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Objective Methods Results Conclusion To review the available literature on variant genital gender‐affirming surgery (GGAS), including the reasons for performing it, the surgeries themselves and their outcomes.A systematic review on the performance of variant GGAS was conducted (International Prospective Register of Systematic Reviews [PROSPERO] identifier: CRD42022306684) researching PubMed, Embase, Web of Science and Cochrane databases from inception up to 31 December 2023. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed, and risk of bias was assessed for each study using the five‐criteria quality assessment checklist.In total 23 case series were included, of which 17 on masculinising and six on feminising surgeries. Patients mainly choose these surgical procedures out of personal desire to avoid risk of complication or because they do not have dysphoria about certain parts of their genitalia. Complications in masculinising surgeries primarily arose from the extended urethra, which could be mitigated through primary perineal urethrostomy. Both phalloplasty and metoidioplasty carried a higher risk of urethral complications when the vagina was preserved. In feminising surgeries, risk of visceral damage and requirement for lifelong self‐dilation could be avoided when vulvoplasty was performed without vaginal canal creation. All studies had a high risk of bias.This review highlights the importance of variant GGAS and acknowledges the preferences of transgender and gender‐diverse individuals. Patients should be informed about the risks and benefits of each step in these procedures. [ABSTRACT FROM AUTHOR]

Endourology plays an important role in modern urological practice. Compared to open surgery, it offers many advantages. In Africa, endourology is not widely practiced or non‐existent in some referral centres. Several factors have been linked to this challenge. This article explores and proposes strategies to improve endourology practice in the African context. Recognising the unique challenges and opportunities in the region, the document discusses key initiatives and recommendations to promote the growth and development of endourological practices, including the identification of local needs, training, technological adaptation, etc. It aims to provide valuable information on the advancement of endourology in Africa. [ABSTRACT FROM AUTHOR]

The Getting It Right First Time (GIRFT) programme is a quality improvement initiative covering the National Health Service in England. The programme aims to standardise clinical practices and improve patient and system level outcomes by utilising data‐driven insights and clinically‐led recommendations. There are GIRFT workstreams for every medical and surgical specialty, including urology. Defining features of the GIRFT methodology are that it is clinically led by experienced clinicians, data‐driven, and specialty specific. Each specialty workstream conducts deep‐dive visits to every hospital, analysing performance data and engaging with clinicians and management to identify and share improvement priorities. For urology, GIRFT has completed deep‐dive visits and published reports outlining priority areas for development. Reports include recommendations pertaining to streamlining care pathways, reducing the acuity of care environments, enhancing emergency services, optimising utilisation of outpatient services, and workforce training and utilisation. The GIRFT academy provides guides for implementing best practices specific to priority areas of care. These include important disease pathways, and GIRFT‐advocated innovations such as urology investigation units and urology area networks. GIRFT offers clinical transformation, cost reduction, equity in access to care, and leaner models of care that are often more environmentally sustainable. Evaluation efforts of the programme have focussed on assessing the adoption of GIRFT recommendations, understanding barriers to change, and modelling the climate impact of advocated practices. [ABSTRACT FROM AUTHOR]

Objective Materials and Methods Results Conclusions To analyse the litigation trends and the reasons for claims within the specialty of Urology, within the UK National Health Service (NHS), over a 16‐year period.Data were requested from NHS Resolution under the Freedom of Information Act 2000. This included the total number of claims in Urology, the number of these that were successful (settled or closed), and the costs in damages paid out per financial year between 2006 and 2022. A breakdown of the successful claims by their primary cause was also collected. These were coded into the categories: ‘non‐operative’, ‘intraoperative’, ‘postoperative’, and ‘other’.A total of 4124 litigation claims were made between 2006 and 2022 and 60.9% (2511/4124) of these claims were successful. In all, £145 million (British pounds) was paid out in damages. The number of successful claims increased 2.9‐fold from the start to end of this 16‐year period, and the costs in damages paid out increased 10‐fold. Regarding primary causes for the successful claims, failure or delay in treatment (20.9%, 525/2511), failure or delay in diagnosis (14.5%, 364/2511), and intraoperative problems (9.1%, 229/2511) accounted for the highest proportion. Overall, non‐operative causes for successful claims accounted for 73.3% (1840/2511), intraoperative for 20.1% (504/2511), and postoperative for 3.9% (98/2511).The number of successful urological litigation claims, and their associated costs is rising. The majority are due to non‐operative causes, which may be partially explained by NHS waiting lists alongside the effects of the coronavirus disease 2019 (COVID‐19) pandemic. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of 'spin' (i.e., reporting practices that distort the interpretation of results by positively reflecting negative findings or downplaying potential harms) strategies and level of spin in urological observational studies and whether the use of spin has changed over time. Materials and Methods: MEDLINE and Embase were searched to identify observational studies comparing therapeutic interventions in the top five urology journals and major urological subspecialty journals, published between 2000 and 2001, 2010 and 2011, and 2020 and 2021. Results: A total of 235 studies were included. Spin was identified in 81% of studies, with a median of two strategies per study. The most commonly used strategies were inadequate implication for clinical practice (30%), causal language or causal claim (29%), and use of linguistic spin (29%). Moderate to high levels of spin were found in 55% of conclusions. From 2000 to 2020, the average number of strategies used has significantly decreased each decade (H = 27.459, P < 0.001), and the median level of spin in conclusions was significantly lower in studies published in the 2020s and 2010s than in the 2000s (H = 11.649, P = 0.003). Conclusions: Our results suggest that 81% of urological observational studies comparing therapeutic interventions contained spin. Over the past two decades, the use of spin has significantly declined, but this remains an area for improvement, with 70% of included studies published in the 2020s employing spin. Medical writing should scrupulously avoid words or phrases that are not supported by data in the manuscript. [ABSTRACT FROM AUTHOR]

