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Objective To prospectively assess clinical and cost effectiveness of emergency ureteroscopic laser fragmentation of urinary stones causing symptoms or obstruction. Patients and methods 100 consecutive patients with an average (median) age 55.6 (57.5) years and average (median) stone size of 8.2 mm (± 7 mm) between October 2018 and December 2021 who underwent emergency ureteroscopy and laser fragmentation formed the study cohort as part of a clinical service quality improvement. Primary outcome was single procedure stone-free rate and cost-effectiveness. The secondary outcomes were complications, re-admission and re-intervention. A decision analysis model was constructed to compare the cost-effectiveness of emergency ureteroscopy with laser fragmentation (EUL) and emergency temporary stenting followed by delayed ureteroscopy with laser fragmentation (DUL) using our results and success rates for modelling. Results Single procedure stone-free rates (SFR) for EUL and DUL were 85%. The re-intervention rate, re-admission and complication rates of the study cohort (EUL) were 9%, 18%, and 4%, respectively, compared to 15%, 20%, and 5%, respectively for the control cohort (DUL). The decision analysis modelling demonstrated that the EUL treatment option was more cost-efficient, averting £2868 (€3260) per patient for the UK health sector. Total cost of delayed intervention was £7783 (€8847) for DUL in contrast to £4915 (€5580) for EUL. Conclusions Implementation of quality improvement project based on a reduction in CT detection-to-laser fragmentation time interval in acute ureteric obstruction or symptoms caused by stones had similar clinical effectiveness compared to delayed ureteroscopic management, but more cost-effective. [ABSTRACT FROM AUTHOR]

To determine if the partner (partner or spouse) can reliably assess the quality of life (QoL) and bother of the patient suffering from lower urinary tract symptoms (LUTS) before and after treatment thereby assisting in management. 458 men referred with LUTS to a university hospital and 219 partners were recruited into the study between January 1993 and September 1994. Assessment included AUA score, flow rates, QoL and bother validated self-reported questionnaires completed by patients and spouses throughout the study. Data were collected at baseline, 3, 6 months, 6 and 12 years of follow-up. 280 men underwent TURP and 178 were managed by medical (non-surgical) treatment. For the TURP group, the mean QoL for patient and partner at baseline were 8.16 and 9.90 respectively. At 6 months, 6 and 12 years, these improved to 2.43, 3.71, 3.74 and 1.76, 4.07, 4.76 respectively. For the non-surgical treatment group, the mean QoL for patient and partner at baseline were 7.08 and 8.35 respectively. At 6 months, 6 and 12 years, these improved to 5.0, 3.6, 3.28 and 5.67, 3.61, 2.81 respectively. A similar trend applied to the bother score. Improvements in QoL and bother noted by partners agreed with that of patients and were statistically significant. The longest prospective in-depth study has shown marked conformity between patients and partners regarding QoL and bother after treatment. Partners are affected by patients’ LUTS, appreciate the improvement after treatment and may be valuable contributors in assessment. [ABSTRACT FROM AUTHOR]

Objectives: The objective of our study was to study trainees' feedback and rating of models for training transurethral resection of bladder lesions (TURBT) and prostate (TURP) during simulation. Methods: The study was performed during the "Transurethral resection (TUR) module" at the boot camp held in 2019. Prior to the course, all trainees were required to evaluate their experience in performing TURBT and TURP procedures. Trainees simulated resection on two different models; low-fidelity tissue model (Samed, GmBH, Dresden, Germany) and virtual reality simulator (TURPMentor, 3D Systems, Littleton, US). Following the completion of the module, trainees completed a questionnaire using a 5-point Likert scale to evaluate their assessment of the models for surgical training. Results: In total, 174 simulation assessments were performed by 56 trainees (Samed Bladder–40, Prostate–45, TURPMentor Bladder–51, Prostate–37). All trainees reported that they had performed < 50 TUR procedures. The Samed model median scores were for appearance (4/5), texture (5/5), feel (5/5) and conductibility (5/5). The TURPMentor median score was for appearance (4/5), texture and feel (4/5) and conductibility (4/5). The most common criticism of the Samed model was that it failed to mimic bleeding. In contrast, trainees felt that the TURPMentor haptic feedback was inadequate to allow for close resection and did not calibrate movements accurately. Conclusions: Our results demonstrate that both forms of simulators (low-fidelity and virtual reality) were rated highly by urology trainees and improve their confidence in performing transurethral resection and in fact complement each other in providing lower tract endoscopic resection simulation. [ABSTRACT FROM AUTHOR]

