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KSS/SouthThamesUrologyMeetingAgenda/AbstractsBooklet
Ashford&StPetersNHSHospital,
Educationcentre
Monday,24thApril2017
KSS/SouthThamesUrologyMeetingAshford&StPetersNHSHospital,Educationcentre
Monday,24thApril2017Introduction: Welcome to Chertsey, the home of the third stump in cricket! Yes, the town of Chertsey has a place in the history of cricket. “Lumpy” Stevens, the gardener of Lord Tankerville, was an outstanding bowler. He could deliver the ball between the 2 stumps frequently and caused disputes, as the bails were not knocked out. This led to the introduction of the third stump in the game of cricket in 1776. With this in mind, we have arranged this STC meeting at St Peter’s hospital to kindle new ideas and concepts for the future of urology that might perhaps create history. We have the usual business meeting in the morning followed by the presentations from the trainees from both, KSS and the London deanery. A large number of high quality presentations were received and we were simply spoilt for choice! We have selected some thought provoking papers, which will hopefully generate good discussions. There will be the usual prizes for the best paper, which will be selected by independent judges. We hope you will spend some time with the exhibitors in the postgraduate centre, as our sponsors have been very supportive. We are also very grateful to our secretary Jo Mucklow for helping as part of the organising committee. Hope you enjoy this academic event at Ashford and St Peter’s Hospital. Ravi Kulkarni & Sachin Agrawal.
KSS/SouthThamesUrologyMeeting
Ashford&StPetersNHSHospital,EducationcentreMonday,24thApril2017
Programme1000–1200 SouthThamesDeaneryMeeting 1000–1200 KSSDeanerymeeting 1200–1230 Jointmeeting 1230pm–1330 Lunch 1330-1500 AcademicSession1 1500–1530 Tea 1530–1540 College&RegionalUpdate 1540–1650 AcademicSession21650–1700 UrologyCatheterProject AwardofDerekPackhamMedal1700-1730 STCUpdate1730 Meeting,Close1800 Dinner Thecompanieskindlysupportingthemeetingarelistedbelow:BostonScientific,Astellas,BespokeMedicalProtection,KarlStorz,Allergan,Ferring,CookMedical,PierreFabre,Olympus,Takeda,WolfRichard(UK),KyowaKirin,Genesis,HitachiOursponsorshavehadnoinvolvementregardingtheeducationalcontentnorhastherebeenanyinvolvementoranysupportprovidedforthecontent,logistics,selectionofvenueoranyothermeetingarrangements.
Academic sessions: 1330- 1500 Academic Session 1: 7mins per presentation, 3 mins questions
1. A change in UTI incidence in our intradetrusor Botox patient cohort following changes in pre-operative protocol and antibiotic prophylaxis. A Brewin, E White, R Walker, T Nitkunan. Presenting author: Dr. Anna Brewin
2. Internet use in patients attending urology outpatient clinics and
undergoing urological surgery- friend or foe? Amelia Kerr, Amy Burrows, Patrick Olaniyi, Niyati Lobo, Charles Coker. Presenting author: Amelia Kerr
3. Red Patches Detected at Flexible Cystoscopy: Are We Getting It Right?
Niyati Lobo, Ahmed Ali and Tim Larner. Presenting author: Niyati Lobo
4. Rectal swab cultures and targeted prophylactic antimicrobial regimes do not reduce the risk of sepsis following transrectal prostate biopsy: Marios Hadjipavlou, Waseem Mulhem, Mazin Eragat, Charlotte Kenny, Chris Wood, Martino Dall’Antonia, Mohamed Y Hammadeh. Presenting author: Marios Hadjipavlou.
5. Audit on the antibiotic management of upper urinary tract infections.
Olivia Jones, Christopher de Souza, Jade Harrison, Denosshan Sri, Rashmi Singh, Sarbjinder Sandhu. Presenting author: Olivia Jones
6. Medium term outcomes and safety profile of Botulinum Toxin Type A
intra-vesical injections in men with idiopathic detrusor overactivity. Nicholas Faure Walker, Jane Watkins, Christopher Dowson, Sachin Malde, Claire
7. Maximising Income from PCNL. H Warren, K Keen, A Khan, S Willis, J
Glass, G Noble, K Thomas, M Bultitude. Presenting author: Hannah Warren
8. Factors affecting intrarenal pressure during flexible ureteroscopy and Laser lithotripsy. Neophytos Petrides, Rajesh Krishnan. Presenting author: Neophytos petrides
9. Point of Care INR testing on the day of surgery: a small prick with BIG
results. Kamran Haq, Donald Choi, Andrew Chetwood, Nimalan Arumainayagam. Presenting author: Kamran Haq
1530- 1640 Academic Session 2: 7mins per presentation, 3 mins questions
10. Internet use in patients attending urology outpatient clinics and undergoing urological surgery- friend or foe? Amelia Kerr, Amy Burrows, Patrick Olaniyi, Niyati Lobo, Charles Coker. Presenting author: Amelia Kerr
