOI: 10.1177/20514158221090044
       
  • Incidence of dural metastases in castrate-resistant prostate cancer

    • Free pre-print version: Loading...

      Authors: Adree Khondker, Jethro CC Kwong, Christopher Tran, Emily Evans, Ishan Aditya, Lucshman Raveendran, Yingming A Chen, Amna Ali, Andrew Feifer
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Purpose:The natural history and clinical manifestations of dural metastases (DM) in castrate-resistant prostate cancer (CRPC) will change with advances in new hormonal therapy. Here, we characterised the incidence, clinical presentation, and outcomes of patients with DM in a contemporary patient cohort with CRPC.Methods:We retrospectively reviewed our CRPC database from 2012 to 2020. The primary outcome was the diagnosis of DM, defined as metastasis to the dura mater in the brain or spine. We describe the presenting symptoms, biochemistry, radiologic findings, and therapy sequence for all DM patients. Multivariable logistic regression was performed to identify predictors of DM.Results:Six of the 275 patients (2.2%) with CRPC developed DM. The average age of CRPC diagnosis for patients with DM was 65.6 years. Mean patient survival was 4.5 months after the diagnosis of DM. At the time of CRPC diagnosis, patients who developed DM were significantly younger, had lower baseline haemoglobin, higher lactate dehydrogenase (LDH), and elevated alkaline phosphatase (ALP) compared to those without DM. On multivariable analysis, younger age of CRPC diagnosis was found to be a predictor for DM.Conclusion:The presence of neurological symptoms in the context of younger age, anaemia, and elevated baseline LDH and ALP are associated with DM in CRPC.Level of Evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-23T10:28:25Z
      DOI: 10.1177/20514158221090040
       
  • Therapeutic value of pelvic lymph node dissection in high-grade prostate
           cancer

    • Free pre-print version: Loading...

      Authors: Dwayne TS Chang, Jian Li, Isaac Thyer, Ronald J Cohen
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:This study aimed to assess the therapeutic value of pelvic lymph node dissection (PLND) in high-grade margin-negative prostate cancer without and with lymph node metastases.Methods:We retrospectively reviewed cases in the Western Australian radical prostatectomy (RP) database between January 1, 2010, and December 31, 2017. We identified men who had RP only (no PLND) and those had RP with PLND. Further, a subset of high-grade (Gleason score (GS) ⩾8) margin-negative cancers were identified. We assessed the therapeutic impact of PLND in this high-risk but potentially curable subset.Results:A total of 5648 prostatectomies were performed, and 1209 of these had concurrent PLND, negative surgical margins, and follow-up prostate-specific antigen (PSA) data. Of 558 men with high-grade margin-negative prostate cancer, 395 men had PLND, while 163 did not. There were significantly more patients with T3/T4 disease in the PLND group compared to those without PLND. Preoperative PSA did not differ significantly between the two groups. However, when stage matched, PLND had no impact on the numbers of men who were cured compared to those who failed surgical intervention.Conclusion:PLND has value in staging high-grade prostate cancer but has limited impact on producing a durable PSA cure or avoiding adjuvant therapy.Level of evidence:Not applicable for this multicenter audit.
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-23T08:57:59Z
      DOI: 10.1177/20514158211020563
       
  • Robotic-assisted radical cystectomy with intracorporeal urinary diversion:
           Initial South Australian experience

    • Free pre-print version: Loading...

      Authors: Andrew RH Shepherd, Zachary Bunjo, Peter Sutherland, Andrew Fuller
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Aim:The aim of this study was to describe the initial experience with robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) performed by two robotic surgeons at a single, Australian centre.Methods:Retrospective analysis was conducted on 30 consecutive patients who underwent RARC with ICUD with curative intent for muscle-invasive and high-risk non-muscle-invasive bladder cancer between 2017 and 2021. Variables analysed included patient baseline characteristics, operative and peri-operative outcomes, as well as short-term pathological outcomes.Results:A total 30 patients were included; 87% were male and the median age was 71 years. Half of patients had muscle-invasive bladder cancer and 93% had ileal conduit formation (with the remaining two patients undergoing neobladder formation). The median operating time was 247 minutes. The median estimated blood loss was 450 mL and 20% of patients received a blood transfusion. A high-grade complication (Clavien III–V) was encountered in 13% of patients post-operatively. At 90 days, 30 overall complications (Clavien I–V) occurred across 67% of the patients.Conclusion:This series provides further support for the safe introduction of RARC with ICUD in Australia. Further studies with extended duration of follow-up, including oncological outcomes, are required to support widespread adoption of RARC.Level of evidence:Level 4 (case series)
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-19T06:47:02Z
      DOI: 10.1177/20514158221084828
       
  • Incidence, management and treatment outcomes of renal malignancy in a
           

    • Free pre-print version: Loading...

      Authors: T Manasa, Vivek Meyyappan, Puvvada Sandeep, Prasad Mylarappa, D Ramesh, Vivek Jayakumar, Gowtham Krishna Penmetsa
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Introduction and Objective:Although the incidence of malignancy in renal transplant recipients is on the rise owing to boom in the post-transplant immunosuppressive therapy, there is paucity of literature regarding their reporting and management. In this study, we report the incidence of de novo renal malignancies, post-renal transplantation at our centre over a 16-year period and discuss their management.Methods:All patients who underwent renal transplantation at our department between March 2004 and February 2020 were included and retrospectively reviewed. We analysed the incidence of renal malignancy both in the native kidney and the graft, histological subtype, time to and type of treatment.Results:A total of 376 patients underwent renal transplantation. Mean age of recipients was 48.2 and 52.15 years among those who developed cancer. 13 (2.93%) of 376 recipients developed urogenital malignancy, of whom 8 had renal cell carcinoma (RCC) in their native kidneys and 1 in the allograft. Transitional cell carcinoma (TCC) of renal pelvis was noted in three patients with one concomitant TCC of bladder. No treatment-related graft losses occurred in the native kidney malignancy. Patients with RCC underwent nephrectomy while TCC of renal pelvis underwent nephroureterectomy with bladder cuff excision. Transurethral resection was done for bladder tumour. All patients were followed up as per standard protocol.Conclusion:A rise in urological post-transplant malignancies mandates regular surveillance after renal transplantation to ensure early detection of de novo malignancies and early initiation of treatment. Goal should be to minimise adverse graft outcomes with no compromise on oncological outcomes.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-19T06:45:22Z
      DOI: 10.1177/20514158221081814
       
  • Robot-assisted surgery in horseshoe kidneys: A safety and feasibility
           multi-centre case series

    • Free pre-print version: Loading...

      Authors: Alexander Ng, Arjun Nathan, Nicholas Campain, Mariella Fortune-Ely, Siddhant Patki, Yuigi Yuminaga, Faiz Mumtaz, Aziz Gulamhusein, Maxine Tran, Senthil Nathan, Ravi Barod, Axel Bex, Prasad Patki
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:We assessed the safety and feasibility of minimally invasive robot-assisted surgery for horseshoe kidney (HSK).Method:A prospectively maintained data set for consecutive patients undergoing robotic kidney surgery was reviewed for patients with HSK. Cases were performed by experienced robotic surgeons, across two high-volume centres between 2016 and 2020.Results:Seven patients underwent robotic surgery for HSK, comprising three partial nephrectomies for renal masses, one nephroureterectomy and three benign nephrectomies for non-functioning kidneys. The median age was 53 (interquartile range (IQR) = 47–60) years and median body mass index (BMI) was 25 (IQR = 25–26.5). Median console time was 120 (IQR = 118–215) minutes and median estimated blood loss was 150 (IQR = 125–250) mL. The median pre- and post-operative estimated glomerular filtration rate (eGFR) was 76 (IQR = 72–90) and 71 (IQR = 60–81), respectively. There were no higher-grade complications (Clavien–Dindo III–IV) and one Clavien–Dindo grade II complication (wound infection treated with IV antibiotics). Median length of stay (LOS) was 2 days and there were no 30-day readmissions. Negative margins were achieved in 75% of tumour resections.Conclusion:We report one the largest series of robot-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in centralised high-volume centres with acceptable perioperative outcomes. Established benefits of minimally invasive surgery, such as reduced LOS and low complication rates, were demonstrated.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-19T05:17:59Z
      DOI: 10.1177/20514158221088451
       
  • Adjustable Transobturator Male System® (ATOMS) as a novel treatment for
           men with stress urinary incontinence in the United Kingdom

    • Free pre-print version: Loading...

