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Objective: The purpose of this article is to present our minimally-invasive techniques for upper tract urothelial carcinoma and review the perioperative and early oncological outcomes at our centre. Materials and methods: A retrospective review of all patients undergoing minimally-invasive surgery for upper tract urothelial carcinoma over a 3-year period following institutional approval was performed. Perioperative and early oncological outcomes were assessed. Results: Twenty-three cases of minimally-invasive single-stage nephroureterectomy were performed with a mean patient age of 69.45 years. Twelve (52%) of these cases were for high-grade disease and six (27%) had received neo-adjuvant chemotherapy. There were no intraoperative complications, no positive surgical margins and four (17.4%) of patients had a post-operative complication. Mean length of stay was 5.5 days and there was one readmission within 30 days of surgery. Seven patients (30%) experienced either local or distant recurrences with a median time to recurrence of 6 months. Recurrence free survival was 69.6%. Two patients died during the follow-up period. Conclusion: Our minimally-invasive techniques provides a safe and reproducible approach for upper tract urothelial carcinoma. Our perioperative outcomes and oncological are comparable to similar studies, but more long-term follow-up and larger patient numbers are required to validate oncological efficacy. Level of evidence: 4.

Introduction Throughout the COVID-19 pandemic we conducted virtual urology clinics for the first time at our institution. We aimed to assess patient satisfaction with the virtual clinic format. Method Patients who underwent virtual consultation were contacted by phone and surveyed about their appointment. Convenience, thoroughness, satisfaction, preference and reason for appointment were assessed via questionnaire Results 77 randomly selected patients were contacted. 63 males (82%), 14 females (18%). Median age 61 years (range 16–86). 62 (80%) reviews, 12 (16%) new referrals, and 3 (4%) post-operative patients were surveyed. 55 (71%) were booked for repeat appointment, 13 (17%) for further investigations, 6 (8%) discharged, and 3 (4%) listed for surgery. 73 (95%) found it convenient, 3 (4%) were neutral and 1 (1%) found it inconvenient. 74 (96%) felt thoroughly assessed and 76 (99%) of patients had all their concerns addressed. 74 (96%) were satisfied with their review, 2 (3%) were neutral, and 1 (1%) was dissatisfied. Going forward, 50 (65%) would prefer virtual follow-up and 27 (35%) would prefer an in-person review. Conclusions Virtual clinic is preferable to the majority of patients in our urology service and is deemed convenient, thorough and satisfactory by them. It should be facilitated going forward in appropriately selected patients.

Testicular torsion is the most concerning underlying cause of acute scrotal pain that can lead to loss of the affected testicle. Whether a torted testicle can be salvaged surgically is directly affected by prompt presentation and diagnosis. This study aims to evaluate the awareness of testicular torsion amongst Irish parents and evaluate their response to a potential torsion. An anonymous questionnaire was distributed to parents attending general paediatric clinics and an acute paediatric unit in two paediatric tertiary referral centres. SPSS statistical analysis software was used to perform multivariant analysis of the data. There were 242 completed surveys. Fifty-six percent of responders had an awareness of torsion. In the event of an episode of severe testicular pain parents who were aware of testicular torsion were 4 times more likely to present immediately than those who had no awareness of torsion (OR 4.2, 95% CI 1.4–12.2, P

Acute urinary retention (AUR) is a common urologic emergency. However, its management is not standardized due to lack of clinical guidelines. We retrospectively reviewed the treatment of all male patients admitted to our institution with AUR over 12 months. Data was obtained from the HIPE (Hospital Inpatient Enquiry) data system, each patient’s electronic discharge summary and from patient medical records. There were 130 AUR admissions during the period. About 74 admissions were due to benign prostatic enlargement (BPE). Of these, 45.9% (n = 34) passed their trial without catheter (TWOC). The remainder (n = 40) failed their TWOC necessitating recatheterization and consideration for transurethral resection of prostate (TURP) or re-TWOC. An indwelling urinary catheter (IDC) was inserted for 27.5% (n = 11) of patients with a failed TWOC secondary to comorbidities. This group had a mean age of 78 years (range 68–96 years). Of those who failed their TWOC, 32.5% (n = 13) had a TURP on index admission. Of the remaining 16 patients with failed TWOC, 75% (n = 12) were discharged with an IDC and readmitted for an elective TURP with a median waiting time of 55 days (range 17–138 days). 18.75% (n = 3) passed a re-TWOC and thus offset the need to have any surgical intervention and 6.25% (n = 1) proceeded to a radical retropubic prostatectomy for biopsy proven prostate adenocarcinoma. Admission of patients with acute urinary retention leads to a definitive management decision and reduced prolonged catheterization.