11. Home and away: comparing mechanism of renal trauma and subsequent
management in two major trauma centres in London and Adelaide. S Rintoul-Hoad, J Makanjuola, C Brown, R Catterwell. Presenting author: S Rintoul-hoad
12. Renal function loss after Cryoablation of Small Renal Masses in Solitary
Kidneys - European Registry for Renal Cryoablation (EuRECA) multi institutional study. Rudd I, Farrag K, Neilsen TK, Lagerveld BW, Keeley F, Guazzoni, G, Barber NJ, Sriprasad S. Presenting author: Iain Rudd
13. Salvage robot assisted radical cystectomy (sRARC): a demonstration of
our experience in technical feasibility and perioperative outcomes. Kawa Omar , Parsons B, Rajesh Nair, Ramesh Thurairaja , Shamim Khan. Presenting author: Kawa Omar
14. Exploring patient readmissions following Robot-Assisted Radical
Cystectomy at a Tertiary Bladder Cancer Service. Dimitrios Moschonas, Pavlos Pavlakis, Jamie Lindsay, Annelisse Ashton, Alison Roodhouse, Chris Jones, Ricardo Soares, Murthy Kusuma, Simon Woodhams, Michael Swinn, Hugh Mostafid, Matthew Perry, Krishna Patil Presenting author: Jamie Lindsay
15. Evaluating prognostic factors for recurrence and mortality from upper
tract urothelial carcinoma (UTUC) after nephroureterectomy (NU) from a 16 year experience. P Brousil, M Ager, A Coscione, R Macarthur, S Sandhu, K Anson, B Ayres, P Le Roux, C Anderson. Presenting author: P Brousil
16. The Prostate Cancer Diagnosis Pathway; Quality Improvement Against
CWT Targets. Philip James, Nimalan Aruminayagam, Senthy Sellaturay, Sachin Agrawal. Presenting author:Philip James
17. New haematuria NICE guidelines: what about the under 40s? Ola Blach,
Ahmed Ali, Tim Larner. Presenting author: Ola Blach
Abstracts
Academic Session 1
Mr Nimalan Arumainayagam Mr Jai Seth
TitleofpresentationAchangeinUTIincidenceinourintradetrusorBotoxpatientcohortfollowingchangesinpre-operativeprotocolandantibioticprophylaxis.AuthorsDr.ABrewin,MissEWhite,MrRWalker,MissTNitkunan,EpsomandStHelierUniversityHospitalsNHSTrustContactemailaddress:A.E.Brewin@doctors.org.ukAbstractIntroductionTheincidenceofUTIfollowingintradetrusorBotox®inourTrustwaspreviouslyfoundtobe33%.Thisledtochangesinantibioticprophylaxisandproceduralprotocol.Oralco-amoxiclavisnowgivenforlocalanaestheticcases.Theprotocolinvolvesaurinespecimensentforculture2weeksprior,andanonthedaycheckforUTIsymptomsandurinedipstick.Theaimofthisre-auditwastodeterminewhethertheUTIratehadalteredsincethesechanges.PatientsandMethodsDatawasgatheredfromthe42patientswhowereplannedtoreceiveintradetrusorBotox®betweenJanuaryandJune2016.InformationfromourBotox®database,clinicletters,operationnotesandmicrobiologyresultswerereviewed.ResultsOneofthe42plannedprocedureswascancelledduetoUTIsymptomsandpositiveurinedipstickonproceduralday.24/41(59%)wereunderlocal.Idiopathic:neurogeniccaseswere29:12.10/37(27%)pre-procedureurinecultureswerepositive(>10^8cfu/l).ThepercentageofallorganismssensitivetoTrimethoprimwas78%.Allpre-procedureUTIsweretreatedwithappropriateantibiotics.8/41(20%)patientshadaprovenUTIfollowingintradetrusorBotox®.ThepercentageofallorganismssensitivetoTrimethoprimwas43%.Apositiveurineculturewasunrelatedtocleanintermittentself-catheterisationordiabetes.ConclusionTherehasbeenareductionofpost-Botox®UTIincidencefrom33%to20%followingchangesintheprotocol.ChangesinbacterialresistancepatternsareseenpostBotox®andthiswarrantsfurtherstudy
TitleofpresentationInternetuseinpatientsattendingurologyoutpatientclinicsandundergoingurologicalsurgery-friendorfoe?AmeliaKerr,AmyBurrows,PatrickOlaniyi,NiyatiLobo,CharlesCokerBrightonandSussexUniversityHospitalsNHSTrustEmail:Amelia.kerr@bsuh.nhs.ukIntroductionPatientsareincreasinglyusingtheInternetformedicalinformation,whichmaybeofvariablequalityandcauseunnecessaryanxiety.ThisstudyaimstoexaminetheuseoftheInternetanditsimpactamongpatientsattendingurologyclinicsandundergoingurologicalsurgery.MethodsPatientsattendingurologyclinicsorundergoingelectivesurgeryatateachinghospitalweresurveyedregardingtheiruseoftheInternetforinformationovera2-monthperiod.Results
• 364questionnaireswerecompleted(162patientsattendingclinicand202undergoingsurgery).
• PatientsattendingclinicweremorelikelytousetheInternettoseek
informationthanthoseundergoingsurgery(47%vs24%)andmorelikelytodiscusstheirfindingswiththeirurologist(58%vs21%).
• TheNHSandWikipaediawebsitesweremostcommonlyusedbybothgroups.TheBAUSwebsitewasleastcommonlyused.