      Authors: Bob Yang, Francesca Lewis, Clare Jelley, Steve Foley
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objectives:To investigate the first experience in the United Kingdom of using the Adjustable Transobturator Male System® (ATOMS) in treating men with stress urinary incontinence (SUI).Methods:Between 2015 and 2021, 71 men (average age: 70.3, range: 50–81 years) were recruited and followed up. Of these, 67 (94%) had SUI secondary to a radical prostatectomy and 16 (23%) had previous radiotherapy post-prostatectomy. Seventy men underwent an insertion of ATOMS® under general anaesthetic. In one patient, due to his underlying morbid obesity, it was not possible to insert ATOMS and thus he was excluded from the study. Follow-up was up to 6 years (mean: 4 years, range: 2–6 years).Results:Out of 70 men, 53 (76%) were dry after ATOMS insertion (defined as using a maximum of one pad per day for reassurance only). Dryness was achieved within 6 months for 34/53 patients (range: 1–24 months). The average pad use was 3.4 pre-operatively and 0.7 post-operatively. Of the men who did not achieve dryness, 7/17 (41%) had previously undergone radiotherapy. There were 11 (16%) complications: two cases of infected device requiring removal, one case of balloon mechanism erosion requiring re-implantation, one case of balloon mechanism require repositioning, four cases of persistent perineal or scrotal pain, two cases of urinary retention and one case of a superficial wound infection treated medically. Overall, five devices were removed.Conclusions:The ATOMS appears to be a safe and efficacious treatment for men with SUI. Previous radiotherapy decreased the efficacy of ATOMS. Further studies on ATOMS with larger numbers of patients and longer follow-ups are required. In particular, establishing randomised control trials to confirm these positive outcomes as well as ascertain its long-term safety profile.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-19T05:15:05Z
      DOI: 10.1177/20514158221086409
       
  • A 12-year experience in the management of traumatic bladder rupture at an
           Australian level 1 trauma centre

    • Free pre-print version: Loading...

      Authors: Henry H. Yao, Jan Fletcher, Jeremy Grummet, Peter L. Royce, Mark Fitzgerald, Uri Hanegbi
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To review the contemporary bladder trauma epidemiology, diagnosis and management over a 12-year period at a level 1 trauma centre in Australia.Patients and Methods:From July 2001 through June 2013, 97 multi-trauma patients at a level 1 trauma centre in Australia were identified to have sustained bladder rupture. Data on demographics, clinical presentation, diagnosis, management and complications were extracted from the TraumaNET database, medical records and health-coding database.Results:Of the 97 patients, 98% of bladder ruptures resulted from blunt trauma mostly from road accidents. There was a male preponderance of 64%. Intra-peritoneal bladder rupture (51%) was the most common type of injury followed by extra-peritoneal bladder ruptures (42%) and combined intra- and extra-peritoneal bladder ruptures (7%). Concomitant pelvic fractures occurred in 78% of patients and concurrent intra-abdominal injuries in 68%. Initial imaging missed 28% of bladder ruptures, with computed tomography with intravenous contrast missing 65% of bladder ruptures. The majority of intra-peritoneal bladder ruptures and 56% of extra-peritoneal bladder ruptures were repaired surgically, with 83% of repairs performed in conjunction with another surgical procedure. The in-hospital mortality rate was 9%, and all deaths were due to concomitant injuries.Conclusion:Traumatic bladder rupture is associated with a 9% mortality rate due to the frequently associated significant concurrent injuries. Computed tomography cystogram or plain cystogram is the imaging modality of choice in diagnosing bladder rupture. Intra-peritoneal bladder ruptures should be repaired surgically, while extra-peritoneal bladder ruptures can be treated conservatively in selected patients. The timing of surgical repair should be coordinated with other specialties.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-19T05:11:12Z
      DOI: 10.1177/20514158221086401
       
  • Association of prostate size with capsule thickness and glandular
           epithelial cell density: The possible clinical implications on prostate
           cancer development

    • Free pre-print version: Loading...

      Authors: Jake Sellers, Ellen Ward, Preston Weaver, John Garza, Luis Brandi, Werner TW de Riese
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Benign prostatic hyperplasia (BPH) and prostate cancer (PCa) are the two most common urologic diseases in aging males. The negative association between prostate/BPH size and incidence of PCa is well documented in the literature. However, the exact mechanism is not well understood. This study aims to further investigate the possible effect of prostate volume on prostate capsule thickness and glandular cell density in the prostatic peripheral zone (PZ).Materials and Methods:A total of 100 patients were selected that had undergone radical prostatectomy with prostate sizes ranging from 20 to 160 mL. Quantitative measurements of capsule thickness and density of epithelial glands within the peripheral zone not affected by cancer were analysed and calculated on histo-anatomical slides using computer-based imaging software. Associations between the different variables were calculated using Spearman correlation with 95% confidence intervals (CIs).Results:In the non-cancerous areas of the PZ, prostate volume and average capsule thickness are positively associated (rs = +0.6526, 95% CI +0.5233 to +0.7526, p < 0.0001), while prostate volume and average glandular epithelial cell density of the PZ are negatively associated (rs = −0.6011, 95% CI −0.7133 to −0.4589, p < 0.0001). These associations remain consistent on subgroup analysis.Conclusion:The findings of this study support the hypothesis that transition zone (TZ) growth in large BPH prostates may cause pressure on the outer PZ, leading to fibrosis and atrophy of the glandular tissue. This may provide a protective effect against PCa, as most PCa originates in the PZ of the prostate.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-19T05:09:08Z
      DOI: 10.1177/20514158221086399
       
  • Utilisation of a rectal hydrogel spacer for vaginoplasty in a cadaver
           model

    • Free pre-print version: Loading...

      Authors: Crystal An, Kirtishri Mishra, Laura Bukavina, Itunu Arojo, Rachel Pope, Shubham Gupta
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:A major source of complications in vaginoplasty results from injury to the rectum during dissection of the neovaginal cavity. The SpaceOAR™ System is a rectal hydrogel spacer mostly used as a safety technique during prostate cancer treatment.Objective:This was a feasibility study performed in a single cadaveric perineum.Methods: Prior to standard cavity dissection, SpaceOAR was injected transperineally into the Denonvilliers’ fascia under guidance of transrectal ultrasound. Dissection of the neovaginal cavity with spacer gel was qualitatively assessed to be significantly easier, allowing for a blunt and quick approach.Results:A satisfactory vaginal length was achieved rapidly and safely.Conclusions:We show that transgender vaginoplasty using this adaptation of SpaceOAR is technically feasible in the cadaveric model and may reduce the incidence of rectal injury or rectovaginal fistula during neovaginal cavity creation. Future experimental endeavours should focus on the reproducibility of this approach and characterise the degree of rectal protection provided.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-19T05:08:01Z
      DOI: 10.1177/20514158221086140
       
  • Renal abscess in children: Is size an important determinant in deciding
           treatment options'

    • Free pre-print version: Loading...

      Authors: Prashant Jain, Ashish Prasad, Rachna Sharma, Sarika Jain
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:Renal abscess (RA) is rarely seen in the paediatric age group. The proposed management protocols are mainly derived from the adult series which may not be appropriate in children.Objective:In this retrospective analysis of cases with renal and perinephric abscesses, the objective is to correlate the clinical presentation, radiological findings and treatment options and also to propose a paediatric-specific practical management algorithm.Study design:This is a retrospective study of cases with renal and perinephric abscesses admitted between March 2012 and February 2020. The patients were reviewed for demographics, presentation, predisposing factors, laboratory investigations, imaging, management and outcome.Results:Analysis of 12 paediatric patients (13 renal units) with RA (median age 4 years) was done. Organisms were isolated in 8 of 12 (66.6%) patients with Gram-negative organisms being the commonest. On admission, all patients were started on empirical broad-spectrum antibiotics. Except for two patients who were critically ill with frank sepsis and had a tender renal lump, the rest of them were initially offered conservative management with intravenous antibiotics, and the response was reviewed after 48–72 hours. Of five units with abscess size of ⩽3 cm, two units (40%) responded to conservative management, while three units (60%) required intervention, and of eight units of size >3 cm, three units (37.5%) responded to conservative management and five units (62.5%) required intervention. None of the abscesses with perinephric collection (30.7%) responded to antibiotics and required intervention.Conclusion:A protocol based on the size of RA as recommended in most of the adult series may not be appropriate in the paediatric age group because of the differences in clinical presentation, predisposing factors and immune response. The clinical condition on presentation, response to antibiotic therapy and the presence of perinephric collection should be considered as an important determinant in deciding the need for intervention.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-14T09:37:27Z
      DOI: 10.1177/20514158221084821
       
  • Long-term complications of bulking agents in the treatment of stress
           urinary incontinence: Results of a national survey

    • Free pre-print version: Loading...

