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The spread of the aggressive disease caused by the novel respiratory syndrome coronavirus-2 (SARS-CoV-2) has had an impact not only on the health and psyche of people, but also on the state of health systems in different countries, by complicating the treatment and diagnostic process. These changes have affected patients with cancers to a greater extent. The diagnosis, treatment, and follow-up of patients are of particular scientific and practical interest when working in conditions of special anti-epidemic control. Objective. To assess the possibility of reducing the frequency of hospitalization of patients with non-muscle-invasive bladder carcinoma (NMIBC) during the Covid-19 period. Subjects and methods. Sixty-four patients with urinary tract malignancy, including 19 (29.7%) patients with low-and high-risk re-current NMIBC, were followed up in two clinics (Saint Petersburg, Russia) in March to October 2020. All the patients were oper-ated on;the patients at high risk for recurrence received a cycle of adjuvant BCG therapy. Methods for cytological examination of urine sediment and the biomarkers UBC and Cyfra 21-1 were used for special laboratory diagnosis;the server stations of both clinics were applied for telehealth consultations (TCs). Results. TCs were used to reduce hospitalization rates: after TCs, all the patients reported a reduction in transport costs and recovery time after hospitalization. TCs could protect the followed-up patients against COVID-19 infection, by observing the rules of clinical examination, and achieve maximum individualization of treatment. The authors refused to perform diagnostic operations for low-risk NMIBC and to use laboratory tests using urinary biomarkers. At the place of their residence, outpatients underwent urinalysis for several indicators, transmitting the result to the clinic's servers or through a monitoring system. Inpatient treatment was used only in cases of gross hematuria or after recording abnormal laboratory test results. Control cystoscopy detected no re-current tumor. Conclusion. During the spread of COVID-19, the periods of endoscopic examinations and control diagnostic operations can be post-poned, by replacing face-to-face consultations with TC monitoring. Outpatient laboratory and radiation examinations are indicat-ed in patients with new-onset gross hematuria or after combination treatment. Repeated operations, including diagnostic ones, should be performed in the case of multiple NMIBCs or after incomplete excision of the primary tumor.Copyright © 2021.
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Importance: Women with interstitial cystitis/bladder pain syndrome (ICBPS) face isolation and treatment challenges. Group medical visits using Centering models have successfully treated other conditions but have not been explored in ICBPS. Objective(s): This study aimed to describe ICBPS pain and symptom control comparing standard treatment alone versus standard treatment augmented with Centering visits. Study Design: This prospective cohort study recruited women with ICBPS receiving standard care (control) or standard care augmented with group Centering. We administered validated questionnaires at baseline and monthly for 12 months. The primary outcome was change in the pain numerical rating scale, with Patient-Reported Outcomes Measurement Information System Pain Interference Scale and Bladder Pain/Interstitial Cystitis Symptom Score change as secondary measures. Result(s): We enrolled 45 women (20 Centering, 25 controls). Centering had significantly better numerical rating scale pain scores at 1 month (mean difference [diff], -3.45) and 2 months (mean diff, -3.58), better Patient-Reported Outcomes Measurement Information System Pain Interference Scale scores at 1 month (mean diff, -10.62) and 2 months (mean diff, -9.63), and better Bladder Pain/Interstitial Cystitis Symptom Score scores at 2 months (mean diff, -13.19), and 3 months (mean diff, -12.3) compared with controls. In modeling, treatment group (Centering or control) and educational levels were both associated with all the outcomes of interest. Beyond 6 months, there were too few participants for meaningful analyses. Conclusion(s): Women with ICBPS participating in a Centering group have, in the short term, less pain, pain interference, and ICBPS-specific symptoms than patients with usual care alone. Larger studies with more follow-up are needed to determine if this treatment effect extends over time.Copyright © 2022 American Urogynecologic Society. All rights reserved.
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Background: Retrograde pyelograms (RPG's) are a key component of numerous endoscopic urological procedures. They provide a vital role in defining anatomy of the urological tract and assessing structural and functional obstruction of upper tracts. Method(s): Retrospective review of Medicare data published for item number 36818 cystoscopy and ureteric catheterisation guided by fluoroscopic imaging. We also considered item number for endoscopic insertion of ureteric stent (36821). Data collected over 10 year period from 2012 to 2021 inclusive. State population data collected from Australian Bureau of Statistics to calculate the rates per 100 000 people. Result(s): The nationwide median rate of RPG for the period 2012-2021 was 104.2 per 100 000 (interquartile range 100.6-112.9). The rate between states varied widely (Table 1). NSW and Tasmania consistently recorded higher than average RPG uptake across the study period. Queensland, WA, ACT and NT all reported lower than average RPG usage. All states reported a sharp downturn in numbers during 2021 presumably due to the coronavirus pandemic. For ureteric stent insertion, NSW and Tasmania were above average, while Queensland, WA, ACT and NT were consistently below average. Conclusion(s): Use of retrograde pyelogram is variable according to geography, the reasons for which are unclear. Practice patterns, patient demographics and financial considerations are all likely to be contributors. Future research is encouraged to assess the basis for this variation, but also considering use of other imaging (CT intravenous pyelography) and patient factors (e.g. renal disease).