• ThemajorityofpatientsinbothgroupsfoundthatusingtheInternetledto
animprovedunderstandingoftheircondition,bettercommunicationwiththeirurologistandanimprovedabilitytomaketreatmentdecisions.
• Femalepatients,those<65yearsandthosewithmalignantdiagnosesinbothgroupsweremorelikelytofeelanxiousaftersearchingtheInternet.
ConclusionsInternetuseinpatientsattendingoutpatienturologyclinicsandundergoingelectiveurologicalsurgeryiscommonand,inmostcases,allowspatientstobetterunderstandandmanagetheircondition.
TitleofpresentationRedPatchesDetectedatFlexibleCystoscopy:AreWeGettingItRight?NiyatiLobo,AhmedAliandTimLarnerBrightonandSussexUniversityHospitalsNHSTrustEmail:niyatilobo@gmail.comIntroductionRedpatchesofurotheliumarecommonlyseenduringflexiblecystoscopyandfrequentlybiopsiedtoexcludeCIS.Atourinstitution,biopsiesareperformedundergeneralanaesthesia.TheobjectiveofthisstudywastoquantifythediagnosticyieldofbiopsyforredpatchesdetectedatflexiblecystoscopyandtodeterminetheassociationbetweentraineeexperienceandfrequencyofGAbiopsy.MethodsWeretrospectivelyreviewedallGAcystoscopies+/-biopsiesperformedforredpatchesdetectedatflexiblecystoscopybetween30/11/15and30/11/16.Results70patientsunderwentaGAcystoscopy+/-biopsyforaredpatchdetectedatflexiblecystoscopy.32/70(46%)weretwo-weekwaitreferrals.Meanage69.5±14.1years30%wereASA318/70(26%)witharedpatchatflexiblecystoscopyhadanormalGAcystoscopy;72%ofthesecaseswerebookedbyjuniortrainees.Table1.HistologicaldiagnosesinredpatchbiopsiesIndicationforflexiblecystoscopy
n Malignantpathology
Benignpathology
Normalmucosa
TCCsurveillance 30 2/30 19/30 3/30Haematuria 29 1/29 14/29 4/29RecurrentUTI 6 1/6 4/6 0/6StorageLUTS 3 0/3 2/3 0/3Other 2 0/2 2/2 0/2Total 70 4/70(6%) 41/70(57%) 7/70(10%)Complicationsoccurredin3/70(4%),includingoneon-tablearrest.ConclusionsRedpatchbiopsyhasalowdiagnosticyieldofmalignancy.JuniortraineesaremorelikelytolistpatientswithredpatchesforGAcystoscopy±biopsy.Approximately25%ofpatientshadnormalGAcystoscopies;thisrepresentspoortheatreutilizationandexposespatientstounnecessaryperioperativerisk.Basedonthesefindings,wehaveintroducedadepartmentalpolicyofarepeatflexiblecystoscopybyaseniortrainee.
TitleofpresentationRectalswabculturesandtargetedprophylacticantimicrobialregimesdonotreducetheriskofsepsisfollowingtransrectalprostatebiopsyMariosHadjipavlou,WaseemMulhem,MazinEragat,CharlotteKenny,ChrisWood,MartinoDall’Antonia,MohamedYHammadehIntroduction:Sepsisisasignificantcomplicationfollowingtransrectalultrasound-guidedprostatebiopsy(TRUSBx).Ciprofloxaciniscommonlyusedforprophylaxis,howeverthereisemergingevidenceforanincreaseinincidenceofresistantentericorganismsworldwide.WeinvestigatetheeffectofrectalswabculturesandsensitivitiesfortargetedprophylacticantimicrobialregimesinreducingtheriskofsepsisfollowingTRUSBx.Methodology:Allpatientshadconfirmednegativeurinalysispriortobiopsy.609patients(GroupA)receivedaprophylacticantimicrobialregimeofasingleintravenousdoseofgentamicin240mg,rectalmetronidazole1gandoralciprofloxacin500mgtwicedailyfor3days.DuetoasignificantincidenceofciprofloxacinandgentamicinresistanceinpatientsadmittedwithsepsisfollowingTRUBx,ourlocalantibioticrecommendationschanged.Thesubsequent314patients(GroupB)hadrectalswabculturesandsensitivitiesperformedpriortobiopsy.Patientswithrectalfloraorganismsresistanttociprofloxacinorgentamicinreceivedtargetedantimicrobialprophylaxisconsistingofasingledoseoralfosfomycin3g,intravenousamikacin750mgandrectalmetronidazole1g.Datawascollectedforrectalswabcultures,antibioticregimeused,readmissionwithsepsiswithin14daysandbloodorurineculturesresultsonadmission.Results:IngroupA(standardciprofloxacin-basedregime),12of609(2.0%)patientswereadmittedwithsepsisfollowingbiopsy.E.coliwasthemostcommonpathogendetected.Ofthe7patientswithpositiveurineorbloodcultures,4(57%)wereciprofloxacin-andgentamicin-resistantand2(29%)wereciprofloxacin-resistantonly.IngroupB,57of314(18.2%)patientshadciprofloxacinorgentamicinresistantrectalfloraandreceivedthetargetedantimicrobialprophylaxisregime(36ciprofloxacin-resistantonly,8gentamicin-resistantonly,13ciprofloxacin-andgentamicin-resistant).OverallingroupB,5of314(1.6%)patientswerereadmittedwithsepsisdespitereceivingtargetedcombinationofprophylacticantibioticsbasedontheirrectalswabcultures.Ofthesepatients,2hadgrownciprofloxacin-resistantorganismsonrectalswabandreceivedtheappropriateantimicrobialprophylaxisregime.Thedifferencebetweenthetwogroupswasnotstatisticallysignificant(p=0.69).Conclusions:Theincidenceofciprofloxacin-resistantflorainourcommunityissignificant(18.2%).TheriskofsepsisfollowingTRUSBxwasoveralllow,howevertheuseofrectalswabculturesandtargetedcombinationofantibioticregimesdidnotseemtoreducetheriskanyfurther.