      Authors: Sana Patel, Henry Lazarowicz, Rebecca Hamm
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Introduction and Objectives:Bulking agents have been used for decades as an alternative treatment for patients with stress urinary incontinence who are not appropriate for surgery. Despite this their long-term complications are poorly documented and can be misdiagnosed. This paper presents a literature review and the results of a national survey of members of the Section of Female, Neurological and Urodynamic Urology (FNUU) of the British Association of Urological Surgeons (BAUS) identifying the common long-term complications of widely used bulking agents in clinical practice.Methods:Following a comprehensive literature review an electronic survey was sent to members of the BAUS Section of FNUU. Data included hospital trust, use of urethral bulking agents (including type), the approximate number of procedures performed and whether any long-term complications had been observed and managed in their practice. Long-term complications were defined as those arising more than 12 months after treatment.Results:The literature review revealed multiple case reports of complications secondary to bulking agent injection but no high-level evidence regarding frequency or severity. The survey revealed complications including granulomas, erosions, abscesses and misdiagnoses of urethral diverticula and calculi formation. 88% of urologists who responded to the survey had performed a urethral bulking agent injection and 51% of urologists had observed or treated a long-term complication, some many decades after injection.Conclusion:Patients should be made aware of possible long-term complications of what appears to be a minimally invasive procedure in order for them to make an informed choice about treatment options.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-12T11:58:49Z
      DOI: 10.1177/20514158221086405
       
  • Deflux® (NASHATM/Dx) urethral bulking injections: Outcomes over a decade
           in women with stress urinary incontinence

    • Free pre-print version: Loading...

      Authors: Bob Yang, Catherine Hobbs, Steve Foley
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objectives:Urethral bulking injections are thought to be a low risk minimally invasive but temporary treatment option for women with stress urinary incontinence (SUI) with increasing prominence especially in the current era of the mesh controversy. However, little is known about their long-term effects. This study aims to evaluate the efficacy and long-term outcomes of Deflux®, a non-animal stabilised hyaluronic acid/dextranomer (NASHATM/Dx) gel, when used as a urethral bulking agent in the treatment of SUI in women.Methods:All women with SUI treated with Deflux® from 2001 to 2007 were analysed. The success rates, duration of efficacy and short- and long-term complications of the treatment were recorded.Results:A total of 142 women with a follow-up of up to 13 years (mean 8.8 years) were included. Subjective treatment success was achieved in 92/142 (65%) patients. In those who achieved continence, the mean efficacy was 4.7 years. Side effects were uncommon with 12 (6%) of 209 experiencing transient urinary retention and 11 (5%) of 209 experiencing pseudocyst formation. All pseudocysts were treated successfully with an incision and drainage under either general or local anaesthetic. Sixty (42%) of 142 patients went on to have subsequent definitive incontinence surgery, and Deflux® treatment was found not to have negatively impacted the operation.Conclusion:Deflux® urethral bulking injections appear to be efficacious and safe when used as a treatment for SUI in women with a longer duration of efficacy than previously thought and a low side effect profile. This study provides a valuable timeline to help manage the expectations of patients considering urethral bulking treatment.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-12T11:57:49Z
      DOI: 10.1177/20514158221084823
       
  • Can multi-parametric magnetic resonance imaging and prostate-specific
           antigen density accurately stratify patients prior to prostate biopsy'
           

    • Free pre-print version: Loading...

      Authors: Donnacha Hogan, Henry Han-I Yao, Abbie Kanagarajah, Cindy Ogluszko, Phillip Vinh Phu Tran, Phil Dundee, Helen Elizabeth O’Connell
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:This study examines the diagnostic accuracy of multi-parametric magnetic resonance imaging (mpMRI) in a high-volume centre to potentially stratify patients prior to prostate biopsy.Methods:All biopsy naïve patients who had mpMRI prostate and transperineal biopsy of prostate (TPBx) in 2017 and 2018 were included. There were no exclusion criteria. All patients, regardless of the mpMRI result, underwent systematic template biopsy under general anaesthesia with cognitive target biopsy if indicated. Clinicopathological data were extracted from medical records. The primary outcome was the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mpMRI prostate in the detection of prostate cancer (PCa) compared with template TPBx.Results:In total, 140 patients were included. Overall, 57.1% had a positive biopsy. A higher Prostate Imaging-Reporting and Data Systems (PI-RADS) score was associated with a higher risk of diagnosing clinically significant PCa (International Society of Urological Pathology (ISUP) ⩾ 2) (p < 0.001). The sensitivity, specificity, NPV, and PPV of mpMRI in detecting clinically significant PCa with a PI-RADS ⩾ 3 lesion, was 95% (95% confidence interval (CI) 83.0–99.3%), 41% (95% CI 31.3–51.3%), 95.3% (95% CI 84.2–99.4%) and 39.2% (95% CI 29.4–49.6%), respectively. Combining this with prostate-specific antigen density (PSAD) of
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-12T11:56:49Z
      DOI: 10.1177/20514158221084820
       
  • The emerging role of cross-resistance between taxanes and AR-targeting
           therapy in metastatic prostate cancer

    • Free pre-print version: Loading...

      Authors: Kang Yao, Shun Li, Qingyong Liu, Fei Wu
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:To date, the number of prostate cancer ranked first among newly diagnosed malignant tumors in men from multiple countries. Localized prostate cancer could be controlled by curative therapy. However, for patients with metastatic prostate cancer (mPC), the prognosis is poor. As among first-line treatments of systemic therapies for mPC, docetaxel and androgen receptor (AR)-targeted therapies have been widely used. However, mPC patients inevitably developed resistance to the current therapy. More importantly, there is a cross-resistance between docetaxel-based chemotherapy and AR-targeting therapy during the treatment process, which could impair the overall survival benefits without proper administration.Objective:Therefore, it is urgent to elucidate the mechanism of cross-resistance and explore the optimal sequential strategy.Methods:Here, in this review, we systematically reviewed and summarised the updated literature on clinical evidence and mechanistic research of treatment resistance in mPC.Results:Emerging evidence indicated that AR splice variants, AR overexpression or mutations, AR nuclear translocation, as well as AR signaling reactivation collectively contributed to the cross-resistance. With the current understanding of cross-resistance, multiple solutions are promising for improving the benefits, including refining the sequencing of available therapies for mPC, in combination with potential targeted inhibitors or immune checkpoint inhibitors. Further studies are needed to explore the combination of emerging strategies and eventually control the progression of prostate cancer.Conclusions:This review defined the mutual and unique resistant mechanism of these treatments, which might help to focus and accelerate therapeutic research that may ultimately improve clinical outcomes for patients with prostate cancer.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-12T10:18:55Z
      DOI: 10.1177/20514158221088689
       
  • Teleconsultation versus traditional clinical assessment of patients
           undergoing circumcision: A retrospective cohort study

    • Free pre-print version: Loading...

      Authors: Joseph Natale, John Pascoe, Charles Horn, Jack Coode-Bate, Andrew Dickinson
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To determine whether standalone teleconsultation is an effective alternative to face-to-face assessment of patients requiring circumcision. To determine what environmental and efficiency benefits may arise as a result of service alteration.Patients and Methods:All cases listed for circumcision during first UK lockdown (1 February to 30 September 2020) were reviewed. Cases were collated from operative lists, theatre logs and secretarial records. Cancellations and rationale were recorded. Local audit approval was granted for conduct of this study. Statistical analysis was conducted in JASP.Results:A total of 101 patients were listed for circumcision during the study period. The overall odds of cancellation was 0.063. There was no significant difference in odds of cancellation between telephone clinic and face-to-face clinic odds ratio 0.371 (confidence interval (CI): 0.039–3.46). Telephone clinic could achieve a per-patient cost reduction of £81 and a total reduction in CO2 emissions of 637 kg.Discussion:This is the first study to demonstrate teleconsultation as a suitable method to list patients for circumcision without a face-to-face appointment. The COVID pandemic has accelerated transformational change in outpatient service design instigated by the National Health Service (NHS) Long-Term plan. The environmental and efficiency savings demonstrated suggest sustainable change beyond the pandemic.Level of Evidence:Level 3 (cohort study)
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-12T10:16:40Z
      DOI: 10.1177/20514158221088680
       
  • Clomid after failed Onco-microsurgical testicular sperm extraction: A case
           for delaying contralateral surgical sperm retrieval

    • Free pre-print version: Loading...

