Urology (urinary tract)
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Research outputs from the Urology department at the RD&E.
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Item Successful treatment of ureteral-stent-related fungal ball using fluconazole instillation through a nephrostomy tube(Elsevier, 2023-09-01) Chacko, A. Z.; Misra, S.The kidneys are the most common solid organ to be infected by Candida sp. And may occur due to hematogenous spread, ascending infection, or with the presence of stent and nephrostomy tubes. Evidence for treatment is limited to case reports. We successfully cleared a candida infection of a ureteric stent in a 35-year-old diabetic gentleman by instilling 300 mg of fluconazole in 500 mL of normal saline over 8 hours once daily for 7 days via the nephrostomy tube.Item Potential Carbon Savings with Day-case Compared to Inpatient Transurethral Resection of Bladder Tumour Surgery in England: A Retrospective Observational Study Using Administrative Data(Elsevier, 2023-06-01) Phull, M.; Begum, H.; John, J. B.; van Hove, M.; McGrath, J.; O'Flynn, K.; Briggs, T. W. R.; Gray, W. K.BACKGROUND: The National Health Service (NHS) in England has set a net-zero target for carbon emissions by 2040. Increasing use of day-case surgery pathways may help in meeting this target. OBJECTIVE: To investigate the estimated difference in carbon footprint between day-case and inpatient transurethral resection of bladder tumour (TURBT) surgery in England. DESIGN SETTING AND PARTICIPANTS: This was a retrospective analysis of administrative data extracted from the Hospital Episode Statistics database for all TURBT procedures conducted in England from April 1, 2013 to March 31, 2022. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Day-case and inpatient TURBT procedures were identified and the carbon footprint for key elements of the surgical pathway was estimated using data from Greener NHS and the Sustainable Healthcare Coalition. RESULTS AND LIMITATIONS: Of 209 269 TURBT procedures identified, 41 583 (20%) were classified as day-case surgery. The day-case rate increased from 13% in 2013-2014 to 31% in 2021-2022. The move from inpatient stays to day-case surgery between 2013-2014 and 2021-2022 demonstrates a trend toward a lower-carbon pathway, with an estimated saving of 2.9 million kg CO(2) equivalents (equivalent to powering 2716 homes for 1 yr) in comparison to no change in practice. We calculated that potential carbon savings for the financial year 2021-2022 would be 217 599 kg CO(2) equivalents (equivalent to powering 198 homes for 1 yr) if all hospitals in England not already in the upper quartile were able to achieve the current upper-quartile day-case rate. Our study is limited in that estimates are based on carbon factors for generic surgical pathways. CONCLUSIONS: Our study highlights potential NHS carbon savings that could be achieved by moving from inpatient stays to day-case surgery. Reducing variation in care across the NHS and encouraging all hospitals to adopt day-case surgeries, where clinically appropriate, would lead to further carbon savings. PATIENT SUMMARY: In this study we estimated the potential for carbon savings if patient undergoing bladder tumour surgery were admitted and discharged on the same day. We estimate that increasing use of day-case surgery between 2013-2014 and 2021-2022 has saved 2.9 million kg CO(2) equivalents. If all hospitals were to achieve day case-rates comparable to those in the highest quarter of hospitals in England in 2021-2022, then the carbon equivalent to powering 198 homes for 1 year could have been saved.Item The management of recurrent urinary tract infections within a nurse-led urology team(Mark Allen Group, 2023-05-01) Churchill, K.The aim of this article is to share experience and learning of managing recurrent urinary tract infections (UTIs) within a specialist urology nurse-led team based at a district general hospital. It looks at current practice and supporting evidence for how to manage and treat recurrent UTIs in both male and female patients. Two case studies are presented to illustrate the management strategies and outcomes, demonstrating a planned approach that informs the design of a local management guideline to organise patients' care.Item Diagnosis, treatment and survival from bladder, upper urinary tract, and urethral cancers: real-world findings from NHS England between 2013 and 2019(Wiley, 