TitleofpresentationAuditontheantibioticmanagementofupperurinarytractinfectionsAuthors:OJones,CdeSouza,JHarrison,DSri,RSingh,SSandhuDepartmentofUrology,KingstonHospitalContactemailaddress:oliviajones@doctors.org.ukIntroductionPyelonephritisisacommonurologicaladmissionandtreatmentwithappropriateantibioticsisessentialinpreventingitscomplications,promptdischargeandavoidreadmission.Weauditedourtrustsantimicrobialpracticeinpyelonephritisagainstnationalguidanceandlocalantimicrobialresistanceprofiles.Weexploredouradherencetoantimicrobialstewardshipandimplementedimprovementstoensureappropriateprescribing.MethodsAclosedloopretrospectiveauditofpatientsadmittedundertheurologyteamduetopyelonephritiswascarriedout,evaluatingtheirantibiotictreatmentduringadmissionanddischargeagainsttheircultures.Thefirstcyclewasbetween1/3/16–1/6/16andfollowingimplementations,asecondcycleconductedbetween7/12/16–7/3/17.Results71patientswereincludedintotal(33and38incycle1and2respectively),withameanageof41.Thefirstcycledemonstratedasignificantnumberofpatientsdischargedwithinappropriateantibiotics(19%)duetoantimicrobialresistance.Subsequentchangestotheantibioticsatdischargeweremadeandmethodsforensuringresultsofdelayedculturesareactionedappropriatelysawadecreaseininappropriateantibioticprescribingatdischarge(6%).WenotedanincreaseinresistancetoourfirstlineantibioticsAmoxicillinandTrimethoprimof188%and240%respectivelyacrossthetwocycles.Interestinglynosignificantrelationshipwasnotedbetweendischargeoninappropriateantibioticswithreadmissions(p=1.00).ConclusionAntibioticstewardshipisimportantinattemptingtoreducetheincidenceofresistantorganisms.Wehavenotedanincreaseinresistancepatternsinthecontextofinappropriateantibioticprescribing.Adaptingmethodsforreviewingcultureresultshasshownaclearimprovementinantibioticprescribing.
TitleofpresentationMediumtermoutcomesandsafetyprofileofBotulinumToxinTypeAintra-vesicalinjectionsinmenwithidiopathicdetrusoroveractivityAuthors:NicholasFaureWalker,JaneWatkins,ChristopherDowson,SachinMalde,ClaireTaylor&ArunSahaiGuys&StThomasNHSFoundationTrustContactemailaddress:nicholas.faure.walker@gmail.comAbstractIntroduction:IntravesicalBotulinumtoxininjectionsforidiopathicdetrusoroveractivity(IDO)issupportedbylevel1evidencebutthereislessdataavailableformenthanwomen.Methods:Patientsreceivedbetween100and200UOnabotulinumtoxinA.Outcomeswereassessedfromaprospectivedatabaseusingtheincontinenceimpactquestionnaire7(IIQ7)andurogenitaldistressinventory6(UDI6)scores.Urinarytractinfection(UTI)wasdefinedasurinarysymptomsrequiringtreatmentwithantibiotics.RESULTS:Of628documentedinjections,493wereforIDO.Ofthese112(22.7%)wereformen.60menhad1injection,25had2,9had3,7had4,3had5,2had6,and1patienthad7,8,9,10,11and12injections.Meanageformenwassimilarforwomen(54.1yvs56.7y,p=0.41).MeanIIQ7andUDI6scorechangesfrombaselineto4-12weekfollowupwas-6.8and-4.1(p<0.01)formenand-11.0and-5.9forwomen(p<0.01).However,nostatisticallysignificantdifferencebetweengenderswasobservedatfollowup(IIQ7,p=0.137;UDI6,p=0.23).Denovointermittentself-catheterization(ISC)wasrequiredby20/65(30.8%)menwithfollowupdatato4/15(26.7%)ofwomen(p=0.04).UTIwasreportedin5(7.8%)menand3(17.6%)ofwomenwithfollowupdata(p=0.175).Conclusion:IntravesicalBotulinumToxininjectionsforIDOaresimilarlyefficaciousatimprovingqualityoflifescoresinmenandwomen.AlthoughtheISCratewassimilarformenandwomen,UTIwasreportedlessofteninmen.