Objective: To explore the causes of the decrease in bladder cancer survival that has occurred over the past four decades. Methods: We extracted data from the South Australian Cancer Registry. Data from the period 1 January 1977 to 31 December 2020 were extracted to explore changes in incidence and survival among a total of 8356 patients diagnosed with ≥pT1 disease. Invasive bladder cancer was defined as ≥pT1 in this study. Results: Invasive bladder cancer age‐standardized incidence decreased from 7.20 cases per 100 000 people in 1977 to 5.85 cases per 100 000 in 2020. The mean age at diagnosis increased from 68 years to 76 years. The crude incidence for patients aged 80 years and over increased by 3.3% per year (95% confidence interval [CI] 2.1 to 4.6). Overall survival decreased over the study period (hazard ratio [HR] 1.22 [95% CI 1.09 to 1.35]), however, survival increased after adjusting for age at diagnosis (HR 0.80 [95% CI 0.76 to 0.94]). Despite a decrease in non‐bladder cancer‐specific deaths in older people, there was no change in the bladder cancer‐specific death rate in older people (HR 0.94 [95% CI 0.70 to 1.26]). Male sex was associated with higher survival (HR 0.87 [95% CI 0.83 to 0.92]), whereas socioeconomic advantage was not. Conclusions: Invasive bladder cancer survival has decreased over the past 40 years, with the age structure of the population being a significant contributing factor. Patient summary: We looked at why bladder cancer survival is decreasing using a large cancer registry with information from 1977 to 2020. We found that people are now more likely to be diagnosed at an older age. Older people often live for a shorter time with bladder cancer compared to younger people. Bladder cancer survival has decreased because there are more older people with the disease than previously. [ABSTRACT FROM AUTHOR]

A study published in BJU International examined the complications associated with robot-assisted radical cystectomy (RARC) with intracorporeal neobladder reconstruction. The study analyzed data from 858 patients who underwent the procedure at 16 European centers between 2003 and 2022. The results showed a high overall rate of complications, with urinary tract infection (UTI) being the most common complication. The study highlighted the need for improvements in surgical technique and peri-operative management to reduce complications. The findings also suggested the importance of careful management of the urinary device and consideration of neoadjuvant therapy in patient care. [Extracted from the article]

Objectives: To provide a practical review of immune‐related adverse events (irAEs) that may be encountered in uro‐oncology patients. Patients and Methods: We conducted a literature review of studies reporting irAEs including articles published through September 2023 for uro‐oncology patients and the potential relevancy for the practicing urologist. Results: Immunotherapy has revolutionised cancer treatment, extending its impact to urological malignancies including for patients with urothelial, kidney, and prostate cancers. Immuno‐oncology (IO) compounds have achieved measurable and durable responses in these cancers. Urologists, choosing to administer or co‐manage IO patient care, should be prepared to understand, evaluate, and treat irAEs. This review discusses the spectrum of irAEs that can be encountered. Ongoing trials are exploring the use of immunotherapy at earlier stages of uro‐oncological diseases, thus underscoring the evolving landscape of urological cancer treatment. Paradoxically, some data suggests that the occurrence of irAEs is associated with improved oncological outcomes. Conclusions: Immune‐related AEs, while manageable, may be life‐threatening and require lifelong therapy. A thorough understanding of AEs and toxicity of a novel drug class is imperative. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence and trends of essential study design elements in preclinical urological studies, as well as key factors that may improve methodological rigour, as the demand for methodological rigour in preclinical studies is increasing since research reproducibility and transparency in the medico‐scientific field are being questioned. Methods and Results: PubMed was searched to include preclinical urological studies published between July 2007 to June 2021. A total of 3768 articles met the inclusion criteria. Data on study design elements and animal models used were collected. Citation density was also examined as a surrogate marker of study influence. We performed an analysis of the prevalence of seven critical study design elements and temporal patterns over 14 years. Randomisation was reported in 50.0%, blinding in 15.0%, sample size estimation in 1.0%, inclusion of both sexes in 6.3%, statistical analysis in 97.1%, housing and husbandry in 47.7%, and inclusion/exclusion criteria in 5.0%. Temporal analysis showed that the implementation of these study design elements has increased, except for inclusion of both sexes and inclusion/exclusion criteria. Reporting study design elements were associated with increased citation density in randomisation and statistical analysis. Conclusions: The risk of bias is prevalent in 14‐year publications describing preclinical urological research, and the quality of methodological rigour is barely related to the citation density of the article. Yet five study design elements (randomisation, blinding, sample size estimation, statistical analysis, and housing and husbandry) proposed by both the National Institutes of Health and Animal Research: Reporting of In Vivo Experiments guidelines have been either well reported or are being well reported over time. Systematic Review Registration: PROSPERO CRD42022233125. [ABSTRACT FROM AUTHOR]

Objective: To present a narrative review of fundamental information needed to manage postoperative complications in patients who have undergone genital gender‐affirming surgery (GAS). Methods: A narrative review was performed using the following keywords: 'gender‐affirming surgery', 'complications', 'emergency', 'postoperative'. Articles were included after being reviewed by two primary authors for relevance. Four clinicians with significant experience providing both primary and ongoing urological care to patients after GAS were involved in article selection and analysis. Results: The most common feminising genital GAS performed is a vaginoplasty. The main post‐surgical complications seen by urologists include wound healing complications, voiding dysfunction, postoperative bleeding, vaginal stenosis, acute vaginal prolapse and graft loss, rectovaginal fistula, and urethrovaginal fistula. The most common masculinising genital GAS options include metoidioplasty and phalloplasty. Complications for these surgeries include urethral strictures, urethral fistulae, and urethral diverticula. Penile implants may also accompany phalloplasties and their complications include infection, erosion, migration, and mechanical failure. Conclusion: Genital GAS is increasing, yet there are still many barriers that individuals face not only in accessing the surgeries, but in receiving follow‐up care critical for optimal outcomes. Improved education and training programmes would be helpful to identify and manage postoperative complications. Broader cultural level changes are also important to ensure a safe, gender‐inclusive environment for all patients. [ABSTRACT FROM AUTHOR]

