Single-Use Disposable Flexible Cystoscopes: Implementation in a Mobile Bedside Portable Cystoscopy Service

Introduction &Objective: Single-use disposable cystoscopes have recently been introduced, with portable smaller screens and good quality images. Within our institution, emergency cystoscopy was mainly done in the emergency operating theatre with reusable cystoscopes. We report our experience in developing a mobile bedside portable cystoscopy service with use of single-use disposable cystoscopes. Method(s): With the increase in COVID-19 admissions and unwell patients in isolation, to decrease patient transfers, exposure risks, reduce inpatient admissions and bed occupancy, we introduced the single use portable bedside cystoscopy service in our department. The Ambu aScopeTM 4 Cysto single-use disposable flexible cystoscope paired with a small portable viewing screen was used. From 24th September 2021 to 22nd Feb 2022, we deployed 17 cystoscopes, with 16 in the emergency setting. With the scope, we had a portable accessory kit, with an inventory of adjunct equipment including guidewires and urethral dilators. We also developed a standardised workflow to activate the service. We retrospectively review our series. Result(s): A total of 17 cystoscopes were deployed in this 5-month period. Location wise, 7 (41%) were in the emergency department, 3 (18%) in COVID-19 isolation ward and intensive care unit, 1 (6%) in high dependency, 5 (29%) in general ward, and 1 (6%) in the angiography suite. 6 patients (35%) had challenges for transfer out of the ward due to infectious isolation or clinical status. Indications included difficult urethral catheter insertion (n = 14, 82%), urethral evaluation in trauma (n = 1, 6%), urethral catheter malfunction (n = 1, 6%) and ureteric catheterisation before renal tumour ablation (n = 1, 6%). Adjunctive procedures performed with cystoscopy included: indwelling urethral catheter insertion (n = 10, 59%), urethral dilatation with indwelling catheter insertion (n = 5, 29%), suprapubic catheter insertion (n = 1, 6%) and ureteric catheterisation (n = 1, 6%). No immediate complications were noted. 3 emergency department patients were discharged from the emergency department directly after cystoscopy, saving an inpatient bed and inpatient stay costs. Conclusion(s): The advent of single-use disposable flexible cystoscopes and its utilisation in a portable cystoscopy service has allowed us to bring cystoscopy in a compact mobile manner to the bedside of patients including those who emergently need cystoscopy, reducing need for patient transfer, inpatient stay, operating theatre usage and operating theatre nurse manpower, avoiding arrangements for emergency operating theatre.

Transiting Ureteric Stent Change under General Anaesthesia in Major Operation Theatre to a Procedure under Local Anaesthesia in Ambulatory Endoscopy Suite

Introduction &Objective: Patients with long term ureteric stents for urinary diversion need regular changes, done at intervals appropriate for their condition, type of stent and adjusted to stent encrustation risks. This is usually done under General Anaesthesia in the operating room. We present our series of patients on ureteric stents with change of stents done under local anaesthesia in the endoscopy suite as an outpatient day procedure. Method(s): Since July 2021, we started a stent change service for our patients on long term ureteric stents done solely by Urologists in the outpatient day procedure setting under Local anaesthesia. This is done in the outpatient endoscopy suite away from the operating theatre, with flexible cystoscopy aided by fluoroscopy. We review our series of ureteric stent changes including indications and technical success rate of stent change. Result(s): 56 patients underwent stent change under local anaesthetic from 7th July 2021 to 16th Feb 2022, with mean age of 75 years old (range 55 to 97). 24(42%) were male and 32(57%) female. 9 patients had bilateral stents changed (16%), with the rest unilateral. Etiology wise, 34 (61%) had strictures, 13 (23%) had stones, and 9 (16%) had extraluminal compression. Mean duration from the last stent change was 4.6 months (SD = 1.38) based on clinical condition and stent type. 54 (96%) of patients had successful stent changes. The two patients with unsuccessful stent changes had failed retrograde wire access, one with tight extraluminal compression and the other with severe stent encrustation. Advantages of the new service for the patients include avoiding risks of sedation or general anaesthesia, and procedure performed as day surgery with decreased duration of hospital stay, particularly in this time of COVID-19 pandemic. From a resource point of view, this has freed up operating theatre space and anaesthetist manpower to focus on Urological procedures needing general anaesthesia, decreasing waiting time for higher acuity cases. Conclusion(s): Moving flexible cystoscopy guided ureteric stent change from major operation theatre under general anaesthesia to an ambulatory endoscopy center setting under local anaesthesia is a feasible and safe option for patients with long-term ureteric stents. It avoids risk of general anaesthesia, is potentially cost saving and conserves hospital resources.

Combating the coronavirus disease 2019 pandemic in the HONG KONG hospital authority paediatric infectious disease centre

Since the coronavirus disease 2019 (COVID-19) outbreak in late December 2019, and escalation of the public hospital infectious disease outbreak response level to the highest "emergency" level three days after two COVID-19 cases were diagnosed on 22 January 2020, all public hospitals implemented a series of isolation policies, rescheduled clinical services and mobilised resources to support frontline clinical staff. This article reviewed these multi-level policies adopted in the Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, which have ensured that the healthcare system was not overwhelmed and frontline staff was not over-stressed and infected.

Novel Bat Alphacoronaviruses in Southern China Support Chinese Horseshoe Bats as an Important Reservoir for Potential Novel Coronaviruses

While bats are increasingly recognized as a source of coronavirus epidemics, the diversity and emergence potential of bat coronaviruses remains to be fully understood. Among 1779 bat samples collected in China, diverse coronaviruses were detected in 32 samples from five different bat species by RT-PCR. Two novel alphacoronaviruses, Rhinolophus sinicus bat coronavirus HKU32 (Rs-BatCoV HKU32) and Tylonycteris robustula bat coronavirus HKU33 (Tr-BatCoV HKU33), were discovered from Chinese horseshoe bats in Hong Kong and greater bamboo bats in Guizhou Province, respectively. Genome analyses showed that Rs-BatCoV HKU32 is closely related to BatCoV HKU10 and related viruses from diverse bat families, whereas Tr-BatCoV HKU33 is closely related to BtNv-AlphaCoV and similar viruses exclusively from bats of Vespertilionidae family. The close relatedness of Rs-BatCoV HKU32 to BatCoV HKU10 which was also detected in Pomona roundleaf bats from the same country park suggests that these viruses may have the tendency of infecting genetically distant bat populations of close geographical proximity with subsequent genetic divergence. Moreover, the presence of SARSr-CoV ORF7a-like protein in Rs-BatCoV HKU32 suggests a common evolutionary origin of this accessory protein with SARS-CoV, also from Chinese horseshoe bats, an apparent reservoir for coronavirus epidemics. The emergence potential of Rs-BatCoV HKU32 should be explored.