TitleofpresentationMaximisingIncomefromPCNLAuthors:HWarren,KKeen,AKhan,SWillis,JGlass,GNoble,KThomas,MBultitudeGuy'sandStThomas'NHSFoundationTrustContactemailaddress:hannahwarren@doctors.org.ukIntroductionHospitalsreceivepaymentforservicesbasedclinicalcoding,representingthehealthresourcesconsumed.RemunerationforPCNLvariedsignificantlyandoftendidnotcorrelatewithcasecomplexity.WethereforesetouttoensurewewerecodingaccuratelyforPCNL.MethodsConsecutiveadultsundergoingPCNLprocedureswereidentifiedfromcodingdepartmentrecordsfrom1stJanuary-14thAugust2016andcross-checkedwithoperatingdiaries.Codingdatawascomparedtoelectronicpatientrecords,operationnotesanddischargesummaries.CodingdataforSeptemberwasretrospectivelycorrectedandthedifferenceinincomemeasured.ResultsDatafrom50PCNLprocedureswereanalysed.Themeanpatientagewas58(range23–85)years,medianpost-operativelengthofstaywas3days(range1–14),andmeanincomepercase£3494(range£1,154-£7,829).Itwasnotedthatproceduralcode‘M16.5RemovalofNephrostomyTube’wasresponsibleforupgradingtheHRGcodefrom‘intermediateintervention’to‘majorprocedure’.Allpatientshavenephrostomytubesremovedpriortodischargeeitheronthewardorintheinterventionalsuite,butthiswasinconsistentlycapturedincodingdata,resultinginlostincome.UpdatingcodinginformationforSeptember2016resultedina£19,769upliftinincome.ConclusionImprovingaccuracyofcodingcanleadtosignificantlyincreasedtariffsforPCNL.WeintroducedalocalcodingpolicytooptimisetheaccuracyofclinicalcodingforPCNL,withoutincreasingadministrativeburdenforclinicians.Weadvocateregularmeetingsbetweencliniciansandcoderstoidentifyopportunitiesforcodingimprovement
TitleofpresentationFactorsaffectingintra-renalpressureduringflexibleureteroscopyandLaserlithotripsyAuthors:NeophytosPetrides,RajeshKrishnanKentandCanterburyHospitalContactemailaddress:np262@cantab.netIntroductionPelvicpressureduringrenalsurgeryhasbeenstudiedinanimalmodelsbuthasnotbeenexaminedextensivelyinclinicalstudies.Ouraimwastoinvestigatetheeffectofaccesssheaths,preoperativestentingandirrigationmethodsonpelvicpressuresandtoassessthecorrelationbetweenintra-operativeintra-pelvicpressuresandpost-operativepainorsepsis.MethodsDatawereprospectivelycollectedfor82patientsundergoingureterorenoscopyandlaserlithotripsy.Initialandendpressuresweremeasuredusinganarterialtransducerconnectedtoaflexibleureteroscope.Avisualanaloguescalewasusedtoassesspost-operativepain.ResultsMeanfinalpressurewithasyringeinjectionwas20.3cmH2O,andwithno-pressureirrigation21.6cmH2O.Thepeakpressureforsyringeinjectionwas43cmH2O,whereasforno-pressurecontinuousflow56cmH2O.Therenalpelvicpressureswere14.29mmHgwithasheathand18.78mmHgwithout(p=0.08).Howeverifthepressuredifferencewastakenintoaccounttherewasasignificantdropp=0.002.Therewasnocorrelationbetweeninitialorfinalrenalpelvicpressuresandpost-operativepainscores,andnocasesofpost-operativesepsis.Therewasnosignificantdifferenceinmeanpost-operativepainscoresbetweenthosewhohadpost-operativestentdrainage(mean2.2)versusuretericcatheterdrainage(mean2.8).ConclusionNoneofthefactorsassessedinourstudycausedadifferenceinrenalpelvicpressures,apartfromaccesssheathspossibleleadingtoareduction.Increasedrenalpelvicpressuresdonotseemtobeassociatedwithpostoperativesepsisorincreasedpainscores.