Keywords: Causality; Urology; observational research; guidelines; reporting EN Causality Urology observational research guidelines reporting 4 8 5 06/23/23 20230701 NES 230701 As statistical editors and reviewers, we have noticed that observational research papers submitted for publication often share a common set of problems with respect to the issue of causality. For instance, it would be hard to draw conclusions about the effects of chemotherapy if all (or almost all) chemotherapy patients were Stage 3 or 4 whereas the patients not receiving chemotherapy were all Stage 1 or 2. To address this in a causal inference framework, we could include obesity as a covariate in a multivariable model testing the association between statin use and overdiagnosis, with an interaction term between statin use and PSA levels. [Extracted from the article]

Objectives To address the association of perioperative surgical checklist across variable surgical expertise with transurethral resection of bladder tumour (TURBT) accuracy and oncological outcomes in non-muscle-invasive bladder cancer. Patients and Methods We relied on our prospective collaborative database of patients treated with TURBT between 2012 and 2017. Surgical experience was stratified into three groups: resident vs young vs expert consultants. The association of surgical experience with detrusor muscle (DM) presence and adherence to the standardised peri-procedural nine-items TURBT checklist was evaluated with logistic regression models. A Cox regression model was used to investigate the association of surgical experience with recurrence-free survival (RFS). Results A total of 503 patients were available for analysis. TURBT was performed by expert consultants in 265 (52.7%) patients, by young consultants in 149 (29.6%) and by residents in 89 (17.7%). Residents were more likely to have DM in the TURBT specimen than expert consultants (odds ratio [OR] 1.75, 95% confidence interval [CI] 1.03-2.99, P = 0.04). Conversely, no differences in DM presence were seen between young vs expert consultants (OR 1.09, 95% CI 0.71-1.70, P = 0.69). The median checklist completion rate was higher for both residents and young consultants when compared to experts' counterparts (56% and 56% vs 44%, P = 0.009). When focusing on patients receiving a second-look TURBT, the persistent disease was associated with resident status (OR 4.24, 95% CI 1.14-17.70, P = 0.037) at initial TURBT. Surgical experience was not associated with 5-years RFS. Conclusion Surgeon's experience in the case of adequate perioperative surgical checklist implementation was inversely associated with the presence of DM in the specimen but directly linked to higher probability of persistent disease at re-TURBT, although no 5-year RFS differences were noted. [ABSTRACT FROM AUTHOR]

Objective To assess urology trainees' exposure to transperineal prostate biopsy (TP-Bx) and intent to use TP-Bx in practice. Subjects and Methods A 34-question survey about prostate biopsy was distributed to urology trainees in the United States and Europe. Primary outcomes were exposure to TP-Bx in training and intent to use TP-Bx post training. Exposure to transrectal prostate biopsy (TR-Bx) and magnetic resonance imaging-targeted biopsy (MRI-Bx) was also assessed. Survey answers were compared between groups as categorical variables using Fisher's exact test. Multivariable logistic regression was used to identify factors associated with intent of performing TP-Bx post training. Results A total of 658 trainees from 19 countries completed the survey. Of these, 313 trainees (48%) reported exposure to TP-Bx, 370 (56%) reported exposure to MRI-Bx, and 572 (87%) reported exposure to TR-Bx. There was significant heterogeneity in TP-Bx exposure among countries (P < 0.001), with the highest prevalence in Italy (72%) and the lowest prevalence in Greece (4%). Intent to perform TP-Bx post training was higher in those exposed to TP-Bx during training (89% vs 58%; P < 0.001) and did not differ between trainees in postgraduate year (PGY) 1-3 vs those in PGY =4 (73% vs 72%; P = 0.7). On multivariable regression, exposure to TP-Bx in training was independently associated with increased intent to perform TP-Bx post training (odds ratio 5.09, 95% confidence interval 3.29-8.03; P < 0.001). Conclusions Fewer than half of 658 surveyed urology trainees reported exposure to TP-Bx, with significant heterogeneity among countries. Greater experience with TP-Bx in training was associated with greater intent to perform TP-Bx post training. A minimum requirement of TP-Bx cases during urological training may increase resident familiarity and adoption of this guideline-endorsed prostate biopsy approach. [ABSTRACT FROM AUTHOR]

Objective: To introduce a wireless high‐definition endoscopic system (WHES) and compare it with a Storz high‐definition (HD) system for image resolution, colour resolution, weight, and costs. Materials and Methods: The WHES incorporated a portable light‐emitting diode light source and a wireless camera module, which can be compatible with different types of endoscopes. Images were wirelessly transmitted to a monitor or mobile platform such as smartphone through a receiver. The International Standards Organization 12233 resolution chart image was used for the comparison of image resolution and Munsell Colour Checker Chart for colour resolution. In all, 38 endourologists used a Likert questionnaire to blindly evaluate cystoscopic images from a patient with haematuria. The surgical team was asked about the overall performance of the WHES in 20 laparoscopic adrenalectomies using a unvalidated subjective survey. Results: There was no difference in image resolution between the two systems (5.82 vs 5.89 line pairs/mm). Without lens and respective light sources, there were better purple (ΔE = 21.48 vs 28.73), blue (ΔE = 34.88 vs 38.6) and red colour resolution (ΔE = 29.01 vs 35.45) for the WHES camera (P < 0.05), but orange (ΔE = 43.45 vs 36.52) and yellow (ΔE = 52.7 vs 35.93) resolutions were better for the Storz HD camera (P < 0.05). Comparing the WHES to a Storz laparoscopic system, the Storz system still had better resolution of orange and yellow, while the resolution of purple, blue, and red was similar for the two systems. The expert comments on resolution, brightness, and colour for cystoscopy were not statistically different, but the ergonomics score for the WHES was higher (3.7 vs 3.33, P = 0.038). The overall cost of the WHES was $23 000–25 000 compared with $45 000–50 000 for a Storz system. There were 100% general satisfaction for the WHES in the survey. Conclusion: We developed a new WHES that provides the same resolution images as a Storz laparoscopic system and acceptable colour resolution with the advantages of wireless connection, small volume, low cost, portability, and high‐speed wireless transmission. [ABSTRACT FROM AUTHOR]