      Authors: Nawal Khan, Tet Yap, Julia Kopeika, Majed Shabbir
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background & Objectives:Onco-microsurgical testicular sperm extraction (Onco-microTESE) allows the microsurgical extraction of testicular sperm from the unaffected regions of the tumour-bearing testis at the time of radical orchidectomy. We report the case of a 36-year-old hypogonadotropic male with a testicular tumour and non-obstructive azoospermia.Method:A left radical orchidectomy was performed with simultaneous onco-microTESE. Although some sperm were found during the procedure, these were unsuitable for cryopreservation due to abnormal morphology. Given his low testosterone level (4.1 nmol/L), contralateral surgical sperm retrieval at the same sitting was not performed. Histology of the affected testicle demonstrated a classical seminoma and ‘Sertoli cell only’ appearance. He was subsequently started on clomiphene citrate.Results:After 9 months of clomiphene citrate, repeat semen analysis showed a total of 2.8 million sperm (1 million/mL), with 80% motility. Four vials of semen were cryopreserved, and this ejaculated sperm was used for in vitro-fertilisation (IVF) with intracytoplasmic sperm injection (ICSI). All six harvested eggs were fertilised. By day 5, there were two top grade blastocysts available, one of which was transferred and another frozen. After 9 months, the couple welcomed the birth of a healthy male infant.Conclusion:To our knowledge, this case is the first to demonstrate the benefit of clomiphene citrate in a patient with testis cancer resulting in a reversal of azoospermia and a subsequent live birth with assisted conception.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-08T12:26:44Z
      DOI: 10.1177/20514158221081315
       
  • Emergency ureteric lithotripsy – Improving clinical care in the
           GIRFT era

    • Free pre-print version: Loading...

      Authors: Ben Horsburgh, Stephanie Carr
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Emergency ureteric stone treatment with lithotripsy is a key topic in Urology. This study describes the process of change in this unit to develop protocol-led quality care for patients with obstructing ureteric stones.Subjects/patients (or materials) and methods:A retrospective series of 675 consecutive patients undergoing emergency ureteric stone lithotripsy. Treatment data, times from referral to treatment completion and outpatient follow-up by endourologist are analysed. Data are reviewed over a 4-year period while protocol-led care was introduced.Results:This study demonstrates significant improvement in timely patient management. In 2017, the median time from referral to post-treatment review was 147 days. With the introduction of the protocol-led booking system, the median time from referral to post-treatment review was reduced to 14 days. Improvements in evidence-based shock wave delivery and clinical coding are demonstrated.Conclusion:This study demonstrates improvement in patient care through timely booking of lithotripsy treatment and follow-up. Barriers to improving care include IT support and changing established practice. Ongoing metrics for emergency ureteric lithotripsy should include the time taken from referral to post-treatment clinical review by an endourologist.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-05T06:37:33Z
      DOI: 10.1177/20514158221081421
       
  • Adopting low dose CT in evaluating renal calculi-progress from 2008-18 in
           a large UK tertiary hospital

    • Free pre-print version: Loading...

      Authors: Richard Raynor, Arumugam Rajesh
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:Computed tomography (CT) of the urinary tract is a commonly performed investigation and it is crucial to adhere to low dose protocols to avoid unnecessary radiation burden.Aims:To review the adoption of low-dose techniques over time, defined as a dose length product (DLP) < 200mGy.cm, in a large teaching hospital over three locations with 12 CT scanners.Methods:Data were obtained from the radiology information system for exams completed under the coding for unenhanced CT evaluation for renal calculi between 14 Feb 2008 and 31 December 2018. Examinations where the DLP was not correctly recorded, was below 40mGy.cm, or where the equipment used could not be identified were excluded. The distribution of doses and the median DLP per scanner was calculated.Results:In all, 20,080 studies were available across 12 CT scanners in the 10- year period. The average Median DLP has reduced from 501mGy.cm in 2008 to 178mGy.cm in 2018.Conclusions:Improvements in CT technology and implementation of low-dose protocols have resulted in significantly lower doses for evaluation of kidney stones since 2008. Although this study demonstrates significant variation between scanners, the overall adoption of low dose techniques is excellent.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-01T10:37:32Z
      DOI: 10.1177/20514158221082876
       
  • A ten-year observational study of the use of two-way catheters
           post-transurethral resection of the prostate without the use of post-op
           irrigation

    • Free pre-print version: Loading...

      Authors: Leo Kretzmer, Adebiyi Damola, Manvir JS Sandher, Wiliam Martin, Syed Ali Ehsanullah, Adam Jones, Sumi Manirajan, Serkan Cakir, Jo Gao, Andrea Ginepri, Sid Singh, Ike Apakama
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:Over 15,000 transurethral resections of the prostate (TURP) are performed annually in the United Kingdom. It is therefore vital that every aspect of peri-operative care be optimised. Our centre favours the use of two-way catheters post-operatively without the use of continuous bladder irrigation (CBI).Objectives:To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared with standard three-way catheterisation. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed.Design, setting, and participants: This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Following TURP patients were catheterised with two-way catheters. Prospective patient data were collected pertaining to peri-operative factors. These data were then compared with the data published in the literature.Results:687 patients underwent TURP at our centre between 2009 and 2019. The average age of patients was 71.42 (±7.89). 87.17% (n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days, increasing to 2.20 days if patients required three-way catheters or 2.53 days if requiring CBI. TWOC was successful in 97.71% of patients. Complication rate was 8.73% (n = 60). When compared with other centres, our method reduced lengths of admission and transfusion rates (1.6 days versus 3.1 days and 0.87% versus 2.83%, respectively).Conclusion:Our method is safe and is associated with a reduced length of admission. We recommend this practice to the wider urological community.Patient summary:This study looked at whether there was any impact on patients if two-way catheters were used following TURP. We found that use of two-way catheters reduced length of admission and duration of catheterisation. We also found that it did not increase likelihood of peri-operative complications in comparison with other centres.
      Citation: Journal of Clinical Urology
      PubDate: 2022-04-01T10:37:01Z
      DOI: 10.1177/20514158221081815
       
  • Small cell carcinoma of the prostate: Pathological and magnetic resonance
           imaging findings

    • Free pre-print version: Loading...

      Authors: Pranav Sharma, Aiyapa Aruna Ajjikuttira, Kate McLean, Benjamin Shepherd
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Level of evidence: IV
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-29T12:46:23Z
      DOI: 10.1177/20514158221081415
       
  • Utilisation of anatomic grading of nerve-spare during robot-assisted
           radical prostatectomy to prognosticate erectile function recovery

    • Free pre-print version: Loading...

      Authors: Henry H Yao, Alvaro Bazo, Kathryn Ball, Timothy R Terry, Thomas J Walton
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To determine if a precise 5-point nerve-spare (NS) scoring system at the time of robot-assisted radical prostatectomy (RARP) correlates with post-operative erectile function recovery (EFR).Patients and methods:From 2014 to 2018, 277 patients underwent RARP by a single surgeon. NS quality was recorded as: grade 1, non-NS; grade 2,
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-29T12:45:35Z
      DOI: 10.1177/20514158221081306
       
  • Effect of asymptomatic bacteriuria on readmissions and rate of urosepsis
           after ureterorenoscopy for urolithiasis

    • Free pre-print version: Loading...

      Authors: Abdallah Daggamseh, Andrew Dickinson, Nicholas Campain, Anna Longshaw, Andrew Maccormick, Catherine Miller
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:This study aims to assess whether the rate of readmissions after ureterorenoscopy (URS) is dependent on results of urine microscopy, culture and sensitivity (MC&S) or nitrite dipstick test performed before the procedure.Patients and Methods:All patients attending for ureteroscopy for stone disease over 12 months were included and had urine dipstick performed immediately prior to the surgery with mid-stream urine (MSU) sample sent for culture. Asymptomatic bacteriuria (ABU) was not treated before ureteroscopy. All included patients received standard antibiotic prophylaxis. Readmissions within 30 days of the procedure were evaluated.Results:A total 120 ureteroscopies were included, of which 20% had ABU. Eight patients (6.67%) were readmitted due to all procedure-related complications; among them, five (4.17%) were readmitted with urinary tract infection (UTI). Readmission rates with UTIs were similar for patients with sterile urine and those who had untreated ABU. Of those patients who were readmitted with UTI, all had a negative nitrite result on preoperative urine dipstick specimens. Most patients (54.17%) who had ABU also had a negative urinary nitrite test.Conclusions:Screening and routine treatment of ABU before ureteroscopy for urolithiasis may be unnecessary provided patients have standard antibiotic prophylaxis. Moreover, urine nitrite testing before ureteroscopy may not be a useful screening test for ABU before ureteroscopy.Level of evidence:2
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-25T10:04:42Z
      DOI: 10.1177/20514158211073444
       
  • Proposal of sialyl Lewis x/a as prognostic biomarkers in clear cell renal
           cell carcinoma: A study on a cohort of 117 patients submitted to curative
           surgery

    • Free pre-print version: Loading...