TitleofpresentationPointofCareINRtestingonthedayofsurgery:asmallprickwithBIGresultsAuthors:KamranHaq,DonaldChoi,AndrewChetwood,NimalanArumainayagamStPeter'sHospitalChertseyContactemailaddress:kamranhaq@doctors.org.ukAbstractTheNationalHealthServiceisexperiencingaperiodoffinancialpressure.Trustsareincreasinglylookingtocutcostswhilstmaintainingorimprovingpatientcare.Achievingthesegoalssimultaneouslyischallenging,leadingmanytruststofocusonmaximizingtheutilizationofexistingresourcestoprovideabetterservicewithoutincurringextracosts.ThisprojectidentifiedPOCTINRtestingasaservicethatcouldimprovetheefficiencyofthepatientpathwayforelectivesurgicalprocedures.Indoingso,itcoulddeliverafinanciallyviableservicewithincreasedpatientsafetyandsatisfactionrates.Prospectivedataanalysisidentified190patientssuitableforPOCTannually.CalculationsshowedthatcheckingINRresultsinthismannerwouldbetimeeffective,saving238hoursperannumcomparedtotheestablishedmethod.Thistimesavingcorrelatedtoasignificantfinancialsavingwhentranslatedtoincreasedtheatreutilizationandtheremovalofadditionalcostsincurredbycancellationsandoverrunninglists.Theservicewouldalsoresultinasafer,morepredictablepatientexperience.Basedonthisdata,abusinesscasewassubmittedtothetrustproposingtheinstallationofaPOCTINRmachineintheadmissionslounge.ThiswasapprovedandtheservicewasestablishedinFebruary2017.Reassessmentofthepathwayrevealedanimprovedservicebeingusedbyahigherthanprojectedcaseload.AuditofthePOCTaccuracyversusformallaboratorytestingrevealednodiscrepancy.Introductionofthisservicehasstreamlinedapreviouslyinefficientprocessresultinginthedeliveryofasafer,morepredictablepatientpathwaywithclearfinancialbenefits
AbstractsAcademic Session 2
Ms Tharani Nitkunan
Ms Katie Chan
TitleofpresentationHomeandaway:comparingmechanismofrenaltraumaandsubsequentmanagementintwomajortraumacentresinLondonandAdelaideAuthors:SRintoul-Hoad,JMakanjuola,CBrown,RCatterwellInstitution:King'sCollegeHospitalContactemailaddress:S.rintoul-hoad@doctors.org.ukAbstractIntroductionandObjective:Thekidneyisaffectedin1-5%ofalltraumas,therebyrepresentingasignificanturologicalworkloadintraumacentres.Wewantedtocomparethepatternoftrauma,severityofinjuryandmanagementattwodifferenttraumacentresintwodifferentcontinents.Methods:8yearsofrenaltraumadatawascomparedbetweentwomajortraumacentres:London2009-2016,Adelaide2004-2012.Results:119patientswereanalysedfromLondon,89%male(n=106),averageage32years;comparedto180patientsfromAdelaide,86%male(n=154),averageage37years.Mechanismofinjurydifferedbetweenmalesandfemales.ThecommonestcauseoftraumainLondonwasassault(37%,n=44);comparedtoAdelaide(10%,n=18).ThecommentcauseoftraumainAdelaidewasmotorvehicleaccident(36%,n=65)(excludingmotorbikes),comparedtoLondon(18%,n=22).Motorbikerelatedtraumaaccountedfor25%(n=42)oftraumainAdelaidecomparedto13%(n=15)inLondon.Sportinginjuryasthecauseofrenaltraumawassimilar;13%(n=16)London,14%(n=26)Adelaide.Bothcentreshadisolatedrenaltraumain25%ofcases.13%ofpatientshadembolisationinLondon(grade2-4),comparedto5%inAdelaide(allgrade4-5);howeverAdelaidehadahigherlaparotomyrateof1:5comparedtoLondon1:10.Thegrade5injuryratewassimilar,butLondonhadpredominatelygrade3-4injuries(33%and38%respectively),whereasAdelaidehadsimilarproportionofgrade1-4injuries.Conclusion:Renaltraumapatternsvarywhichleadstointerestingcomparisonsincludingtheirmanagemente.g.embolisationvslaparotomy.Standardisedrenalgradingallowsforinternationallearning.
TitleofpresentationRenalfunctionlossafterCryoablationofSmallRenalMassesinSolitaryKidneys-EuropeanRegistryforRenalCryoablation(EuRECA)multiinstitutionalstudy.RuddI1,FarragK1,NeilsenTK2,LagerveldBW3,KeeleyF4,Guazzoni,G5,BarberNJ6,SriprasadS11:DepartmentofUrology,DarentValleyHospital,Kent,UK2.DepartmentofUrology,AarhusUniversityHospital,Aarhus,Denmark3:DepartmentofUrology,St.LucasAndreasHospital,Amsterdam,TheNetherlands4:DepartmentofUrology,SouthmeadHospital,Bristol,UK5:DepartmentofUrology,IstitutoClinicoHumanitasIRCCS,ClinicalandResearchHospital,Milano,Rozzano,Italy6:DepartmentofUrology,FrimleyParkHospital,Camberley,UKIntroductionandobjectives:Thepresenceofasmallrenaltumour(SRM)inasolitarykidneymakesnephronsparingsurgeryandpreservationofrenalfunctionimperative.TheobjectiveofthisstudywastoestimateandquantifythelossofkidneyfunctioninsolitarykidneyswithSRMsafterlaparoscopicassistedcryotherapy(LAC)andtoexaminewhetheranyofthesepatientsrequiredrenalreplacementtherapy,fromtheEuropeanRegistryforRenalCryoablation(EuRECA)database.MaterialandMethods:Ofthe808patientsfromeightEuropeancentresinthedatabase,102patientshadSRMsinsolitarykidneys.Patientdemographics,BodyMassIndex,ASAgradeandtheirtumourparticularswerecollected.Renalfunctiondataintheformofestimatedglomerularfiltrationrate(eGFR)andchronickidneydisease(CKD)stratificationbothpreoperativelyandat3monthspostoperativelywereanalysed.Results:Themedian(IQR)agewas67(59-81)years,themedian(IQR)BMIwas26(23.9-28.9)kg/m2andthemedian(IQR)ASAscorewas2(2-3).Themedian(IQR)tumoursizeincross-sectionalimagingwas26(19-38)mm.Themeanpre-operativeeGFRwas55.0(SD18.1)andthepost-operativeeGFRwas51.8(SD18.8).Thechangewas-3.1(-5.2,-1.0)(95%CI)units,whichwasstatisticallysignificant(P=0.004).ThechangeintheCKDstagescomparingbeforeandafterLCAwasnotsignificant(paired2tailt-test,P=0.06).ThedecreaseintheeGFRdidnottranslatetoanysignificantadverseoutcomeandnoneofthesepatientsneededanyformofrenalreplacementtherapyatanytimeaftersurgery.Conclusion:ToourknowledgethisisthelargeststudyofrenalfunctionfollowingcryotherapyinSRMsinsolitarykidneys.Cryotherapyinthisimperativesituationissafeandmaybeatreatmentoptiontoavoiddialysis.