ObjectivesTo evaluate the landscape of retractions of literature and to determine the prevalence of research misconduct in the field of urology.MethodsThree databases (PUBMED, Embase, Retraction Watch) were queried for all retracted studies on urological topics in both urological and non-urological journals from April 1999 to March 2018. Two reviewers screened the records and determined the final list of articles to be included in the analysis.ResultsA total of 138 articles met the inclusion criteria. Over 80% of retractions occurred after 2009. Retractions originated from 76 different journals (13 urological journals) and 28 countries. The most common reasons for retraction were plagiarism (28%), fake peer review (20%), error (20%), and falsification of data (13%). Misconduct accounted for two-thirds of the retractions (n = 93). A large watermark, indicating retraction of the article, was present in 75% of the manuscripts. Articles were cited a total of 4454 times, 38% of citations happened after retraction. The majority of retracted articles related to urological oncology (70%). The highest number of retractions for an individual author was five. Rates of retraction among popular urological journals since 2010 have increased but remain a small proportion of all publications: BJUI, 0.189%; World Journal of Urology, 0.132%; European Urology, 0.058%; Urology, 0.047%; and Journal of Urology, 0.024%.ConclusionRetractions of urological literature, similarly to retractions of other biomedical literature, have been rising over the last decade. The majority of these retractions stem from research misconduct. Despite retractions, flawed articles continued to be cited.

Objectives: To prospectively analyse robotically administered transperitoneal transversus abdominis plane (robot‐assisted transversus abdominis plane [RTAP]) compared with both ultrasonography‐guided transversus abdominis plane (UTAP) and local anaesthesia (LA) with regard to pain control and narcotic use in patients undergoing robot‐assisted prostatectomy (RARP) or robot‐assisted partial nephrectomy (RAPN). Subjects/Patients and Methods: Patients undergoing RARP or RAPN were randomized in a single‐blind 2:2:1 fashion to RTAP:UTAP:LA, with the study powered to evaluate superiority of UTAP to LA and non‐inferiority of RTAP to UTAP. We compared time to deliver the block, operating room time, postoperative pain scores using the visual analogue scale, and intra‐operative and postoperative analgesia consumption. Results: A total of 143 patients were randomized and received treatment. There was no significant difference in patient baseline characteristics. UTAP did not demonstrate superiority to LA in terms of pain control. RTAP and LA were faster to administer than UTAP (time to perform block 2.5 vs 2.5 vs 6.25 min; P < 0.001). There was no difference in postoperative narcotic, acetaminophen, ketorolac or ondansetron requirements among the three groups (P > 0.05). The study was terminated early due to the unexpected efficacy of LA. Conclusion: This study showed that UTAP and RTAP do not provide superior pain control to LA. The efficiency, effectiveness, and ease of administration of LA make it an excellent option for first‐line therapy for postoperative analgesia. [ABSTRACT FROM AUTHOR]

Objective: To present the results of a nationwide survey among urological patients to evaluate their perception of the quality of care provided by residents. Methods: An anonymous survey was distributed to patients who were referred to 22 Italian academic institutions. The survey aimed to investigate the professional figure of the urology resident as perceived by the patient. Results: A total of 2587 patients were enrolled in this study. In all, 51.6% of patients were able to correctly identify a urology resident; however, almost 40% of respondents discriminated residents from fully trained urologists based exclusively on their young age. Overall, 98.2% patients rated the service provided by the resident as at least sufficient. Urology trainees were considered by more than 50% of the patients interviewed to have good communication skills, expertise and willingness. Overall, patients showed an excellent willingness to be managed by urology residents. The percentage of patients not available for this purpose showed an increasing trend that directly correlated with the difficulty of the procedure. Approximately 5–10% of patients were not willing to be managed by residents for simple procedures such as clinical visits, cystoscopy or sonography, and up to a third of patients were not prepared to undergo any surgical procedure performed by residents during steps in major surgery, even if the residents were adequately tutored. Conclusions: Our data showed that patients have a good willingness to be managed by residents during their training, especially for medium‐ to low‐difficulty procedures. Furthermore, the majority of patients interviewed rated the residents' care delivery as sufficient. Urology trainees were considered to have good communication skills, expertise and willingness. [ABSTRACT FROM AUTHOR]

Objective To assess European Association of Urology (EAU) risk groups for biochemical recurrence (BCR) of prostate cancer relative to prostate-specific membrane antigen-positron emission tomography (PSMA-PET) status and oncological outcomes. Patients and Methods A retrospective analysis of a study that incorporated PSMA-PET for men with BCR after radical prostatectomy (RP) was undertaken. EAU risk groups were considered relative to clinical variables, PSMA-PET findings, and deployment of salvage radiotherapy (SRT). The primary oncological outcome was event-free survival (EFS) and this was analysed relative to clinical and imaging variables. An 'event' occurred if prostate-specific antigen (PSA) level rose >0.2 ng/mL above nadir or additional therapies were introduced. Results A total of 137 patients were included, most of whom had EAU high-risk disease (76%) and/or low PSA levels (80% <0.5 ng/mL) at the time of PSMA-PET. EAU risk group was not associated with regional nodal/distant metastasis on PSMA-PET. Regional nodal/distant metastasis on PSMA PET (compared to negative/local recurrence: hazard ratio [HR] 2.2; P = 0.002) and SRT use (vs no SRT: HR 0.44; P = 0.004) were associated with EFS. EAU high-risk status was not significantly associated with worse EFS (HR 1.7, P = 0.12) compared to EAU low-risk status. Among patients who received SRT, both regional/distant metastasis on PSMA-PET (HR 3.1; P < 0.001) and EAU high-risk status (HR 2.9; P = 0.04) were independently associated with worse EFS, which was driven by patients in the EAU high-risk group with regional/distant metastases (38%; HR 3.1, P = 0.001). Conclusions In patients with post-RP BCR, PSMA-PET findings and receipt of SRT predicted EFS. In patients receiving SRT, PSMA status combined with EAU risk grouping was most predictive of EFS. These findings suggest that the EAU risk groups could be improved with the addition of PSMA-PET. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)‐mandated urological procedures, and the proportion of undergraduates considering urology as a career. Subjects and Methods: The uroLogical tEAching in bRitish medical schools Nationally (LEARN) study was a national multicentre cross‐sectional evaluation. Year 2 to Year 5 medical students and Foundation Year (FY) 1 doctors were invited to complete a survey between 3 October and 20 December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES). Results: In all, 7063/8346 (84.6%) responses from all 39 UK medical schools were included; 1127/7063 (16.0%) were from FY1 doctors who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory‐based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. In all, 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. Conclusion: The LEARN Study is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated against the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures. [ABSTRACT FROM AUTHOR]

