Journal of Clinical Urology最新文献

{"title":"Abstracts Book 2023","authors":"Mr John Fitzpatrick, M. Shaw, A. Rogers, J. Sayer","doi":"10.1177/20514158231172341","DOIUrl":"https://doi.org/10.1177/20514158231172341","url":null,"abstract":"Introduction: Patients with urolithiasis undergo regular follow-up. PROM based follow up using the USIQoL would be innovative and resource friendly, if matches traditional outcomes. We undertook a study to assess the feasibility of using the USIQoL as a tool for virtual follow-up. Patients (or Materials) & Methods: The study involved 2 phases. The 1st phase was the development of the USIQoL based model using existing data. The 2nd phase involved prospective, single-blind application of the model (for outpatient follow-up), over a 12 months. The outcomes were need for intervention or not, based on clinical/radiological data. We assessed correlation between the USIQoL scores and clinical outcomes, and also formulated potential USIQol cut-off scores which could be used to discriminate between intervention/no intervention (i.e., follow-up only). This was done using Binomial Logistic regression (BLR), ROC curves and Youden Index. Results: 441 patients [average age group 46-64, M=298, F=143]. The relationship between USIQoL scores and clinical outcome was statistically significant [BLR: PPH exp(B) 1.148, p <0.001, 95% CI 1.063-1.240; PSH exp (B) 1.179, p 0.025, 95% CI 1.020-1.363]. The chosen cut-off scores were PPH 8 and PSH 10. Application of the model with the cut-offs demonstrated appropriate sensitivities and specificities [PPH sensitivity 0.861, specificity 0.400; PSH sensitivity 0.861, specificity 0.420]. Conclusions: This novel feasibility study demonstrates the potential of the USIQoL to be used as an aid to virtual follow-up using the proposed cut-off scores. This could transform outpatient care of patients with urinary calculi. Further larger scale study will confirm our findings.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 1","pages":"4 - 84"},"PeriodicalIF":0.3,"publicationDate":"2023-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45776116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BAUS oncology guidance for implementing streamlining in cancer MDT meetings: Selecting standards of care and operational considerations","authors":"B. Lamb, K. Linton, K. Narahari","doi":"10.1177/20514158231168463","DOIUrl":"https://doi.org/10.1177/20514158231168463","url":null,"abstract":"It is widely recognised that multidisciplinary team meetings (MDTMs) are the cornerstone of cancer practice in the United Kingdom and many countries around the world. While MDTMs offer several key benefits to patients, healthcare professionals and cancer registration, data and audit services, in the United Kingdom they have over time become too large, onerous and ‘transactional’ often discussing cases that have a pre-determined management plan. In response to this growing problem, National Health Service (NHS) England and NHS Improvement produced an multidisciplinary team (MDT) streamlining document as a guide to encourage MDTM to consider a ‘Standard of Care’ (SoC) approach to conditions with a predictable agreed management plan based on national, regional cancer network or local cancer unit protocols. This would then enable more meaningful discussion of complex cases with in the MDT. This document did not gain much traction and had little impact on UK urological cancer MDTM. As a result, The British Association of Urological Surgeons (BAUS) was approached by the NHS Getting It Right First Time (GIRFT) Leads in 2021 to promote an SoC-based streamlining to urological cancer MDT working. Having consulted widely with colleagues, cancer networks and cancer delivery teams, the BAUS Section of Oncology sought views from its membership during a dedicated MDTM session in the Sections of Oncology Meeting, December 2021. From this extensive engagement with stakeholders, we have put together the following guidance for use as a framework to facilitate the agreement of local policies in the interests of supporting the needs of patients and MDTs. Level of evidence: level 5 (Expert opinions based on non-systematic reviews of results or mechanistic studies)","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44383340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial","authors":"B. Somani","doi":"10.1177/20514158231170664","DOIUrl":"https://doi.org/10.1177/20514158231170664","url":null,"abstract":"","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 1","pages":"177 - 177"},"PeriodicalIF":0.