TitleofpresentationSalvagerobotassistedradicalcystectomy(sRARC):ademonstrationofourexperienceintechnicalfeasibilityandperioperativeoutcomesAuthors:KawaOmar,ParsonsB,RajeshNair,RameshThurairaja,ShamimKhanDepartmentofUrology,Guy’sandStThomas’NHSFoundationTrustContactemailaddress:kawaomar@doctors.org.ukObjectiveTodemonstratetechnicalfeasibilityofrobotic-assistedsalvagecystectomyanddescribeperi-operativeoutcomes.MaterialsandMethodsReviewof245patientsfromaprospectivelymaintainedradialcystectomydatabasebetweenNovember2013andOctober2016wasperformed.sRARCwasdefinedinpatientswhounderwentpreviousexternalbeamradiotherapyorbrachytherapyeitherforprimarybladderorprostatecancer.Results:12patientsmettheinclusioncriteria(12-male);medianage72years(range54-88),medianBMI27kg/m2(22-37)andASAscorewas2(2-3)).Sevenpatientsunderwentradicalexternalbeamradiotherapyand2hadbrachytherapyforprostatecancerand3underwentchemo-radiotherapyformuscleinvasivebladdercancer.Diversiontechniquesincludedilealconduit(n=10)andcutaneousureterostomies(n=2).Themeanoperatingtimewas320minutes(range240-480)andlengthofstaywas8days(range6-30).Themeanestimatedbloodlosswas360ml(range:200-600).Onepatientsustainedanintraoperativerectalinjuryrequiringadefunctioningcolostomy.Medianpostoperativefollow-upwas90-days(range:29-1067).TwopatientssustainedClavien-3complications,tworequiredpost-operativere-admissionwithin90days.Positivesurgicalmarginswereidentifiedintwopatientswithprostatecancer.Therewere3recurrencesinthefollow-upperiod(2pelvicrecurrences1inprostatecancerand1bladdercancer,1urethralrecurrence).Conclusion:WedemonstratetechnicalfeasibilityofsRARCandacceptableshort-termcomplicationrates
TitleofpresentationExploringpatientreadmissionsfollowingRobot-AssistedRadicalCystectomyataTertiaryBladderCancerServiceDimitriosMoschonas,PavlosPavlakis,JamieLindsay,AnnelisseAshton,AlisonRoodhouse,ChrisJones,RicardoSoares,MurthyKusuma,SimonWoodhams,MichaelSwinn,HughMostafid,MatthewPerry,KrishnaPatilRoyalSurreyCountyHospital,UrologyDepartmentIntroductionandObjectiveRehospitalisationrateisacarequalityindicatoraftermajorcanceroperations.Weaimtoexaminetheincidenceandcausesofearlyandlatereadmissionstohospitalfollowingrobot-assistedradicalcystectomy(RARC).MethodAretrospectiveanalysiswasperformedof158consecutivepatientswhounderwentRARCatRoyalSurreyCountyHospitalsincetheformationofatertiarybladdercancerserviceinApril2013.Demographic,operativeandpostoperativedatawerecollectedforallcasesandanalysisoflengthofstayandpatientreadmissionwithin90dayswasperformed.ResultsMedianlengthofhospitalstaywas5days(3-28).Theincidenceof90-dayreadmissiontohospitalwas16%(26of158)andwefoundtreatmentcomplicationstobetheonlyfactorsignificantlyassociatedwithreadmission(Table5).Threepatientshadmorethanonereadmission.Thirty-twopercentofreadmissionswereinfectionrelated(urinary,pelviccollection,lymphocele)and24%gastrointestinal(ileus,smallbowelobstruction).Fourpatientsrequiredanintervention,includingtworequiringgeneralanaesthesia.Ofthe30incidents,8wereconsideredaspotentiallyavoidable(backpain,scrotaloedema,oralcandidiasis).ConclusionTheresultsfromourcentredemonstrateashortlengthofhospitalstaywithlowearlyandlatereadmissionrates.Thisillustratesafavourablepatientoutcomeforaprocedureassociatedwithinherentmorbidityasaresultofminimallyinvasiveapproachandmultimodalenhancedrecoveryprotocol.Theoptimisationofthepost-dischargenetworkcanfurtherreducerehospitalisationandminimisetheservicefragmentationthatcanexistwithinatertiaryreferralfacility.