Conference speaker selection committees should promote greater gender equality in speaker selection and female leadership in the field of urology. When comparing male and female speakers from the AUA, we found that male speakers from the AUA had a higher number of publications than their female counterparts. Our objectives were: (i) to assess female speaker representation on surgical topics at major urological conferences and (ii) to analyse the demographics of the speakers that may influence speaker selection. [Extracted from the article]

Objectives: To present the number and outcomes of urological referrals to the General Medical Council (GMC) and provide a breakdown of the doctors' demographics. Methods: Data were requested and collected from the GMC under the Freedom of Information Act 2000 for all complaints about urologists between 2007 and 2021 (14‐year period). Results: Between 2007 and 2021 a total of 635 urologists were referred to the GMC, totalling 734 referrals (1.15 referrals/doctor). Of these, 50% (364) were closed following a provisional enquiry (PE; 1 month) and another 43% were investigated but no action was taken. Action was taken for only 7% of urologists (49); these urologists were given advice, required to do extra training, suspended from practice, or erased from the medical register. Compared to the current urology workforce, a marginally higher proportion of those referred were international medical graduates or from diverse backgrounds. Conclusion: For urologists unfairly referred to the GMC it is reassuring to know that half of cases are closed at a PE. Of those investigated, only 7% of urologists were given sactions, suspension or given extra training. Reassuringly, our data demonstrate a robust process of GMC investigation, with most doctors going back into work following suitable complaints and, over the last 14 years, only nine urologists received sanctions, two of whom were erased from the medical register. There were only marginal differences when comparing our data to the current urologist population with regard to race and location of primary medical qualification. Conversely, the male‐to‐female split was more heavily weighted towards males being referred to the GMC. [ABSTRACT FROM AUTHOR]

The WACS training comprises 30-36 months of general surgical training (Part 1), followed by 36 months of specialist training (Part 2) in an accredited hospital, leading to the specialist fellowship examination. From very cheap to expensive.Use of everyday objects as modelsTask-training modelsIsolated animal organsBox trainersTask-training manikinsCadavers ht In 2011, Robert Lane [21] delivered a workshop on the Future of Surgical training in Africa, the importance of coordination and COSECSA's role. The WHO recommends the inclusion of simulation-based education and training stating its benefits as '... helping students to acquire skills and to accelerate learning' [19], whilst Burch's [20] editorial 'Should simulation-based training be an essential, non-negotiable component of training for a career in healthcare provision? Keywords: simulation; low and middle-income countries; technical skills; non-technical skills; training; urology EN simulation low and middle-income countries technical skills non-technical skills training urology 563 571 9 05/13/22 20220501 NES 220501 Abbreviations BSS Basic Surgical Skills COSECSA College of Surgeons of East, Central and Southern Africa COVID-19 coronavirus disease 2019 3D three-dimensional F-2-F face-to-face HICs high-income countries LMICs low- and middle-income countries MDGs Millennium Development Goals NOTSS non-technical skills for surgeons RCT randomised controlled trial SBE simulation-based education SDGs Sustainable Development Goals SSA Sub-Saharan Africa TS Touch Surgery™ app. [Extracted from the article]

The coronavirus disease 2019 (COVID‐19) pandemic has brought about many changes in the relationships between high‐income countries and partner organisations in low‐ or low–middle‐income countries, such as predominate in sub‐Saharan Africa. Medicine, surgery and in particular urology is no exception to the changes that COVID‐19 has demanded. Urolink represents the British Association of Urological Surgeons (BAUS) on the global urology stage and has been deleteriously impacted by the pandemic. Education, one of the pillars of Urolink's founding philosophies, has conventionally been delivered by face‐to face teaching, training, or mentoring by UK urologists at their host's site outside of the UK. As a consequence of the inability to travel due to the pandemic, BAUS Urolink has evolved a virtual on‐line webinar package evolved by, and delivered between, urologists in Lusaka, Zambia, and various centres in the UK. The aim was to deliver curricular‐based educational topics to trainees in both countries. This programme has generated a number of live webinars and archived recordings during the pandemic that has proven accessible and educationally acceptable to trainees in the UK and Zambia. This webinar series has also generated relationships between young urologists on different continents, given each a different view of healthcare delivery outside of their country of origin at no appreciable cost, and would appear to be an educational mechanism that is durable for, and applicable to, a wider participation in the post‐pandemic world. [ABSTRACT FROM AUTHOR]

The provision of effective urological management in low‐ and middle‐income countries requires the delivery of appropriate and effective care adapted to the needs, capability and resources of the host country. However, a deeper cognisance of the culture, the religious practices and the logistics of healthcare in that environment determines the ability to effectively to 'twin', that is, to provide a long‐term healthcare partnership. Patient beliefs can have profound effects on the understanding of the aetiology of illness, its relevance to their long‐term health and the stigmatization of their family's social status. Consequently, individuals may have a greater willingness to seek help from practitioners of traditional medicine due to its availability as well as the lower costs of such medicine by comparison to those of medicine from high‐income countries (HICs). This can influence the treatment of many urological conditions and lead to late‐presenting states such as malignant ureteric obstruction. Social mores, such as cultural paternalism, can also influence many practices that are assumed by HICs to be part of normal healthcare provision, including the delivery of patient information and provision of informed consent to treatment. Doctor's status and dress have greater importance in many countries in sub‐Saharan Africa (sSA) than in the UK and the modes of greeting and addressing colleagues and patients can affect the fluency and effectiveness of clinical interactions. A local cultural and religious knowledge is essential, therefore, to optimize the assimilation of external help. Logistics are perhaps the most important factor that needs to be grasped to provide a sustainable healthcare environment. Limitations in resource allocation are a major factor in planning effective urological treatment in many countries in sSA, whether this is the provision of trained personnel, basic infrastructure, a tenable workspace, equipment or drugs. This paper explores all of these factors, and looks at how their recognition assists urologists in providing a twinning process. [ABSTRACT FROM AUTHOR]

