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Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV

Background Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems. Methods During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days. Results 500 patients underwent surgery with median age 62.5 (IQR 51–71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19. Conclusion It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration., Highlights • Priority surgeries are being cancelled every week due to the COVID-19 pandemic. • A multicentre surgical referral network was set up as part of an NHS England approach to continuing safe surgery • The referral network consisted of 14 NHS trusts and surgery was performed at a single COVID-19 ‘cold site’. • After 500 surgeries performed, there was a 0% 30-day mortality from COVID-19. • It is safe to continue cancer and priority surgery during the COVID-19 pandemic with appropriate service reconfiguration.

We report on the details of the insulator-metal transition (IMT) induced in ${\mathrm{Bi}}_{2}$${\mathrm{Sr}}_{2}$(${\mathrm{Ca}}_{\mathit{z}}$,${\mathit{R}}_{1\mathrm{\ensuremath{-}}\mathit{z}}$)${\mathrm{Cu}}_{2}$${\mathrm{O}}_{8+\mathit{y}}$ (R=Y, Gd, Nd) by ${\mathrm{Ca}}^{2+}$ doping. The resistivity in the insulating regime is analyzed using a generalized hopping approach based on the connectivity criterion. This enables us to estimate the dependence of the localization radius ${\mathit{a}}_{\mathit{H}}$ on the Ca concentration independent of dimensionality. Insulating samples with a Y content not too far from the critical concentration ${\mathit{z}}_{\mathit{C}}$=(0.43\ifmmode\pm\else\textpm\fi{}0.02) show metallic conduction at high temperature and hopping conduction at low temperature. This shows the coexistence of delocalized and localized states separated by a disorder-induced mobility edge. Ultraviolet-photoemission-spectroscopy (UPS) spectra give evidence for both a shift in the Fermi level to lower energies and the development of new states at the Fermi level. The existence of a mobility edge together with the shift in ${\mathit{E}}_{\mathit{F}}$ upon ${\mathrm{Ca}}^{2+}$ doping shows that the transition is probably of the Anderson type. We present a schematic picture for the density of states in the vicinity of ${\mathit{E}}_{\mathit{F}}$ based on the results of spectroscopic and transport data. For this density of states we calculate the electrical resistivity using the Kubo-Greenwood formula. The results are in good qualitative agreement with the experiments. At the IMT the localization radius diverges and the metallic conductivity vanishes following a scaling law \ensuremath{\sigma}=${\mathrm{\ensuremath{\sigma}}}_{0}${1-z/${\mathit{z}}_{\mathit{C}}$${\mathrm{}}}^{\mathrm{\ensuremath{\eta}}}$, with a critical exponent \ensuremath{\eta}=1A.

METHODS: A retrospective chart review of all RALPs at Indiana University from October 2002 to July 2014 was performed. RALP success was defined as resolution of symptoms of UPJ obstruction, improved hydronephrosis radiographically, or resolution of obstruction on follow-up Lasix renogram, IVP, or Whitaker test. RALP failure was defined as persistence of symptoms with obstruction demonstrated on functional imaging or requirement for a subsequent UPJ procedure. RESULTS: A total of 133 evaluable patients were identified with an average age of 34 years. 12% had undergone previous failed UPJ procedure (including balloon dilation, endopyelotomy, or pyeloplasty) and 48% had a ureteral stent or nephrostomy placed prior to surgery. Stented RALP was performed in 81.2% of cases while 18.8% were stentless repairs. 89.5% of pyeloplasties were performed with a dismembered technique, while 10.5% were nondismembered Fenger, Y-V, or flap pyeloplasties. 5 intraoperative complications (Clavien I-IIIb) and 18 postoperative complications (Clavien I-IIIa) were described. 129 patients received follow up for an average of 15.7 months (range 1-115 months). 98.3% of patients who were followed for at least twelve months underwent postoperative Lasix renogram. The average increase in split renal function was 1.7% and average decrease in clearance half-time was 23.2 minutes for the ipsilateral kidney in all patients who received preand postoperative Lasix renograms. RALP was determined to be successful in 97.7% of cases. Three failures were noted, all were symptomatic with continued obstruction on functional imaging. Of these failures, one was managed with long-term ureteral stent placement and two required ipsilateral nephrectomy. CONCLUSIONS: Robot-assisted laparoscopic pyeloplasty is an excellent minimally invasive method for correction of UPJ obstruction, resulting in lasting improvement in symptoms and resolution of obstruction for most patients.