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Introduction: Patients presenting with bladder lesions identified during cystoscopy require histological diagnosis, routinely obtained by biopsy under general anaesthetic (GA). GA biopsies are resource intensive as they require the use of an operating theatre and surgical staff. Local anaesthetic cystodiathermy (LAC) is an alternative method for obtaining biopsies, suitable for bladder lesions <5mm in size. LAC can be performed in the outpatient setting thus reducing the need for theatre resources. The aim of our audit was to assess the safety and feasibility LAC bladder biopsies for indeterminate bladder lesions. Method(s): LAC were carried out at our peripheral London outpatient clinic. The main inclusion criteria was the presence of sub 5mm indeterminate lesions identified during routine and surveillance flexible cystoscopy. Patients notes were reviewed for follow up 2 months after their procedure. Result(s): 10 patients underwent LAC between July and September 2021, with an age range of 36-83 years old and ASA grade between 1 and 3. 6 patients were invited following positive findings at routine surveillance cystoscopy, 3 following cystoscopy for new haematuria, and 1 was investigated for routine UTIs. Only one patient had a malignant histology, with 90% reporting a benign biopsy. No patient required admission or subsequent GA biopsy, and no complications were reported. Conclusion(s): LAC is a resource-effective procedure eliminates the exposure of patient to GA. It avoids the need for preassessment and inpatient admission, thus freeing up theatre resources for other patients. This project supports the use of LAC for small indeterminate bladder lesions.
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Introduction: Patients with congenital bleeding disorders (CBD) have an increased bleeding tendency, which varies according to the factor deficiency and severity. In most cases, prolonged bleeding is observed after trauma, surgery and/or invasive procedures. Haemostatic treatment is needed to prevent bleeding complications and allow a good clinical outcome. Our aim is to evaluate the management of patients with CBD in minor procedures. Method(s): Retrospective study of patients with CBD who performed minor procedures over a 7-year period, through review of clinical files. Result(s): Between January 2015 and December 2021, 249 minor procedures were performed in 113 patients with CBD: 42 had diagnosis of Haemophilia A (HA) (15 severe without inhibitors;3 severe with inhibitors;4 moderate and 20 mild);12 had Haemophilia B (HB) (7 severe without inhibitors;2 moderate and 3 mild);5 were carriers of HA and 2 of HB. 35 had von Willebrand disease (VWD);15 had rare bleeding disorders (8 FVII deficiency;6 FXI deficiency;1 FX deficiency) and 2 had diagnosis of inherited platelet glycoprotein deficiencies (1 Glanzmann thrombasthenia and 1 Bernard Soulier syndrome). Most procedures were dental treatments (189);synoviorthesis/ infiltration/mesotherapy (17);endoscopies and colonoscopies (15);skin lesions excision (8);COVID-19 vaccination (5);sebaceous cyst excision (4);cardiac catheterization (3);ureteral stent removal (3);bone marrow biopsy (2);cystoscopy (2) and breast fibroadenoma excision (1). Prophylactic treatment was performed in 237 (95%) of the procedures, respectively FVIII concentrate factor (59);FIX concentrate factor (27);DDAVP (66);von Willebrand factor/factor VIII concentrates (44);bypassing agents (24);platelet (6);inactivated human plasma (9);tranexamic acid (47) and epsilon-aminocaproic acid (161). No side effects were reported. Discussion/Conclusion: Most patients that underwent minor procedures had Haemophilia and VDW(83%). The most common procedure was dental treatment (76%). Patients with CBD require attention and special care in dental practice. The haemostatic prophylactic treatment varies according to the specific haemostatic defect, severity and type of procedure. The treatment performed has been demonstrated safe and effective, with low incidences of haemorrhagic and treatment-related complications. These patients' treatment requires multidisciplinary teams and reference centres.