Objectives: To determine the credibility of online urological information that medical students are likely to encounter, determine possible discrepancies between the credibility of information pertaining to different areas within urology (especially those less relevant to patients), and assess trends in the sponsorship of online urological educational material. Materials and Methods: Health on the Net (HON) principles were used as a validated benchmark to assess the reliability of websites that appeared in the first 150 results of a search using the Google search engine. A variety of urological search terms were used, grouped into three broad categories with varying relevance to patients and medical students. Further analysis focussed on the sponsorship of assessed websites. Results: A total of 5400 websites were assessed for validation over a set of 36 search terms. Only 843/5400 (15.6%) of these were HONcode accredited, indicating a large proportion of unverified and potentially unreliable information. Search engine rankings usually favoured accredited websites (P = 0.009), and accreditation peaked at 51.1% (184/360) in the first page of results, but sorting became weaker outside the highest search results. The percentage of accredited websites varied significantly between different subcategories of search terms such as conditions (18.3% [329/1800], P = 0.003) and procedures (13.5% [243/1800], P = 0.043). Governmental/educational and commercial sources supported the majority of websites assessed for sponsorship (21% [31/150] and 33% [49/150], respectively), and the former were more likely to rank highly in search results. Conclusion: Online urological information frequently lacks validation and is often of indeterminate credibility. There is a marked decrease in the proportion of accredited websites beyond the highest‐ranked results and when considering search categories more relevant to students and less relevant to patients. Students cannot necessarily rely on free online sources for accurate information and could benefit from the development of more rigorous novel tools and platforms. [ABSTRACT FROM AUTHOR]

Abbreviations CFA common femoral artery CFV common femoral vein CIA common iliac artery eGFR estimated GFR EIA external iliac artery EIV external iliac vein ICU intensive care unit IIV internal iliac vein LMWH low-molecular-weight heparin PN partial nephrectomy US ultrasonography Case Presentation A 62-year-old man was referred to our team with a 2.1-cm mass in the upper pole of his transplanted kidney, located in the right iliac fossa. The right common iliac artery (CIA), proximal right external iliac artery (EIA), proximal right external iliac vein (EIV) and internal iliac vein (IIV) were all dissected and looped. The patient's 2.1-cm tumour was deemed amenable to partial nephrectomy (PN), which was preferred to radical nephrectomy given the expressed desire of the patient to avoid the need for dialysis if practicable. [Extracted from the article]

Objective: To determine what importance is given to the puncture and assistive technologies in percutaneous nephrolithotomy (PNL) in the current urological literature. Methods: PubMed was searched for English publications and reviews for the keywords: 'percutaneous nephrolithotomy', 'percutaneous nephrostomy', 'puncture'. The search was limited to the last 5 years, January 2016 until February 2021. Based on 183 abstracts, 121 publications were selected, read, and reviewed. References, older or seminal papers were read and cited if they contributed to a better understanding. A total of 198 references form the basis of this narrative review. Results: The puncture is frequently referred to as the most crucial part of PNL. In contrast, the influence of the puncture on the failure rate of PNL and the specific puncture‐related complications seems to be low in the single‐digit percentage range. However, there are no universally accepted definitions and standards measuring the quality of puncture. Consequently, the impact of the puncture on general PNL complications, on stone scores predicting success rates and on learning curves evaluating surgeons' performance have not been systematically studied. Assistive technologies rely on fluoroscopy and ultrasonography, the latter of which is becoming the preferred imaging modality for monitoring the entire procedure. Needle bending, a problem relevant to all puncture techniques, is not addressed in the urological literature. Conclusions: The importance attached to puncture in PNL in the current urological literature is subjectively high but objectively low. Some basics of puncture are not well understood in urology. Disciplines other than urology are more actively involved in the development of puncture techniques. [ABSTRACT FROM AUTHOR]

Objectives: To investigate volume–outcome relationships in robot‐assisted radical prostatectomy (RARP) for cancer using data from the Hospital Episodes Statistics (HES) database for England. Materials and Methods: Data for all adult, elective RPs for cancer during the period January 2013–December 2018 (inclusive) were extracted from the HES database. The HES database records data on all National Health Service (NHS) hospital admissions in England. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (laparoscopic, open or robot‐assisted), hospital length of stay (LOS), emergency readmissions, and deaths. Multilevel modelling was used to adjust for hierarchy and covariates. Results: Data were available for 35 629 RPs (27 945 RARPs). The proportion of procedures conducted as RARPs increased from 53.2% in 2013 to 92.6% in 2018. For RARP, there was a significant relationship between 90‐day emergency hospital readmission (primary outcome) and trust volume (odds ratio [OR] for volume decrease of 10 procedures: 0.99, 95% confidence interval [CI] 0.99–1.00; P = 0.037) and surgeon volume (OR for volume decrease of 10 procedures: 0.99, 95% CI 0.99–1.00; P = 0.013) in the previous year. From lowest to highest volume category there was a decline in the adjusted proportion of patients readmitted as an emergency at 90 days from 10.6% (0–49 procedures) to 7.0% (≥300 procedures) for trusts and from 9.4% (0–9 procedures) to 8.3% (≥100 procedures) for surgeons. LOS was also significantly associated with surgeon and trust volume, although 1‐year mortality was associated with neither. Conclusions: There is evidence of a volume–outcome relationship for RARP in England and minimising low‐volume RARP will improve patient outcomes. Nevertheless, the observed effect size was relatively modest, and stakeholders should be realistic when evaluating the likely impact of further centralisation at a population level. [ABSTRACT FROM AUTHOR]