s / International Journal of Surgery 12 (2014) S13eS117 S106 Results: 111 patients were assessed; only 63 patients were eligible for randomization (exclusions radiotherapy 38, severe SUI 20 patients). 10 patients agreed to be randomized (16%); 53 patients declined randomization. Three-month follow-up data is currently available on 36 patients. 17/20 (85%) patients treated by sling were cured or significantly improved; all but one with pad weight > 400mls. 3 patients (pad weight 143,500,890mls) were not improved. 14/16 (87.5%) patients treated by AUS were cured or significantly improved; eleven (69%) had severe SUI and six (37.5%) radiotherapy. 2 AUS patients were not improved (bladder over activity, pad weight 1100mls) Conclusions: AUS satisfaction rates were similar to sling. 0787: RETROGRADE LEAK POINT PRESSURE CORRELATES WITH 24 H PAD WEIGHT FOR ASSESSING POST PROSTATECTOMY INCONTINENCE Antoine Kass-Iliyya , Eskinder Solomon, Ishaan Chaudhury, Rizwan Hamid, Daniella E. Andrich, Tamsin J. Greenwell, Ockrim L. Jeremy. University College London Hospital, London, UK. Introduction: Twenty-four hour pad-weight is the standard measurement of stress urinary incontinence (SUI) in men after radical prostatectomy. Poor patient compliance, variability according to patients’ activity and fluid intake represent major disadvantages in reliability of this test. Retrograde leak point pressure (RLPP) measurement is a simple adjunct to urodynamic assessment and gives an objective measure of external urethral sphincter’s closure pressure. We evaluated the correlation between RLPP and 24h pad weight within a randomized study setting. Methods: 53 consecutive men between February-October 2013 were evaluated for surgical intervention. Patients collected 24h pad tests in two separate periods and the mean calculated. Severe incontinence was considered pad weight >400mls. RLPP were performed using a standardized and reproducible (Comiter) technique using a paediatric cuff and 5ml/min perfusion rate. The pressure plateau reached when the sphincter pressure was exceeded was recorded. Results: Mean 24h pad weight was 402±425 mls (range 9-3500), and mean retrograde leak point pressure was 35.7±15.3cm water (range 1283). The degree of individual pad weight variability was not significant. Patients with higher pad weights had significantly lower RLPP measurements, Spearman’s correlation coefficient r1⁄40.59, p

Background, Aim and Method A version of John Rankin9s scale has been an outcome measure in many stroke studies. The original version was modified, and limited inter-rater agreement has led to scoring algorithms and post hoc score adjustments. These recommendations have improved scoring consistency. Nevertheless, only limited scale evaluation is achievable using traditional psychometric methods; in contrast, modern psychometric methods (e.g., Rasch analysis) can help by enabling a test of whether the six Rankin categories are ordered as intended (0–1–2–3–4–5). We applied this test to modified Rankin scale data from two phase 3 lubeluzole trials (n=515; n=591). Results In combined data, and both samples, modified Rankin scale categories were disordered (not working as intended). Moreover, Rankin scale categories remained disordered even when scores were adjusted as suggested by others. Indeed, we have not found a published study where data analysis shows Rankin categories work as intended. This disordering affects the dichotomisation of Rankin data. Conclusions Despite the appeal of apparent clinical simplicity, and approaches to improving scoring, the grading of poststroke sequelae mapped out by Rankin scales does not work. The most likely reason—ambiguity within category definitions. This finding threatens the validity of all studies using Rankin scales and provides one plausible explanation for some negative stroke treatment studies. Has the time come to throw in the towel?

We identify a disorder induced mobility edge E C in the system Bi-221+Y/Ca. The substitution shifts the Fermi energy below E C and causes a superconductor-insulator transition. In the insulating state charge transport happens by Variable-Range-Hopping (Shklovski- Efros case). The transition can either be reached by Y 3+ or Ce 4+ substitution and depends only on the total carrier density.