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PURPOSE: Bladder cancer surveillance is associated with high costs and patient burden. CxMonitor (CxM), a home urine test, allows patients to skip their scheduled surveillance cystoscopy if CxM-negative indicating a low probability of cancer presence. We present outcomes from a prospective multi-institutional study of CxM to reduce surveillance frequency during the coronavirus pandemic. MATERIALS AND METHODS: Eligible patients due for cystoscopy from March-June 2020 were offered CxM and skipped their scheduled cystoscopy if CxM-negative. CxM-positive patients came for immediate cystoscopy. The primary outcome was safety of CxM-based management, assessed by frequency of skipped cystoscopies and detection of cancer at immediate or next cystoscopy. Patients were surveyed on satisfaction and costs. RESULTS: During the study period, 92 patients received CxM and did not differ in demographics nor history of smoking/radiation between sites. 9 of 24 (37.5%) CxM-positive patients had 1 T0, 2 Ta, 2 Tis, 2 T2, and 1 Upper tract urothelial carcinoma (UTUC) on immediate cystoscopy and subsequent evaluation. 66 CxM-negative patients skipped cystoscopy, and none had findings on follow-up cystoscopy requiring biopsy. Six of these patients did not attend follow-up, 4 elected to undergo additional CxM instead of cystoscopy, 2 stopped surveillance, and 2 died of unrelated causes. CxM-negative and positive patients did not differ in demographics, cancer history, initial tumor grade/stage, AUA risk group, or number of prior recurrences. Median satisfaction (5/5, IQR 4-5) and costs (26/33, 78.8% no out-of-pocket costs) were favorable. CONCLUSIONS: CxM safely reduces frequency of surveillance cystoscopy in real-world settings and appears acceptable to patients as an at-home test.
Subject(s)
Carcinoma, Transitional Cell , Urinary Bladder Neoplasms , Humans , Urinary Bladder Neoplasms/pathology , Cystoscopy , Carcinoma, Transitional Cell/pathology , Prospective Studies , Urinary Bladder/pathology , Neoplasm Recurrence, Local/pathologyABSTRACT
At Whipps Cross Hospital, multi-morbid (high-risk) patients undergoing urological surgery are routinely listed on the surgical inpatient pathway. The 'Getting it right first time' [1] review of anaesthesia recommended day-case surgery as the default for suitable procedures, to help with waiting lists as well as to provide patients with a safe environment. To improve patient choice and postoperative outcomes, an ambulatory spinal pathway was piloted. Methods An earlier scoping exercise identified a pool of urology high-risk patients who could potentially benefit from an ambulatory spinal pathway. Based on this, prilocaine use for ambulatory spinal anaesthetic was provisionally approved by the drugs and therapeutic committee. A pilot ambulatory pathway was put in place, which helped identify suitable patients. The pilot pathway was limited to a select group of anaesthetists to minimise variations. Postoperatively, patients were followed up at 3 and 24 h and assessed for postoperative nausea, vomiting, pain, mobilisation, neurological symptoms and cognitive impairment. Results The total number of patients was 19. Mean ASA was 2.9. Average age was 74 years. The mean dose of hyperbaric prilocaine 2% used was 2.9 ml, 21% of cases utilised additional intrathecal additives. Regarding intra-operative analgesia, only paracetamol was used in 15% of cases. There were no conversions to general anaesthetic. The most common procedure was a cystoscopy with or without biopsy (42%). With comorbidities, diabetes mellitus was the most common (58%), followed by cardiac disease (53%) and respiratory disease (42%). At 3 h, 100% of patients were eating and all sensation had returned, 0% had cognitive impairment, 47% were sitting out and 42% mobilising. Sixteen per cent had hypotension and 5% had pain at rest. At 24 h, 0% had cognitive impairment, 50% had required analgesia and 84% were mobilising. All patients reported they would have a spinal anaesthetic again in the future. Discussion With an ageing population, who have multiple comorbidities, there is huge benefit regarding providing the choice of a spinal anaesthetic rather than general anaesthetic, which allows patients to go home the same day. This will not only provide financial savings to the service provider but also help clear the backlog of surgeries due to the COVID-19 pandemic and enhance patient recovery.
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The spread of the aggressive disease caused by the novel respiratory syndrome coronavirus-2 (SARS-CoV-2) has had an impact not only on the health and psyche of people, but also on the state of health systems in different countries, by complicating the treatment and diagnostic process. These changes have affected patients with cancers to a greater extent. The diagnosis, treatment, and follow-up of patients are of particular scientific and practical interest when working in conditions of special anti-epidemic control. Objective. To assess the possibility of reducing the frequency of hospitalization of patients with non-muscle-invasive bladder carcinoma (NMIBC) during the Covid-19 period. Subjects and methods. Sixty-four patients with urinary tract malignancy, including 19 (29.7%) patients with low-and high-risk re-current NMIBC, were followed up in two clinics (Saint Petersburg, Russia) in March to October 2020. All the patients were oper-ated on;the patients at high risk for recurrence received a cycle of adjuvant BCG therapy. Methods for cytological examination of urine sediment and the biomarkers UBC and Cyfra 21-1 were used for special laboratory diagnosis;the server stations of both clinics were applied for telehealth consultations (TCs). Results. TCs were used to reduce hospitalization rates: after TCs, all the patients reported a reduction in transport costs and recovery time after hospitalization. TCs could protect the followed-up patients against COVID-19 infection, by observing the rules of clinical examination, and achieve maximum individualization of treatment. The authors refused to perform diagnostic operations for low-risk NMIBC and to use laboratory tests using urinary biomarkers. At the place of their residence, outpatients underwent urinalysis for several indicators, transmitting the result to the clinic's servers or through a monitoring system. Inpatient treatment was used only in cases of gross hematuria or after recording abnormal laboratory test results. Control cystoscopy detected no re-current tumor. Conclusion. During the spread of COVID-19, the periods of endoscopic examinations and control diagnostic operations can be post-poned, by replacing face-to-face consultations with TC monitoring. Outpatient laboratory and radiation examinations are indicat-ed in patients with new-onset gross hematuria or after combination treatment. Repeated operations, including diagnostic ones, should be performed in the case of multiple NMIBCs or after incomplete excision of the primary tumor. © 2021.