Objective: To outline our step‐by‐step technique for the endoscopic treatment of ureteric stricture. Materials and Methods: Between January 2019 and June 2020, 25 patients with ureteric strictures underwent ureteric bypass and were included in this study. The ureteric bypass surgery included three key steps. First, holmium laser endoureterotomy was used to establish a small channel. Then, balloon dilatation was performed to create a large channel. Finally, an Allium stent was inserted. Results: Over a median follow‐up time of 12 months, the success rate of ureteric bypass surgery was 92.0% (23/25). The median operating time was 78 min. The incidence of pain was 16% (4/25), and the incidence of fever was 4.0% (1/25). The preoperative hydronephrosis volume and urea nitrogen levels decreased significantly after surgery. Conclusions: We performed ureteric bypass for patients with ureteric strictures. This technique was found to be safe and effective over a short follow‐up time. For patients who are not suitable for surgical reconstruction, the ureteric bypass technique is a good choice. [ABSTRACT FROM AUTHOR]

Objective: To determine whether it is possible to reduce the amount of pain and anxiety experienced during a vasectomy by use of two‐dimensional (2D) video glasses or virtual reality (VR) glasses during the vasectomy. Patients and Methods: A non‐randomised controlled trial was performed between October 2017 and March 2018. A total of 176 patients were planned for a vasectomy in an outpatient setting and 141 of these patients were divided sequentially into three groups: Control, 2D video glasses and VR glasses. Follow‐up lasted 7 days. One patient was lost to follow‐up. The main outcomes were pain (visual analogue scale [VAS] score 0–10) and anxiety ((VAS score 0–10), and State‐Trait Anxiety Inventory for Adults [STAI‐AD] score 20–80) during the vasectomy. Data were compared using analysis of variance or chi‐square measurements. Results: No significant differences in pain were found (VAS score of 2 in all groups). The odds ratio (OR) and (95% confidence interval [CI]) in the 2D video glasses group was 1.15 (0.92–1.48) and in the VR group was 0.98 (0.76–1.26). Patients in the VR group experienced significantly more anxiety during the procedure (OR 1.40, 95% CI 1.07–1.85). Also, patients without prior hospitalisation reported significantly more pain than patients with one or more hospitalisations (OR 1.35, 95% CI 1.11–1.65). Conclusions: The VR and 2D video glasses did not reduce pain or stress during the vasectomy. In the VR group, the anxiety levels during the procedure were even higher. [ABSTRACT FROM AUTHOR]

Objective: To objectively determine the percentage of female trainees and consultants who are interested in their career being focussed on female urology (FU) in order to facilitate the improved planning for the future of this sub‐specialty. Subjects and methods: This was an international cross‐sectional study spanning 1 year, from December 2018 to December 2019. An anonymous, voluntary survey was generated using the online survey generator Survey monkey®. The survey was sent to urology consultants and trainees who were female from Australia, New Zealand, and Canada. Results: The total response rate to the survey was 61%. Up to 50% of female consultants and trainees selected a career in FU due to their gender, but up to 75% of respondents were also interested in FU of their own accord. Common concerns held by a majority of respondents included both the medical community's and the public's lack of awareness of FU as a component of urological expertise. Despite these concerns, most of the trainees were not concerned regarding their future work opportunities in FU, and many had intentions to pursue a fellowship in FU. Conclusion: Female urology is an increasingly popular sub‐specialisation of urology, given the steady increase in the intake of female trainees. Similar trends were identified internationally. Urology training in this area will need to continue to increase the community's and the primary health care referrer's awareness in order to ensure the continued success and growth of the sub‐specialty. [ABSTRACT FROM AUTHOR]

Objectives: To characterise the prevalence of impostor phenomenon (IP; tendency for high-achieving individuals to perceive themselves as fraudulent in their successes) amongst attending staff in urology, to identify variables that predict more severe impostorism, and to study the association of IP with burnout., Subjects and Methods: A survey composed of the Clance Impostor Phenomenon Scale (CIPS), demographic information, practice details, and burnout levels was e-mailed to urologists via urological subspecialty societies. Survey results were analysed to identify associations between IP severity, survey respondent characteristics, and symptoms of professional burnout. This study was conducted in the United States of America., Results: A total of 614 survey responses were received (response rate 11.0%). In all, 40% (n = 213) of responders reported CIPS scores qualifying as either 'frequent' or 'intense' impostorism (i.e., scores of 61-100). On multivariable analysis, female gender, fewer years in practice (i.e., 0-2 years), and lower academic rank were all independently associated with higher CIPS scores (adjusted P < 0.05). Regarding burnout, 46% of responders reported burnout symptoms. On multivariable analysis, increase in CIPS score was independently associated with higher odds of burnout (odds ratio 1.06, 95% confidence interval 1.04-1.07; P < 0.001)., Conclusion: Impostor phenomenon is prevalent in the urological community and is experienced more severely in younger and female urologists. IP is also independently associated with burnout. Increased female representation may improve IP amongst our female colleagues. More work is needed to determine strategies that are effective in mitigating feelings of IP and professional burnout amongst urologists, particularly those earlier in their careers., (© 2024 BJU International.)