TitleofpresentationEvaluatingprognosticfactorsforrecurrenceandmortalityfromuppertracturothelialcarcinoma(UTUC)afternephroureterectomy(NU)froma16yearexperienceAuthors:PBrousil,MAger,ACoscione,RMacarthur,SSandhu,KAnson,BAyres,PLeRoux,CAndersonStGeorge'sHospital,EpsomandStHelierHospital,KingstonHospitalContactemailaddress:philbrousil@gmail.comIntroductionUTUCisararebutimportantdisease,whichlacksarobustevidencetogenerateconsensusinmanagement.Ouranalysisseekstoidentifyprognosticfactorsregardingrecurrence,deathandinformmanagementafterNU.MethodsAretrospectiveanalysiswasconductedon121NUpatientswithameanfollow-upof37months.Tumourcharacteristics,mortalityandtheeffectofuretero-renoscopyonrecurrenceweredetermined.32patientswereexcludedduetoinadequatedata.ResultsOverall28(38%)patientshadintra-vesicalrecurrence(IVR)atmediantimeof7mths.IVRwasseenin16patients(28%)whodidn’thavepriorbladdercancer(pBC).Ofthese,systemicrecurrencewasseenin11%(medianrecurrencetime15months).IntheIVRgroup,thepresenceofT2-3andmulti-focaldiseaseintheNUspecimenwassignificantlyhigher(p=0.04,0.02respectively).ThepresenceofG3,CIS,lympho-vascularinvasion(LVI)wasproportionatelyhigherbutnotstatisticallysignificant.UreterictumourlocationdidnotpredictIVR.Pre-operativeuretero-renoscopywasnotassociatedwithrecurrenceordeath.Overallmortalitywas52%withmediansurvival19mths;24%ofpatientsdiedofUTUC(mediansurvival13mths).StatisticallysignificantlyhigherratesofG3,T3,T4,CIS,LVIwereseenintheUTUCdeathgroup.Multi-focalitywasnotsignificantlyhigherintheUTUCdeathgroup.pBCandURSwerenotriskfactorsforUTUCdeath.ConclusionUTUCisanaggressivedisease.Morerigorousbladdersurveillanceisneededwheremulti-focalityandinvasivediseasearepresent.Theabovementionedprognosticfactorsmandatecloserpost-operativeradiographicsurveillanceandpossiblyintervention.
TitleofpresentationTheProstateCancerDiagnosisPathway;QualityImprovementAgainstCWTTargetsAuthors:PJames,TVasileva,NAruminayagam,SSellaturay,SAgrawalAshfordandSt.Peter'sNHSFoundationTrustContactemailaddress:Philly_james@msn.comIntroduction:TheOperationalStandard(OS)forpatientsreferredunderthe“twoweekwait”dictatesthat85%ofpatientsshouldundergotreatment(orbedischargedfromthepathway)within62daysofreferral.Duetoincreasingcomplexityofthediagnosticpathwayofprostatecancer,thisisdifficulttoachieveAtASPH,wehavemitigatedthisproblemwiththeintroductionofthe“ProstatePathway”.Method:RootCauseAnalysis(RCA)wasperformedagainstallbreachesin2016,providingtimelinedataforReferraltoMpMRI,andTRUSBx.Thiswascomparedto2017data(followingtheintroductionofthenewpathway).TheProstatePathwaywillreducethewaitingtimesforMpMRIandsubsequentTRUSbiopsy,bypre-bookingtheinvestigationsafterreceiptofreferral.EightslotshavebeenreservedforbothMRIandTRUSbiopsyeachweek.Thesegoaheadafterclinicianapproval.ThiswillimproveperformanceagainsttheOS.Results:In2016,50outof57breaches(88%)relatedtotheprostatecancer.Medianof23daysfromReferraltoMRI,andamedianof32daysfromReferraltoTRUSbiopsy.In2017,onlyoneprostatecancerbreachhasbeenrecorded(8daysfromReferraltoMRI,9daystoTRUSBiopsy.)Conclusion:Theprospectivedatasofarislimited,yetpromising.RCAhasrevealedmuchimprovedperformanceinthetimetakentoreachadiagnosis,andwelookwellsettoachievetheoperationalstandardssetbyNationalCWTmonitoring.
TitleofpresentationNewhaematuriaNICEguidelines:whatabouttheunder40s?Authors:OlaBlach,AhmedAli,TimLarnerBrighton&SussexUniversityHospitalsContactemailaddress:ola.blach@doctors.org.ukIntroduction:Visiblehaematuria(VH)isacardinalpresentingsymptomofurinarytractmalignancy.Thecurrent2015NICEguidelineonSuspectedcancerrecommendsreferraltoUrologyusingthesuspectedbladdercancerpathwayinpatientsaged45andoverwithVH.Thisrepresentaconsiderablechangefrompreviousrecommendations.Wesoughttodeterminehowmanydiagnosesofbladdercancerwouldhavebeenmissedinpatientsagedunder40atBSUHhadthecurrentNICEguidelinebeenfollowed.Methods:Aretrospectivereviewofbladdercancersdiagnosedinpatientsunder40yearsofageatBSUHsince2005wasundertaken.Results:14patients(11menand3women)diagnosedwithbladdertumourwereidentified.Only1hadsymptomaticNVH,theresthadVH.Medianageatdiagnosiswas34(range20-39,IQR11).13hadcancerdiagnosis(1G1Ta,9G2Ta,2G3T1,and1CIS),and1invertedpapilloma.Recurrenceswereobservedin3cases(allG2Ta),ofwhichoneprogressedtoG3Ta.2patientsunderwentradicalcystectomy.Conclusion:13casesofbladdercancerwouldhavebeenmissedinpatientsagedunder40hadthecurrentNICEguidelinebeenfollowed.Assuch,webelievethatallpatientswithunexplainedhaematuriashouldbereferredviathecancerwait2weekrole.
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