      Authors: Makoto Tanio, Yusuke Fukiage, Akifumi Muramoto, Osamu Yokoyama, Motohiro Kobayashi
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Metastatic recurrence has been reported to occur in 20–30% of patients with clear cell renal cell carcinoma (ccRCC). Although the prognosis of these patients is poor, no marker has been established to predict metastatic potential and/or prognosis. Therefore, we investigated membrane expression of sialyl Lewis x (sLex) and sialyl Lewis a (sLea), which is generally considered to be associated with cancer metastasis.Materials and methods:We enrolled 117 patients who underwent curative surgery for RCC and were pathologically diagnosed as ccRCC. Immunohistochemistry for sLex and sLea was performed to evaluate the signal intensity on the cell membrane. We statistically analysed whether membrane expression of sLex/sLea is correlated with clinicopathological parameters and prognosis.Results:Of the 117 patients, 72 were classified as sLex-positive and 44 as sLea-positive. The sLex-positive group had significantly shorter progression-free survival (PFS) and overall survival (OS) than the negative group. Similarly, the sLea-positive group had significantly shorter PFS than the negative group, and it showed a trend towards a reduction of OS, although it did not reach statistical significance, a fact that could be due to the small sample size.Conclusion:Both sLex and sLea could be possible future prognostic indicators in ccRCC.Level of evidence:Level 3
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-14T08:20:41Z
      DOI: 10.1177/20514158221082884
       
  • Bacterial colonization in three different parts of double J stent

    • Free pre-print version: Loading...

      Authors: Alireza Gorji Daroonkolaee, Alimohammad Fakhr Yasseri, Fatemeh Khatami, Mohammad Saatchi, Hedieh Moradi Tabriz, Roohollah Afsari, Mohammad Mehdi Rakebi, Elham Tehranipour, Maryam Gholamnejad, Rahil Mashhadi, Seyed Mohammad Kazem Aghamir
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Introduction:Due to the extensive use of indwelling stents and catheters in urology, bacterial colonization on these materials is a significant cause of infections in this group of patients. This study aims to investigate and compare the bacterial colonization in urine and in the three zones of the double J (DJ) stent.Methods:Between August 2019 and May 2020, 67 patients (18–78 years old) who underwent DJ stenting were recruited in the study. Surgeries before stenting included transurethral lithotripsy (TUL), percutaneous nephrolithotomy (PCNL), or diagnostic ureteroscopy. Before stenting, sterile urine samples were collected, and urinary cultures were performed, and the same procedure was done after removal of the DJ stents. DJ stent cultures were also performed.Results:61 patients were analyzed. The mean age of all patients was 53 ± 16 years. The mean time of DJ installation in all patients was 27.6 ± 6.7 days (14–43 days). In these three parts of the DJ, 70.5%, 67.2%, and 72.1% of patients were without a colony, respectively. The microorganism distribution is approximately the same in the lower and upperparts, and Escherichia coli has the highest frequency (11.5%). The odds ratio (OR) of contamination was significantly lower in men than in women, but overweight and diabetes were not associated.Conclusion:The severity and pattern of bacterial colonization are not significantly different in the proximal, distal, and middle parts of the DJ stent.
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-14T08:18:00Z
      DOI: 10.1177/20514158221081399
       
  • Do weather parameters affect the incidence of renal colic in a
           predominantly warm country' A multicenter study

    • Free pre-print version: Loading...

      Authors: Dor Golomb, Hanan Goldberg, Arnon Lavi, Ilan Kafka, Nir Kleinmann, Asaf Shvero, Guy Verchovsky, Leonid Boyarsky, Abd Elhalim Darawasha, Omer Sadeh, Matan Mekayten, Nir Stav, David Lifshitz
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Purpose:To determine whether there is any effect of weather parameters on the incidence of renal colic patients presenting to emergency rooms (ERs) during the hottest season in Israel.Materials and Methods:This retrospective multicenter study involved all ER admissions related to renal colic in nine centres throughout Israel between 2010 and 2017. The collected data included the date of ER visits, the patients’ age and sex, and the weather features of ambient temperature, wind velocity, noon heat index, and barometric pressure. Multivariable logistic regression analyses identified predictors of increased ER visits for renal colic.Results:There were 85,501 renal colic-related ER visits during the study period, involving 62,935 (74%) males and 22,566 (26%) females (p < 0.005). The mean ± standard deviation (SD) age of the males and females was 50 ± 5.8 and 48 ± 19.6 years, respectively (p = 0.1). Most of the ER arrivals were in the 31- to 50-year-old age group (37%, 31,508) (p = 0.02). The maximal ambient temperature (odds ratio (OR) = 2.213, 95% confidence interval (CI) = 2.148–2.279, p < 0.0001), lower heat index (i.e. low humidity; OR = 0.880, 95% CI = 0.872–0.887, p < 0.0001) and increased wind velocity (OR = 1.165, 95% CI = 1.149–1.182, p < 0.0001) had a significant linear effect on ER visits for renal colic events.Conclusion:Conditions that increase sweat evaporation during the hottest months, including a decreased heat index and increased wind velocity, correlated with more ER visits for renal colic events, probably due to dehydration associated with elevated sweat evaporation.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-14T08:13:19Z
      DOI: 10.1177/20514158221081313
       
  • The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES): A
           novel technique for the intraureteric assembly of a loop snare for the
           retrograde extraction of a migrated ureteric stent

    • Free pre-print version: Loading...

      Authors: Timothy Peter Napier-Hemy, Michael S Floyd, Azizan Samsudin
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Background:While ureteric stent removal remains a frequently performed endourological procedure stent migration either proximally or distally can present the endourologist with a significant intraoperative dilemma. In cases where the stent is of large calibre or impacted into the mucosa of the ureter, retrieval may prove refractory to traditional approaches.Objective:To present a further novel procedure: The Whiston Snare Technique for Loop Extraction of Stents (WHISTLES) which allows for intraureteric assembly of a tightening loop through a ureteric catheter thus permitting safe retrieval of a migrated stent.Methods:We describe the procedure as it was performed and have recreated the steps in a laboratory environment. This demonstrates an adaptation of existing materials readily found in most urological theatres and is not a prototypical device.Results:The procedure was successfully performed to allow extraction of the migrated ureteric stent.Conclusion:WHISTLES is a reproducible method for the retrieval of migrated ureteric stents where traditional techniques have failed.Level of evidence:5
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-14T08:10:32Z
      DOI: 10.1177/20514158221081305
       
  • Safety, efficacy and functional outcomes of photoselective vaporisation of
           the prostate: A single-centre experience

    • Free pre-print version: Loading...

      Authors: Sanjay Kumar, Sridhar Panaiyadiyan, Prashant Singh, Premnath Dogra
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:The objective of this study was to report the safety, efficacy and functional outcomes following photoselective vaporisation of prostate (PVP) with GreenLight laser for benign prostatic enlargement (BPE).Material and methods:We retrospectively analysed men who underwent PVP from April 2011 to August 2019 for BPE. Preoperative, intraoperative and postoperative details were retrieved from electronic data software. The perioperative and functional outcomes were analysed.Results:A total of 147 patients, with a mean age of 65.4 years, underwent PVP (51 patients – high performance system (HPS), 120 Watts; 96 patients – xcelerated performance system (XPS), 180 Watts). In 20 (13.6%) patients, antiplatelet or anticoagulant were continued in the perioperative period. The mean operative time, lasing time, catheterization time and hospital stay were 54.4 minutes, 38.0 minutes, 48.7 hours and 2.73 days, respectively. Postoperatively, all the functional outcomes IPSS (international prostate symptom score), QOL (quality of life), Qmax (maximum flow rate) and PVR (postvoid residue) were significantly improved from the baseline. The most common complication was dysuria (36.7%). There was no significant perioperative bleeding complications in high-risk men who were on antiplatelet or anticoagulant therapy.Conclusion:PVP is a safe, efficacious and durable surgical option in BPE including patients on antiplatelet or anticoagulant therapy.Level of evidence:Level 4
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-02T09:03:39Z
      DOI: 10.1177/20514158221078471
       
  • Prostate Disease Severity Score: In the management of benign enlargement
           of prostate

    • Free pre-print version: Loading...