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44999537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Widening participation and implementation of the BAUS 10-point plan: A progressive step for an inclusive association","authors":"V. Massella, John Cresswell, Susan Willis, O. Gbolahan, N. Shrotri, Joe Philip, Ian Pearce, B. Somani","doi":"10.1177/20514158231167659","DOIUrl":"https://doi.org/10.1177/20514158231167659","url":null,"abstract":"","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 1","pages":"178 - 180"},"PeriodicalIF":0.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48092795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cohort analysis of patients receiving neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy during the Covid-19 pandemic.","authors":"Sahan S Bennett,&nbsp;Hing Y Leung,&nbsp;Imran Ahmad","doi":"10.1177/20514158211022216","DOIUrl":"https://doi.org/10.1177/20514158211022216","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study was to investigate localised prostate cancer treated with or without neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy, and the impact of Covid-19 treatment disruption, on clinico-pathologic outcomes.</p><p><strong>Patients and methods: </strong>Data was retrospectively collected from 124 consecutive patients treated with robot-assisted laparoscopic prostatectomy between November 2019-September 2020. Sixty-two patients were treated before 13 March 2020 (historic cohort) and 62 afterwards (covid cohort). Thirty-seven patients in the covid cohort additionally received neoadjuvant androgen deprivation therapy (mean duration of 3 months) consisting of bicalutamide 150 mg once a day for 4 weeks, with leuprolide 3.75 mg monthly injections commencing after week 1, up until the date of surgery.</p><p><strong>Results: </strong>Statistical analysis found no difference in peri-operative measures and length of stay for patients treated with or without neoadjuvant androgen deprivation therapy. Patients with delayed surgical treatment offered neoadjuvant androgen deprivation therapy showed a trend towards a reduction in positive surgical margins (<i>p</i>=0.134), N1 disease (<i>p</i>=0.424) and pathological down-staging (50% patients with pT2 disease). Patients within the covid cohort experienced significantly increased detectable prostate-specific antigen levels (<i>p</i><0.007).</p><p><strong>Conclusion: </strong>Our study demonstrated that a three-month duration of neoadjuvant androgen deprivation therapy prior to robot-assisted laparoscopic prostatectomy may improve pathological outcomes but this time-frame is inadequate to influence detectable prostate-specific antigen levels. Covid-19-related treatment delays led to significantly increased detectable prostate-specific antigen levels.</p><p><strong>Level of evidence: </strong>2b.</p>","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 2","pages":"131-139"},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/20514158211022216","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9284172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of early post-operative outcomes between retzius-sparing and anterior approach robotic radical prostatectomy for a single surgeon","authors":"L. Tay, Robert Makin, I. Saxionis, I. Dokubo, K. Patel, S. Sivathasan, S. Smart, A. Warren, N. Shah, B. Lamb","doi":"10.1177/20514158231156314","DOIUrl":"https://doi.org/10.1177/20514158231156314","url":null,"abstract":"The aim of this study was to compare intraoperative and early post-operative outcomes between retzius-sparing robotic-assisted radical prostatectomy (RS-RARP) versus standard approach for RARP (S-RARP). All RARPs by a single surgeon were included and divided into two groups: (1) standard approach including combined anterior–posterior approach (S-RARP); (2) retzius-sparing posterior approach (RS-RARP). Allocation was based on prostate size and location of index lesion on MRI. Initial post-operative follow-up was at 6 weeks. Overall, 169 RARPs were performed between March 2018 and October 2021: S-RARP = 99 versus RS-RARP = 70. There was no significant difference in pre-operative body mass index (BMI), prostate-specific antigen (PSA), International Society of Urological Pathology (ISUP) grade group and clinical T stage. Intraoperative differences were found in blood loss (300 versus 200 mL, p = 0.008), console time (180 versus 135 minutes, p < 0.001) favouring RS-RARP, with no differences in nerve-spare or lymph node dissection. Post-operatively, no difference was found in ISUP grade, pathological T stage, positive surgical margins, number of lymph nodes sampled, readmissions or complications. Gland size in the RS group was smaller (38 versus 29 g, p = 0.001). Early (6 weeks) post-op follow-up showed a significant difference between groups for both pad-free continence (35% versus 53%, p = 0.011) and social continence (79% versus 89%, p = 0.024), but no difference for erectile function recovery (27% versus 50% of baseline) and post-op PSA levels < 0.1 ng/mL (85% versus 93%). Even early in the learning curve, continence recovery, operative time and blood loss were significantly better for RS-RARP than S-RARP. Margin status and PSA levels are comparable to published literature for both groups. Standardised training in RS-RARP might help to improve the uptake of this novel technique. 