Introduction: During the COVID-19 pandemic we conducted virtual telephone clinics in lieu of physical clinics for the first time at our institution This study aims to assess patient satisfaction with the virtual clinic format Methods: Patients who underwent telephone virtual urology consultation were contacted subsequently by phone and surveyed on satisfaction of their virtual review Convenience, thoroughness, satisfaction and preference were assessed via questionnaire, as well as reason for review Results: 77 randomly selected patients were contacted, comprising 63 males (82%) and 14 females (18%) with a median age of 61 years (range 16–86) 62 (80%) reviews, 12 (16%) new referrals and 3 (4%) initial post-operative follow-up patients were surveyed 55 (71%) were booked for further outpatient review, 13 (17%) had further investigations arranged, 6 (8%) were discharged, and 3 (4%) were listed for surgery The majority of patients, 73 (95%), felt it was a convenient way to conduct clinic, 3 (4%) were neutral and 1 (1%) found it inconvenient 74 (96%) felt they were thoroughly assessed and 76 (99%) of patients had their concerns addressed 74 (96%) were satisfied with their phone consultation, 2 (3%) were neutral, and 1 (1%) was dissatisfied Going forward, 50 (65%) would prefer phone follow-up and 27 (35%) would prefer a physical appointment Conclusion: A virtual telephone clinic is preferable to the majority of patients in our general urology service and is deemed convenient, thorough and satisfactory by them It should be facilitated going forward in appropriately selected patients

To assess the proportion of penoscrotal injuries arising from the sport of hurling and to assess work-up and management of each injury. Using Hospital In-Patient Enquiry data, all penoscrotal injuries occurring over a 10-year period between 2007 and 2017 were identified and assessed. Chart review, imaging reports, operative notes and discharge summaries were used to identify the aetiology of each injury and those occurring due to hurling were selected for analysis. Investigations and management of each case were reviewed. Seventy patients presented to our institution over a 10-year period with penoscrotal injuries and, of these, ten patients (14%) presented with injuries arising due to blunt scrotal trauma whilst playing hurling. The average age of these patients was 24.3 years, and the right testicle was injured six times, compared with the left testicle twice and isolated scrotal injuries twice also. One hundred percent of patients underwent diagnostic ultrasonography with Doppler flow assessment with 90% (n = 9) having positive findings. Three patients (33%) required operative management with only one patient (10%) requiring an orchidectomy. There were no delayed or interval procedures. Hurling is a physical sport with a notable proportion of blunt scrotal trauma arising due to the sport. Prompt physical examination and diagnostic ultrasonography are essential in investigations of injuries, and surgical exploration should be considered in all cases with concerns of testicular survival. Groin protection should be recommended to all players and in particular to those at high risk such as single testis or prior injury.

Paratesticular soft tissue tumours are remarkably rare entities, with malignant subtypes accounting for approximately 30%. Due to the paucity of cases, a consensus on the best treatment has not yet been reached, presenting a diagnostic and therapeutic challenge for clinicians. Although rare, three such cases presented to the care of our institution serving a population of approximately 400,000 in the space of 13 months. These were three gentlemen, aged 54, 82 and 86 years old, presenting with left sided testicular swellings. Ultrasound in each case confirmed an extratesticular mass. Only the second gentleman complained of associated pain, however he had experienced scrotal trauma in the preceding weeks. Only one patient had suspicions of metastatic disease, with a 9 mm pulmonary nodule on computed tomography. All patients underwent a radical inguinal orchidectomy with high ligation of the spermatic cord, in keeping with best accepted guidelines. Histology confirmed a well-differentiated liposarcoma, a dedifferentiated liposarcoma and a leiomyosarcoma respectively, all high grade. One gentleman returned to theatre for re-excision of margins. Our case series emphasises the need for full multidisciplinary team specialist sarcoma input, as well as radical resection with judicious margins in order to reduce the risk of local recurrence, in the treatment of these rare tumours.

Elective surgical procedures are often delayed for up to six months in patients who have suffered a myocardial infarction (MI) because of the substantial risk of re-infarction and high peri-operative mortality. The optimal management of patients who have sustained a recent myocardial infarction and who require an emergency abdominal operation, however, has yet to be defined. The use of an intraaortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. Three cases are presented in which IABP was used in patients who had recently sustained a myocardial infarction and who required emergency abdominal surgery. A review of the literature is presented and the application of IABP in such circumstances is discussed. Although clinical experience is limited, the use of the IABP may be useful in selected patients who have sustained a recent MI and who require emergency surgery.

Aim: Parastomal hernia commonly occurs following the formation of a stoma. This is a review of parastomal hernia repair using a modified lateral approach to access the defect. Patients/methods: A case series of 17 patients, with a median age of 65, who underwent parastomal hernia repair via a lateral approach over a five year period, is presented. Results: Of the 17 repairs, there were four minor complications in the form of a superficial cellulitis and conservatively managed ileus. In total, there were four recurrences, though only one recurrence occurred in 11 cases after slight modification of the technique. The period of follow-up ranged from 6 to 60 months. Discussion: The lateral approach is a viable option for repair of parastomal hernia. It does not necessitate a laparotomy or relocation of the stoma.