      Authors: KN Sanman, Santosh Patil, GG Laxman Prabhu, Ranjit Shetty, P Venugopal
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Developing a simple, user-friendly objective severity scoring system for symptomatic benign enlargement of prostate (BEP) and comparing with International Prostate Symptom Score (IPSS).Subjects and Methods:In this prospective study, patients with BEP completed IPSS proforma. A grading system was developed for peak flow of urine (Qmax), transitional zone index (TZI), detrusor wall thickness (DWT) and intravesical prostatic protrusion (IPP). Prostate Disease Severity Score (PDSS) was developed as sum of the variables.Results:Among 115 patients, obstructive voiding (70.43%) was predominant symptom followed by storage symptom (10.44%). Among predominant obstructive voiders, grades 1–3 TZI was common (97.53%), followed by IPP (64.19%) and DWT (62.96%) of varying grade. IPP, DWT, TZI and Qmax proved to be strong determinants of obstructive voiding (p < 0.05). The components of PDSS correlated well with total score (p < 0.05), positively correlated with IPP, DWT and TZI, and negatively with Qmax (p < 0.05); correlation with IPSS was statistically significant (p < 0.05). According to PDSS, 92.5% (37/40) patients with severe, 73.02% (46/63) with moderate, 8.33% (1/12) with mild degree of obstruction needed surgical intervention.Conclusion:The objective nature, comparable correlation with IPSS, potentiality to predict future need for surgical intervention, makes PDSS, a potential user-friendly assessment tool in management of BEP.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-03-02T09:00:58Z
      DOI: 10.1177/20514158221078468
       
  • Delayed spontaneous haematoma after minimally invasive prostatectomy

    • Free pre-print version: Loading...

      Authors: Connor Boyle, Daniel Good, Linda Taylor, Alan McNeill
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Minimally invasive radical prostatectomy has become the standard surgical approach in the United Kingdom. Haematoma formation is a recognised post-operative complication, but this tends to be regarded as an early complication and there is a paucity of clinical information on the challenges of delayed haematoma formation. We present an unusual case of a man presenting with a late post-operative bleed that occurred spontaneously 5 weeks after surgery. A haematoma developed and was associated with complete disruption of the vesico-urethral anastomosis, that imaging had shown to be intact 11 days post-operatively.Level of evidence: 4
      Citation: Journal of Clinical Urology
      PubDate: 2022-02-25T01:31:04Z
      DOI: 10.1177/20514158221075922
       
  • Vigilance is key: Metastatic teratoma in an enlarging retroperitoneal mass
           after treatment of advanced seminoma – a case report

    • Free pre-print version: Loading...

      Authors: Yousef M Abu-Salha, Lauren Ahlschlager, Matthew I Milowsky, Katherine Saunders, Tracy L Rose, Sara E Wobker, Marc A Bjurlin
      Abstract: Journal of Clinical Urology, Ahead of Print.
      We present the case of a patient with pure seminoma in the orchiectomy specimen with retroperitoneal mass and a minimally elevated alpha fetoprotein (AFP). The patient received chemotherapy with positron emission tomography (PET) imaging demonstrating minimal fluorodeoxyglucose (FDG) uptake consistent with no viable tumour. Subsequent imaging revealed slow growth in the residual mass with a mildly elevated fluctuating AFP. A robotic-assisted laparoscopic retroperitoneal lymph node dissection was performed revealing metastatic teratoma. This case illustrates the potential for a missed or ‘burned out’ occult NSGCT in a patient with pure seminoma and the importance of post-treatment surveillance. In advanced seminoma, PET may be used to distinguish viable tumour from necrosis in post-chemotherapy residual masses. However, it is unable to distinguish between teratoma and necrosis in non-seminomatous germ cell tumours (NSGCT). Minimally elevated AFP could be a normal variant or signify a component of NSGCT in such cases.Level of evidence: 4
      Citation: Journal of Clinical Urology
      PubDate: 2022-02-25T01:30:02Z
      DOI: 10.1177/20514158221075411
       
  • Long-term surgical outcome of anterior colporrhaphy and autologous fascial
           sling (AFS) reinforcement for treatment of high-grade cystocoele

    • Free pre-print version: Loading...

      Authors: Danielle Taylor, Henry H Yao, Johan Gani, Helen E O’Connell
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To determine the long-term outcomes of anterior colporrhaphy with pubovaginal sling reinforcement in the management of high-grade cystocoele and significant urethral dysfunction.Materials and Methods:This is a retrospective case series. From May 2008 to October 2017, all patients who underwent concurrent anterior colporrhaphy and pubovaginal fascial sling performed by a single surgeon were included. Subjective success rates were determined from patient-reported outcomes on follow-up questionnaires using The Patient Global Impression of Improvement (PGI-I) scores. Primary outcome of this study was subjective cystocoele recurrence-free survival. Secondary outcome was complication rate.Results:Eighty patients were included with a median age of 63 years. All women had urethral dysfunction (type II urethral hypermobility or intrinsic sphincter deficiency) on fluoroscopic urodynamics in association with a high-grade cystocoele. The median follow-up time for recurrence of cystocoele was 36 months. The 1- and 5-year estimated cystocoele recurrence-free survival was 97.2% and 84.8%, respectively.Conclusion:Anterior colporrhaphy with concurrent pubovaginal sling reinforcement for treatment of high-grade cystocoele is a safe procedure with a high rate of success durable up to 5 years. The risk of complications is low with no patient developing chronic pain or rejection of the fascial graft.Level of evidence:Not applicable.
      Citation: Journal of Clinical Urology
      PubDate: 2022-02-21T10:59:02Z
      DOI: 10.1177/20514158211062476
       
  • The impact of COVID-19 pandemic on acute urology admissions in a busy
           district general hospital in the United Kingdom

    • Free pre-print version: Loading...

      Authors: Divya Bheenick, Matthew J Young, Muhammad Elmussareh, Ased Ali
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Coronavirus disease 2019 (COVID-19) has had unprecedented effects on the healthcare system in the United Kingdom. The pandemic has impacted every service within secondary care, including urology. Our objective is to determine how COVID-19 has influenced acute urology admissions in a busy district general hospital in the United Kingdom.Patient and methods:Retrospective data of patients presenting acutely to the urology department were collected between 13 January to 22 March 2020 (pre-lockdown period) and 23 March to 31 May 2020 (lockdown period). The nature of referrals, types of admission encountered and management required in accordance with the new set of protocols established during the lockdown period were analysed and compared to the same data prior to UK lockdown.Results:Overall, 1092 patients were included in the study. An overall reduction of 32.5% was seen in the total number of admissions. A marked decrease was seen in non-urological pathology as compared to other categories. Urolithiasis showed the highest proportional increase. Treatment varied proportionately to the diagnosis, with conservative management accounting for the most likely treatment during lockdown. However, the proportion of patients requiring interventions during the lockdown period increased overall. No comparative differences were observed during the two periods in terms of source of referral, length of stay and patient age.Conclusion:The admission rate showed a decrease, with no significant difference in the nature and timing of presentation. Our department was able to continue providing effective management to patients presenting acutely during the COVID-19 outbreak.
      Citation: Journal of Clinical Urology
      PubDate: 2022-02-16T08:58:04Z
      DOI: 10.1177/20514158211073435
       
  • Complete inguinal bladder hernia causing acute right upper urinary tract
           obstruction

    • Free pre-print version: Loading...

      Authors: Christopher TJ Madden-McKee, Matthew Getty, Trevor J Thompson
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Case Summary:An 86-year-old male nursing home resident presented with increasing confusion and was initially treated for catheter-associated urinary tract infection. Computed tomography (CT) scan demonstrated complete inguinal bladder hernia with compression of the right vesico-ureteric junction leading to acute obstructive renal failure. Percutaneous nephrostomy was attempted but was not possible due to patient non-compliance. Patient improved with conservative management.Discussion:Bladder involvement in inguinal hernia is rare with most cases being identified at the time of hernia repair and there is a 17% risk of intra-operative bladder injury. Key risk factors include increasing age, male gender, lower urinary tract symptoms and previous hernia repair. Percutaneous nephrostomy followed by inguinal hernia repair is the treatment of choice for most patients. This case highlights that inguinal bladder hernia can lead to acute upper urinary tract obstruction even when the bladder is catheterised.Level of evidence: IV
      Citation: Journal of Clinical Urology
      PubDate: 2022-02-01T11:48:02Z
      DOI: 10.1177/20514158221074522
       
  • Corpus cavernosum abscess complicating distal shunt procedures for
           priapism

    • Free pre-print version: Loading...

      Authors: Finín Cotter, Margaret Shi, Niranjan Sathianathen, Gowribahan Thevarajah, Janice Cheng, Dennis Gyomber, Sudheshan Sundaralingam, Prassannah Satasivam
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Abscess of the corpus cavernosum is a rare condition. We describe the case of a 36-year-old male presenting with bilateral corpus cavernousm abscesses, on a background of distal shunt procedures for recurrent priapism, that was managed with a bilateral corporotomy and systemic antibiotic therapy.Level of Evidence: Level 4
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-31T11:50:29Z
      DOI: 10.1177/20514158211027424
       
  • A ‘real-world’ standard for radical prostatectomy: Analysis of the
           British Association of Urological Surgeons Complex Operations Reports,
           2016–2018

    • Free pre-print version: Loading...