2.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46329269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes for active surveillance are similar for men with favourable risk ISUP-2 to those with ISUP-1 prostate cancer: A pair matched cohort study","authors":"A. Katelaris, A. Amin, A. Blazevski, M. Scheltema, T. Cusick, M. Farraha, Daniela Barreto, A. Haynes, W. Gondoputro, S. Agrawal, P. Stricker, James E. Thompson","doi":"10.1177/20514158231154702","DOIUrl":"https://doi.org/10.1177/20514158231154702","url":null,"abstract":"To compare medium-term outcomes of active surveillance (AS) for men with favourable risk International Society for Urologic Pathology (ISUP)-2 prostate cancer (PCa) to a pair matched group of men with ISUP-1 PCa. This was a retrospective analysis of prospectively collected data from a single institution clinical outcomes registry, using propensity score matching. Men enrolled on AS with favourable risk ISUP-2 PCa with minimum 5-year follow-up were 1:2 propensity score matched to men with ISUP-1 disease. We assessed rates of progression to treatment, metastatic disease, adverse surgical pathology and overall survival. Fifty-five ISUP-2 patients were matched to 105 ISUP-1 patients by propensity score. Median follow-up was 81 months (interquartile range (IQR), 61–109 months). Fifty-seven per cent in the ISUP-1 group progressed to treatment versus 58% in the ISUP-2 group (KM log rank p = 0.24). Estimated 1-, 2- and 5-year progression free survival rates were 93%, 60% and 33% for ISUP-1 patients and 94%, 63% and 16% for ISUP-2 patients, respectively. No patient from either group died of PCa. There was no statistical difference in rates of adverse pathology or metastatic disease between ISUP-2 and ISUP-1 patients on AS. AS for carefully selected men with favourable risk ISUP-2 disease appears safe, with similar oncologic outcomes to men with ISUP-1 disease. Level 2b.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48319810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thanks to Reviewers","authors":"","doi":"10.1177/20514158231153465","DOIUrl":"https://doi.org/10.1177/20514158231153465","url":null,"abstract":"","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136389913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An introduction to quality improvement","authors":"S. Russ, J. Green, L. de Winter, Ellie Herrington, A. Hughes-Hallett, Julia Taylor, N. Sevdalis","doi":"10.1177/20514158221075405","DOIUrl":"https://doi.org/10.1177/20514158221075405","url":null,"abstract":"The concept of quality has moved to the top of the international healthcare agenda in the past 30 years. This has been driven by a growing awareness of the scale of variation in patient outcomes, influenced by both the paucity of and consistency in implementation of evidence-based actions or interventions performed during the delivery of patient care. Concurrently there has been growing interest on the part of healthcare professionals to use a wider range of knowledge and available techniques, from outside of medicine, to continuously improve standards of safe and effective patient care. This is the first in a series of three articles introducing Quality Improvement (QI) methodology and supporting concepts to multidisciplinary teams working in Urology departments in the United Kingdom. We start, in this article, by providing an overview of key QI principles and their industrial roots; we position QI in the context of other approaches to improvement, such as audit, and we outline the key organisations and infrastructure supporting QI work on the ground.","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43680291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial","authors":"B. Somani","doi":"10.1177/20514158231159154","DOIUrl":"https://doi.org/10.1177/20514158231159154","url":null,"abstract":"","PeriodicalId":15471,"journal":{"name":"Journal of Clinical Urology","volume":"16 1","pages":"85 - 85"},"PeriodicalIF":0.3,"publicationDate":"2023-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49029887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}