2023-01-20) Catto, J. W. F.; Mandrik, O.; Quayle, L. A.; Hussain, S. A.; McGrath, J.; Cresswell, J.; Birtle, A. J.; Jones, R. J.; Mariappan, P.; Makaroff, L. E.; Knight, A.; Mostafid, H.; Chilcott, J.; Sasieni, P.; Cumberbatch, M.OBJECTIVE: We report NHS England data for patients with bladder cancer (BC), upper tract urothelial cancer (UTUC: renal pelvic and ureteric), and urethral cancers from 2013 to 2019. MATERIALS AND METHODS: Hospital episode statistics, waiting times, and cancer registrations were extracted from NHS Digital. RESULTS: Registrations included 128 823 individuals with BC, 16 018 with UTUC, and 2533 with urethral cancer. In 2019, 150 816 persons were living with a diagnosis of BC, of whom 113 067 (75.0%) were men, 85 117 (56.5%) were aged >75 years, and 95 553 (91.7%) were Caucasian. Incidence rates were stable (32.7-34.3 for BC, 3.9-4.2 for UTUC and 0.6-0.7 for urethral cancer per 100 000 population). Most patients 52 097 (mean [range] 41.3% [40.7-42.0%]) were referred outside the 2-week-wait pathway and 15 340 (mean [range] 12.2% [11.7-12.6%]) presented as emergencies. Surgery, radiotherapy, chemotherapy, or multimodal treatment use varied with disease stage, patient factors and Cancer Alliance. Between 27% and 29% (n = 6616) of muscle-invasive BCs did not receive radical treatment. Survival rates reflected stage, grade, location, and tumour histology. Overall survival rates did not improve over time (relative change: 0.97, 95% confidence interval 0.97-0.97) at 2 years in contrast to other cancers. CONCLUSION: The diagnostic pathway for BC needs improvement. Increases in survival might be delivered through greater use of radical treatment. NHS Digital data offers a population-wide picture of this disease but does not allow individual outcomes to be matched with disease or patient features and key parameters can be missing or incomplete.Item Protocol for a MULTI-centre feasibility study to assess the use of (99m)Tc-sestaMIBI SPECT/CT in the diagnosis of kidney tumours (MULTI-MIBI study)(BMJ, 2023-01-24) Warren, H.; Wagner, T.; Gorin, M. A.; Rowe, S.; Holman, B. F.; Pencharz, D.; El-Sheikh, S.; Barod, R.; Patki, P.; Mumtaz, F.; Bex, A.; Kasivisvanathan, V.; Moore, C. M.; Campain, N.; Cartledge, J.; Scarsbrook, A.; Hassan, F.; O'Brien, T. S.; Stewart, G. D.; Mendichovszky, I.; Dizdarevic, S.; Alanbuki, A.; Wildgoose, W. H.; Wah, T.; Vindrola-Padros, C.; Pizzo, E.; Dehbi, H. M.; Lorgelly, P.; Gurusamy, K.; Emberton, M.; Tran, M. G. B.INTRODUCTION: The incidence of renal tumours is increasing and anatomic imaging cannot reliably distinguish benign tumours from renal cell carcinoma. Up to 30% of renal tumours are benign, with oncocytomas the most common type. Biopsy has not been routinely adopted in many centres due to concerns surrounding non-diagnostic rate, bleeding and tumour seeding. As a result, benign masses are often unnecessarily surgically resected. (99m)Tc-sestamibi SPECT/CT has shown high diagnostic accuracy for benign renal oncocytomas and other oncocytic renal neoplasms of low malignant potential in single-centre studies. The primary aim of MULTI-MIBI is to assess feasibility of a multicentre study of (99m)Tc-sestamibi SPECT/CT against a reference standard of histopathology from surgical resection or biopsy. Secondary aims of the study include obtaining estimates of (99m)Tc-sestamibi SPECT/CT sensitivity and specificity and to inform the design and conduct of a future definitive trial. METHODS AND ANALYSIS: A feasibility prospective multicentre study of participants with indeterminate, clinical T1 renal tumours to undergo (99m)Tc-sestamibi SPECT/CT (index test) compared with histopathology from biopsy or surgical resection (reference test). Interpretation of the index and reference tests will be blinded to the results of the other. Recruitment rate as well as estimates of sensitivity, specificity, positive and negative predictive value will be reported. Semistructured interviews with patients and clinicians will provide qualitative data to inform onward trial design and delivery. Training materials for (99m)Tc-sestamibi SPECT/CT interpretation will be developed, assessed and optimised. Early health economic modelling using a decision analytic approach for different diagnostic strategies will be performed to understand the potential cost-effectiveness of (99m)Tc-sestamibi SPECT/CT. ETHICS AND DISSEMINATION: Ethical approval has been granted (UK HRA REC 20/YH/0279) protocol V.5.0 dated 21/6/2022. Study outputs will be presented and published nationally and internationally. TRIAL REGISTRATION NUMBER: ISRCTN12572202.