      Authors: Joseph B John, John Pascoe, Sarah Fowler, Thomas Walton, Mark Johnson, Jonathan Aning, Benjamin Challacombe, Rory Bufacchi, Andrew J Dickinson, John S McGrath
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To produce comprehensive and detailed benchmarking data allowing surgeons and patients to compare practice against, by using all recorded radical prostatectomies across a 3-year period in England.Patients and methods:The British Association of Urological Surgeons (BAUS) manages the radical prostatectomy (RP) Complex Operations Database. Surgical departments upload data which they can review and amend before lockdown and data cleansing. Analysis of 2016–2018 data held on the BAUS Complex Operations Database was performed for 21,973 patients undergoing RP in England, producing procedure-specific benchmarking data. General linear models were used to assess differences in patient selection between different operative modalities. Analysis involved assessment of case selection, operative decisions and outcomes, case volume and pathological outcomes.Results:Using national Hospital Episode Statistics, the BAUS RP dataset was estimated 91% complete. Median age was 65 and 96% were American Society of Anesthesiologists (ASA) Grades 1–2. Over 80% had RP performed in a high-volume centre (>100 annual RPs) and 88% had Gleason grade group (GGG) ⩾2 disease on biopsy. Robotic-assisted RP (RARP), laparoscopic RP (LRP) and open RP (ORP) were performed in 85%, 7.2% and 7.7% of cases, respectively. Patient and disease characteristics differed across surgical modalities. Transfusion rates were 0.14% in RARP, 0.38% in LRP and 1.8% in ORP. Increased positive surgical margin (PSM) rates were observed with increasing prostate-specific antigen (PSA), GGG and T-stage, with comparable PSM rates across surgical modalities. Lymph node dissection was performed more commonly in high-risk cases (cT3, PSA> 20, GGG ⩾ 4). Pathological upstaging was common. Median length of stay was 1, 2 and 3 days for RARP, LRP and ORP, respectively. ORP had Clavien–Dindo complications ⩾3 and unplanned hospital readmissions.Conclusion:This analysis has enabled the first set of UK national RP standards to be produced allowing procedure, patient and disease-specific national, centre and individual comparisons. The present degree of service centralisation, operative modalities, and specific aspects of surgical practice can be observed.Level of evidence:2b
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-28T08:42:12Z
      DOI: 10.1177/20514158211063964
       
  • Comparative effectiveness and safety of cocktail therapy versus combined
           sodium hyaluronate and chondroitin sulphate (Ialuril): Intravesical
           instillation treatment of interstitial cystitis/bladder pain syndrome,
           which one to use'

    • Free pre-print version: Loading...

      Authors: Mai Ahmed Banakhar
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To compare effectiveness and safety of intravesical therapy (sodium hyaluronate and chondroitin sulphate) Ialuril versus cocktail therapy for treatment of interstitial cystitis (IC).Materials and methods:Prospective study from March 2013 till August 2019 including all IC patients presented to our urology clinic. All IC patients underwent basic workup including urine test, urodynamic test and gynaecological/genital exam. Postoperatively, all patients received intravesical therapy. Patients were randomly allocated to either cocktail therapy (NaOH + heparin + lidocaine) or Ialuril (Sodium hyaluronate and chondroitin sulphate) therapy as intravesical seven cycles. The primary outcome was therapy effectiveness using Interstitial Cystitis Problem Index (ICPI) and Interstitial Cystitis Symptom Index (ICSI) improvement post therapy. Secondary outcome were for complications and compliance.Results:Total of 32 patients were included (6 males, 26 females) with mean age of 43 years (24–72 years), mean follow-up 36 months (15–72 months). Cocktail intravesical therapy was used in 21 patients while 11 patients received Ialuril. All patients showed improvement on their ICSI and ICPI scores post therapy from their baseline. Statistical analysis showed no significant difference between both groups regarding improvement in ICSI and ICPI index with p-value = 0.552 and p = 0.79, respectively. Infection and non-compliance is significantly high in the cocktail arm p = 0.004, p = 0.027Conclusions:Intravesical cocktail therapy was equally effective as Ialuril in treating IC. Ialuril was preferred over cocktail therapy because of lower side effect; when considering ulcerative IC subgroup, we need large randomised controlled trials to compare therapy benefits.
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-27T11:20:02Z
      DOI: 10.1177/20514158211073449
       
  • Interactive virtual 3D image reconstruction to assist renal surgery in
           patients with fusion anomalies of the kidney

    • Free pre-print version: Loading...

      Authors: Naomi Morka, Lorenz Berger, Eoin Hyde, Faiz Mumtaz, Ravi Barod, Prasad Patki, Niels Graafland, Kees Hendricksen, Maxine Tran, Axel Bex
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Renal fusion anomalies are rare and usually present as horseshoe kidneys or crossed fusion ectopia. The complex renal anatomy seen in patients with these anomalies can present a challenge. Pre-operative planning is therefore paramount in the surgical management of these cases. Herein we report the use of interactive virtual three-dimensional (3D) reconstruction to aid renal surgery in patients with fusion anomalies of the kidney.Materials and Methods:A total of seven cases were performed between May 2016 and October 2020. 3D reconstruction was rendered by Innersight Labs using pre-operative computed tomography (CT) scans.Results:Five patients had malignant disease and two patients had benign pathology. Robotic and open operations were performed in four and three patients, respectively.Conclusion:The use of 3D reconstruction in the cases reported in this series allowed for the identification of variations in renal vasculature, and this informed the choice of operative approach.Oxford Centre for Evidence-Based Medicine Evidence Level:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-17T07:07:11Z
      DOI: 10.1177/20514158211068310
       
  • A single centre service evaluation of the pre-biopsy mpMRI pathway for
           prostate cancer diagnosis

    • Free pre-print version: Loading...

      Authors: Mark Kong, Louise Lee, Kevin Mulcahy, Arumugam Rajesh
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Aim:To study the efficacy and impact of the local pre-biopsy multiparametric magnetic resonance imaging (mpMRI) pathway for prostate cancer diagnosis.Methods:In this tertiary centre, 570 patients had prostate mpMRI across a 6-month period in 2019. A total of 511 patients met inclusion criteria for retrospective analysis. MRI reporting used the Prostate Imaging-Reporting and Data System (PI-RADS) v2.1. These were assessed alongside histological outcomes and diagnostic times. PI-RADS ⩾ 3 were recommended for biopsy consideration. Gleason scoring ⩾ 3 + 4 and 3 + 3 were used to define clinically and non-clinically significant prostate cancer (csPCa and nsPCa), respectively.Results:Overall prostate cancer prevalence was 40% (204/511, csPCa in 31.1%) with an overall biopsy avoidance of 32.1% (164/511). Around 69.7% (356/511) scored PI-RADS ⩾ 3 and 30.3% (155/511) scored PI-RADS 1–2. About 22.6% (35/155) of PI-RADS 1–2 patients proceeded to biopsy, demonstrating a negative predictive value of 91.43% for csPCa. For PI-RADS ⩾ 3 patients, 63.4% (197/312) of those biopsied had cancer (Gleason ⩾ 3 + 3), with 50% (156/312) demonstrating csPCa. Around 76.7% (102/133) of PI-RADS 5, 35.3% (48/136) of PI-RADS 4, 14.0% (6/43) of PI-RADS 3 and 8.6% (3/35) of PI-RADS 1–2 scores demonstrated csPCa. Overall median prostate-specific antigen (PSA) density was 0.15 ng/mL2 (IQR: 0.10–0.27/mL2). PSA density were significantly different across PI-RADS cohorts (H = 118.8, p 
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-07T12:59:16Z
      DOI: 10.1177/20514158211065946
       
  • Testicular metastasis in prostate cancer: A rare case of testicular
           metastasis diagnosed with 68Ga-PSMA and review of the literature

    • Free pre-print version: Loading...

      Authors: Gokhan Ozyigit, Bulent Akdogan, Melek Tugce Yilmaz, Gunes Guner, Murat Fani Bozkurt
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:Testicular metastasis in prostate cancer is a rare entity. We aimed to report the case where this rare condition was diagnosed with Gallium prostate-specific membrane antigen–positron emission tomography/computed tomography (68Ga-PSMA-PET/CT).Subjects/patients and methods:A 68-year-old male with a prostate adenocarcinoma presented with testicular metastasis. The patient was diagnosed with 68Ga-PSMA-PET/CT, and bilateral inguinal orchiectomy was performed. Herein, our case is presented, and a short review of the literature is carried out.Conclusion:68Ga-PSMA-PET/CT is an effective imaging method for detecting rare metastases.Level of evidence:4
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-07T12:17:04Z
      DOI: 10.1177/20514158211068307
       
  • Risk stratification for renal deterioration in the neurogenic bladder
           patient: Should it be a prerequisite for patient selection in
           video-urodynamic studies'

    • Free pre-print version: Loading...