Objective: To look into the urology litigation trends and successful claims in the National Health Service (NHS) over the last 20 years. Methods: We requested data from NHS Resolutions to investigate current litigation numbers, costs and causes for claims. Data collected included the number of claims dating from 1996 to 2019, the total sum of damages paid out each year for urology and the causes for the claims dating from 2009 to 2019. Data from NHS Resolutions were analysed, stratified and categorized by the authors from this information, which was provided as two separate documents. Results: The total cost of damages between 1997 and 2017 was £74.5m (range: £241 325–£7.8m per year). While the number of successful claims was 1653 (range 7–168 per year), the total number of claims was 3341 (range 31–347 per year) and, over time, this has increased almost sevenfold. The cost of damages has increased roughly in line with the number of claims. Over the last 10 years, non‐operative‐related claims accounted for 984 claims, of which the largest subset was for 'the failure to diagnose and/or treat' (n = 639, 65%), with 88 (9%) successful consent‐related claims. There were 226 intra‐operative‐related claims. Of these, wrong‐site surgery, a never‐event, accounted for eight claims and there were six successful claims for failing to supervise juniors. A total of 1129 claims were postoperative claims, with retained foreign body or instrument accounting for 71 (6%) of these. Conclusions: The number and cost of litigation claims have increased year on year. There is a need for continual improvement in patient care, surgical training, counselling, informed consent and early management of complications. The evidence reviewed in this paper suggests that the best approach to this is the combination of rigid adherence to and re‐enforcement of common surgical guidelines and implementation of the national 'Getting it right first time' initiative. [ABSTRACT FROM AUTHOR]

Objective: To develop and evaluate an assessment tool for endourological skills during simulation including cystoscopy, ureteroscopy (URS) and transurethral resection (TUR) procedures. Methods: We designed a Global Assessment of Urological Endoscopic Skills (GAUES) tool, comprised of nine endourology task‐specific and two global‐rating skills items. The tool was developed through two rounds of the Delphi process. The GAUES tool was used to assess acquisition of URS and TUR skills of novices (Year 2 core surgical trainees, CT2) and intermediate level trainees (residents at the start of the UK higher surgical training programme in Urology, Speciality Trainee Year 3, ST3) at the Urology Simulation Boot Camp (USBC) between 2016 and 2018. Validity was evaluated by comparing scores between trainees with different levels of urological experience. Inter‐rater reliability was also assessed. Results: We evaluated 130 residents, 52% of trainees were at an intermediate stage of training and 39% were novices. In all, 9% of the anonymous forms were missing demographics. The completion rate of the GAUES tool during the USBC for URS and TUR was 85% and 89%, respectively. Our analysis demonstrated a significant difference in all domains between intermediates and novices at assessment in URS, except for one domain more suited to clinical assessment (P = 0.226). There was excellent intraclass correlation (ICC) overall between the two experts' judgements, ICC = 0.841 (95% confidence interval 0.767–0.893; P < 0.001, n = 88). Conclusions: We have developed the novel GAUES tool for cystoscopic, URS and TUR skills. Overall, we demonstrated good face, content and construct validity and excellent reliability, suggesting that the GAUES tool can be useful for endourological skills assessment. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the postoperative complication and mortality rate following laparoscopic radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in octogenarians. Patients and Methods: We conducted a retrospective analysis comparing postoperative complication and mortality rates depending on age in a consecutive series of 1890 patients who underwent RARC with ICUD for bladder cancer between 2004 and 2018 in 10 European centres. Outcomes of patients aged <80 years and those aged ≥80 years were compared with regard to postoperative complications (Clavien–Dindo grading) and mortality rate. Cancer‐specific mortality (CSM) and other‐cause mortality (OCM) after surgery were calculated using the non‐parametric Aalen‐Johansen estimator. Results: A total of 1726 patients aged <80 years and 164 aged ≥80 years were included in the analysis. The 30‐ and 90‐day rate for high‐grade (Clavien–Dindo grades III–V) complications were 15% and 21% for patients aged <80 years compared to 11% and 13% for patients aged ≥80 years (P = 0.2 and P = 0.03), respectively. In a multivariable logistic regression analysis adjusting for pre‐ and postoperative variables, age ≥80 years was not an independent predictor of high‐grade complications (odds ratio 0.6, 95% confidence interval 0.3–1.1; P = 0.12). The non‐cancer‐related 90‐day mortality was 2.3% for patients aged ≥80 years and 1.8% for those aged <80 years, respectively (P = 0.7). The estimated 12‐month CSM and OCM rates for those aged <80 years were 8% and 3%, and for those aged ≥80 years, 15% and 8%, respectively (P = 0.009 and P < 0.001). Conclusions: The minimally invasive approach to RARC with ICUD for bladder cancer in well‐selected elderly patients (aged ≥80 years) achieved a tolerable high‐grade complication rate; the 90‐day postoperative mortality rate was driven by cancer progression and the non‐cancer‐related rate was equivalent to that of patients aged <80 years. However, an increased OCM rate in this elderly group after the first year should be taken into account. These results will support clinicians and patients when balancing cancer‐related vs treatment‐related risks and benefits. [ABSTRACT FROM AUTHOR]

ObjectiveTo characterise the use of social media among members of the American Urological Association (AUA), as the use of social media in medicine has greatly expanded in recent years.Subjects and methodsIn December 2012 to January 2013, the AUA e-mailed a survey with 34 questions on social media use to 2000 randomly selected urologists and 2047 resident/fellow members. Additional data was collected from Symplur analytics on social media use surrounding the AUA Annual Meeting in May 2013.ResultsIn all, 382 (9.4%) surveys were completed, indicating 74% of responders had an online social media account. The most commonly used social media platforms were Facebook (93%), followed in descending order by LinkedIn (46%), Twitter (36%) and Google+ (26%). Being aged 5000 tweets from >600 distinct contributors.ConclusionAs of early 2013, among respondents to an e-mail survey, most urologists and urology trainees used some form of social media, and its use in urology conferences has greatly expanded.

ObjectiveTo characterise the use of social media among members of the American Urological Association (AUA), as the use of social media in medicine has greatly expanded in recent years.Subjects and methodsIn December 2012 to January 2013, the AUA e-mailed a survey with 34 questions on social media use to 2000 randomly selected urologists and 2047 resident/fellow members. Additional data was collected from Symplur analytics on social media use surrounding the AUA Annual Meeting in May 2013.ResultsIn all, 382 (9.4%) surveys were completed, indicating 74% of responders had an online social media account. The most commonly used social media platforms were Facebook (93%), followed in descending order by LinkedIn (46%), Twitter (36%) and Google+ (26%). Being aged 5000 tweets from >600 distinct contributors.ConclusionAs of early 2013, among respondents to an e-mail survey, most urologists and urology trainees used some form of social media, and its use in urology conferences has greatly expanded.