Objectives: To present the three-year experience of the multi-component TURP module at Urology Simulation Bootcamp Course (USBC) and demonstrate trainee's competence progression and satisfaction. Methods: During the USBC, a 4-h TURP module was developed and consisted of (a) familiarisation and assembly of resectoscope instrument, (b) didactic lecture on TURP operative techniques and postoperative complications, (c) learning hands-on resection on validated simulators [Samed, GmBH, Dresden, Germany; TURP Mentor™, Simbionix, Israel], and (d) practicing clot evacuation using the Ellik bladder Evacuator. Trainee's level of instrument knowledge, operative competence, and confidence were assessed pre- and post-course. Trainee's feedback was also collected. Results: One hundred thirty trainees participated in the USBC between 2016 and 2018. Eighty-seven percent of trainees scored themselves as 1–3 (low confidence in resection) on a 5-point Likert scale. Trainees significantly improved in their ability to perform resectoscope assembly for resection, coagulation and incision by 33.6% (p < 0.001), 28.1% (p < 0.001) and 34.0% (p < 0.001), respectively. There was a significant improvement in scores in itemised technical skill on the TURP simulator following completion of the TURP module (Mean difference = 3.4 points, 95% CI 2–4, p < 0.001). Ninety-one percent of trainees agreed that the TURP module was useful for their development in urological training. Conclusion: Our results demonstrated that it is feasible to develop and implement a focussed module for teaching TURP with significant improvement in learning. Trainee feedback suggests that they were highly satisfied with the teaching provided and models used. This style of training can be implemented for other common surgical procedures. [ABSTRACT FROM AUTHOR]

Purpose: Transperineal template prostate (TPB) biopsy has been shown to improve prostate cancer detection in men with rising PSA and previous negative TRUS biopsies. Diagnostic performance of this approach especially MR imaging and using reliable reference standard remains scantly reported. Materials and methods: A total of 200 patients, who were previously TRUS biopsy negative, were recruited in this study. All the participants had at least 28-core TPB under general anesthetic within 8 weeks of previous negative TRUS biopsies. In 15 men undergoing laparoscopic radical prostatectomy, prostate specimens were sectioned using custom-made molds and analyzed by experienced pathologist as a feasibility study. Results: In total, 120 of 200 patients (60 %) had positive TPB biopsy results. All of these men had at least one negative biopsy from transrectal route. T2 diffusion-weighted MR imaging showed no lesion in almost one-third of these men (61/200; 30.5 %). Out of these, 33 (33/61; 54 %) showed malignancy on TPB including high-grade tumors (>Gleason 7). Out of 15 patients underwent surgery with a total of 52 lesions (mean 3.5) on radical prostatectomy histology analyses, TPB detected 36 (70 %) lesions only. Some of these lesions were Gleason 7 and more mostly located in the posterior basal area of prostate. Conclusions: Transperineal template biopsy technique is associated with significantly high prostate cancer detection rate in men with previous negative TRUS biopsies, however compared to radical prostatectomy histology map, a significant number of lesions can still be missed in the posterior and basal area of prostate. [ABSTRACT FROM AUTHOR]

Background: Transrectal ultrasound-guided prostate biopsy is a common urological procedure with known complications. We determined the urological complication and 30-day hospital admission rate in a population-based cohort using unique identifier and deterministic methodology of record linkage. Methods: 715 men who underwent a transrectal ultrasound-guided biopsy in Tayside region of Scotland between April 2007 and September 2011 were identified from hospital records using their unique Community Health Index Number. Multiple hospital electronic databases (Central Vision, Insite, Wisdom, and TOPAS) and departmental-based resources (morbidity and mortality records, daily ward electronic records) were linked to estimate urological complications (urinary tract infection, urinary retention, haematuria) and rates of hospital admission. Cross-validation of information was obtained by searching a drug dispensing information network and microbiology database for infective complications. The hospital admission rate was compared for two different prophylactic antibiotic regimens used during the study period. Results: Of the 715 men who underwent transrectal ultrasound biopsy, 386 (53.9 %) were diagnosed with prostate cancer and 329 (46.1 %) were found to have benign histology. The hospital admission rate for urological complications within 30 days of the procedure for men without cancer was 1.95 % (14/715). The 30-day hospital admission rate was not different for different regimens of prophylactic antibiotics. There were 50 (6.99 %; 50/715) urine cultures requested to the microbiology department within 30 days of procedures; out of which 20 (2.79 %; 20/715) were positive. Most of these were generated from general practice requests. Eight blood cultures obtained within the same period were all negative. Eleven patients (1.7 %) presented with urinary retention during the same period and required indwelling catheterisation. None of them had any surgical procedure. Validation of electronic record linkage against telephonic questionnaires by specialist nurse showed a high reliability of the methodology (κ = 0.91). Conclusion: High quality validated record linkage of cohort data in the present study using a unique identifier, protocol-based procedure and antibiotic prophylaxis showed that hospitalisation following TRUS biopsies occurs in less than 2 % of patients. However, a significant number of patients report to primary care, and centrally held records based on coding alone could underestimate the true incidence of complications. [ABSTRACT FROM AUTHOR]