      Authors: Keith Pace, Michaela Farrugia
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:The aim of this retrospective review is to determine whether risk stratification for renal deterioration in neuro-urology patients is supported by urodynamic findings in terms of bladder safety and whether urodynamic findings affect bladder management in this patient group. The primary endpoints are to determine any statistically significant differences between the high and low risk for renal deterioration groups in terms of urodynamic findings regarding bladder safety, and the frequency of changes in bladder management following video-urodynamics (VUDs).Methods:VUDs, which were performed between March 2015 and March 2021 in view of neurogenic lower urinary tract dysfunction, were included in the study. These were divided into those performed in patients with high risk and those in patients with low risk for renal deterioration categories according to criteria specified in the National Institute of Clinical Excellence (NICE) Urinary Incontinence in Neurological Disease guidelines. The two groups were then statistically compared in terms of urodynamic parameters for bladder safety and changes in management thereafter.Results:In total, 69 VUDs were included, 49.3% were classified as having been performed in high risk for renal deterioration patients, and 50.7% as low risk. 50% of those in the former group were found to have an unsafe bladder versus 31.4% in the latter group (p = 0.12). Meanwhile, 65.2% of VUDs resulted in a change in bladder management, with no difference in change in management frequency between the two risk stratification groups (p = 0.36).Conclusion:The lack of statistically significant difference in urodynamic bladder safety findings and change in frequency of bladder management for the low and high risk for renal deterioration categories in this cohort bring into question the need for risk stratification in the clinical decision to perform VUDs in the neurogenic bladder patient.Level of evidence:2c
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-07T12:14:24Z
      DOI: 10.1177/20514158211068293
       
  • A case report on penile duplication: A rare congenital anomaly

    • Free pre-print version: Loading...

      Authors: Rao Nouman Ali, Sohaib Irfan, Wajiha Irfan, Attiq-ur-rehman khan, Muhammad Irfan, Muhammad Khalid Butt
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Introduction: Penile duplication or penile diphallia is a rare congenital anomaly that is mainly associated with renal, anorectal or vertebral anomalies, that is, spina bifida. This condition was first described by Johannes Jacob Wecker in 1609 in Italy.Problem: Its incidence is extremely rare, about one in millions. The aetiology of this condition is unknown up till now; however, it is considered that defect of genital tubercle leads to the formation of diphallia.Methods: The condition is diagnosed clinically, and management depends on the appearance of genitalia and the associated anomalies as well as after taking into account the social and ethical considerations. Most of the time, management involves surgical incision of the non-functioning penis.Results: In this case report, a child of age 10 years presented with double penis since childhood. The child was evaluated clinically and radiologically for any other associated abnormalities, and his non-functional urethra was surgically removed.Level of evidence: Level IV
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-07T12:11:18Z
      DOI: 10.1177/20514158211066419
       
  • MRI-based nomogram for the prediction of prostate cancer diagnosis: A
           multi-centre validated patient–physician decision tool

    • Free pre-print version: Loading...

      Authors: Edwin M Chau, Beth Russell, Aida Santaolalla, Mieke Van Hemelrijck, Stuart McCracken, Toby Page, Sidath H Liyanage, Jonathan Aning, Vincent J Gnanapragasam, Peter Acher
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:To update and externally validate a magnetic resonance imaging (MRI)-based nomogram for predicting prostate biopsy outcomes with a multi-centre cohort.Materials and methods:Prospective data from five UK-based centres were analysed. All men were biopsy naïve. Those with missing data, no MRI, or prostate-specific antigen (PSA) > 30 ng/mL were excluded. Logistic regression analysis was used to confirm predictors of prostate cancer outcomes including MRI-PIRADS (Prostate Imaging Reporting and Data System) score, PSA density, and age. Clinically significant disease was defined as International Society of Urological Pathology (ISUP) Grade Group ⩾ 2 (Gleason grade ⩾ 7). Biopsy strategy included transrectal and transperineal approaches. Nomograms were produced using logistic regression analysis results.Results:A total of 506 men were included in the analysis with median age 66 (interquartile range (IQR) = 60–69). Median PSA was 6.6 ng/mL (IQR = 4.72–9.26). PIRADS ⩾ 3 was reported in 387 (76.4%). Grade Group ⩾ 2 detection was 227 (44.9%) and 318 (62.8%) for any cancer. Performance of the MRI-based nomogram was an area under curve (AUC) of 0.84 (95% confidence interval (CI) = 0.81–0.88) for Grade Group ⩾ 2% and 0.85 (95% CI = 0.82–0.88) for any prostate cancer.Conclusion:We present external validation of a novel MRI-based nomogram in a multi-centre UK-based cohort, showing good discrimination in identifying men at high risk of having clinically significant disease. These findings support this risk calculator use in the prostate biopsy decision-making process.Level of evidence:2c
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-07T12:07:19Z
      DOI: 10.1177/20514158211065949
       
  • Distal ureteral atresia – an embryological dilemma

    • Free pre-print version: Loading...

      Authors: Subramanya Kattepura, Attibele Mahadevaiah Shubha, Kanishka Das
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Introduction:Distal ureteral atresia is a rare urinary tract anomaly generally associated with ipsilateral renal dysplasia and abnormalities such as multicystic dysplastic kidney, hydronephrosis and megaureter in the contralateral kidney. Despite burgeoning investigation modalities, definitive preoperative diagnosis of this condition is rarely feasible, also the embryological disarray of events that result in the development of this anomaly and the associated malformations is not clearly understood.Case presentation:We hereby report two cases of distal ureteral atresia and discuss the diversity in their presentations, diagnosis, atypical associations and management and review the possible embryological mal-development.Conclusion:Distal ureteral atresia with urogenital sinus as in Case 1 has not been documented so far and a plausible embryological explanation is deduced regarding its occurrence. The course of the affected kidney following timely and adequate relief of obstruction in Case 2 is depicted, highlighting the eventual management.Level of evidence:Not applicable
      Citation: Journal of Clinical Urology
      PubDate: 2022-01-07T04:29:02Z
      DOI: 10.1177/20514158211048107
       
  • Pyelolymphatic fistula causing chyluria: Mysterious case of recurrent
           milky urine

    • Free pre-print version: Loading...

      Authors: Venetia Hoe, Henry Han-I Yao, Richard J Baverstock, Kevin V Carlson
      Abstract: Journal of Clinical Urology, Ahead of Print.

      Citation: Journal of Clinical Urology
      PubDate: 2022-01-07T01:00:16Z
      DOI: 10.1177/20514158211068305
       
  • Microdissection oncoTESE (micro-oncoTESE) in azoospermic men with
           suspected testicular cancer: Analysis of outcomes from a specialist centre
           

    • Free pre-print version: Loading...

      Authors: Asheesh Kaul, Athos Katelaris, Aiman Haider, Alex Freeman, Kamran Ahmed, Hussain M Alnajjar, Asif Muneer
      First page: 341
      Abstract: Journal of Clinical Urology, Ahead of Print.
      Objective:The main aim of this study was to report the outcomes of azoospermic men with suspicious testicular lesions, undergoing microsurgical sperm retrieval (micro-oncoTESE) at the time of radical/partial orchidectomy.Patients and methods:Testicular lesions suspicious for cancer were confirmed on ultrasound scanning. In patients undergoing radical inguinal orchidectomy, ex vivo microdissection of the unaffected testicular parenchyma was performed. Microdissection was performed in vivo for partial orchidectomy. The primary outcome measure was surgical sperm retrieval (SSR) rate.Results:A total of 33 patients (median age 33 years, interquartile range (IQR) 22) with suspected testicular cancer (TCa) underwent micro-oncoTESE. Histological analysis confirmed TCa in 26 patients and benign pathology in 7 patients. The overall SSR rate was 39%. Sub-analysis of patients with TCa and benign histology found that the SSR was 46% and 14%, respectively. There was no significant difference in maximum tumour length between successful and unsuccessful SSR groups 33.9 mm ± 23 (SD) versus 29.8 mm ± 17.5 (SD) (p = 0.62).Conclusion:Based on our cohort, micro-oncoTESE provides an option for sperm retrieval in azoospermic men with testicular lesions.
      Citation: Journal of Clinical Urology
      PubDate: 2022-02-21T11:00:39Z
      DOI: 10.1177/20514158211073426
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 3.239.4.127
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-