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Introduction: Renal papillary necrosis (RPN) is a multifactorial complication that occurs under the following conditions: Pyelonephritis, obstruction of the urogenital tract, non-steroidal anti-inflammatory drugs (NSAIDs) abuse, diabetes mellitus (DM2), and coronavirus disease 2019 (COVID-19). The present report presented a case of right ureteral obstruction due to RPN. Case Presentation: The patient was a 68-year-old woman referred to the hospital due to flank pain, fever, vomiting/nausea, frequency, and nocturia. She also had a history of DM2, hypertension, dialysis, COVID-19, and the use of NSAIDs and antihypertensive. The results of computed tomography (CT) scan suspected a clot, bladder fungus or RPN, and COVID-19. After performing the ultra-sound, mild hydroureteronephrosis and two echogenic foci were seen in the right kidney, suggesting a possible RPN. The patient was transferred to the urology service. After cystoscopy and urethroscopy, a severe stenosis was seen in the distal right ureter. As soon as inserting double J, lots of pus came out. The definitive diagnosis was RPN, ureteral obstruction, and pyelonephritis. Conclusion(s): It is important to pay enough attention to the disorders related to the urinary system, especially in the elderly with a history of NSAIDs abuse, DM2, hypertension, COVID-19, and renal diseases. Additionally, the underlying diseases, blood glucose, infection, dehydration, and use of NSAIDs must be well-controlled to protect nephro-ureteral structures. Copyright © 2022, Author(s).
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Introduction: IgA nephropathy (IgAN) is an immune complex glomerulonephritis (GN) characterized by glomerular deposition of IgA-dominant immune complexes, often accompanied by mesangial hypercellularity. Antineutrophil cytoplasmic antibodies (ANCAs) cause small-vessel vasculitis and pauci-immune crescentic GN. The coexistence of ANCAs and IgAN is quite rare. ANCAs have been associated with inflammatory bowel disease (IBD) but are more prevalent in ulcerative colitis (~75%) than Crohn's disease (~17%). IBD-associated ANCAs are usually p-ANCA or atypical ANCA rather than c-ANCA. ANCA-associated vasculitis (AAV) can be associated with tumor necrosis factor-alpha inhibitors such as infliximab. We report a rare case of c-ANCA PR3-positive IgAN in a patient with IBD treated with infliximab who presented with proteinuria. Case Description: A 27-year-old female with history of Crohn's disease since 2010 treated with infliximab, allergic rhinoconjunctivitis, mild asthma, erythema nodosum in June 2021 (resolved with prednisone), Charcot-Marie-Tooth disease, psoriasis, and COVID-19 disease in Oct 2021, was found to have positive c-ANCA (1:160) and PR3 (5.0 AI, reference <1.0) in Dec 2021, raising question of vasculitis. Her rhinosinusitis was well controlled with allergy medications without oral steroids. She was referred to Nephrology for proteinuria with urinalysis (UA) in April 2022 showing 2+ protein, 3+ blood, 2-10 WBC, 20-50 RBC. Urine protein/creatinine ratio was 1.9. She had foamy urine but no gross hematuria. She previously had UA with packed RBC in June 2021. Urogram showed non-specific bladder wall thickening. Cystourethroscopy was negative. In April 2022, her BP was 97/66 and she had no edema. A renal biopsy in May 2022 revealed IgAN (M0 E1 S1 T0 C0). She was started on lisinopril and fish oil. Discussion(s): This is a very rare case of c-ANCA PR3-positive IgAN in IBD treated with infliximab. The patient's history of sinusitis along with c-ANCA PR3 antibody positivity suggested possibly an AAV associated with infliximab, which has been reported rarely in IBD. Her proteinuria of 1.9 g/day raised concern for GN due to pauci-immune AAV. However, renal biopsy showed IgAN rather than AAV. This case highlights the importance of renal biopsy in establishing a definitive diagnosis of glomerular disorders in patients with ANCA positivity, as serum ANCAs do not necessarily represent pauciimmune GN.
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Introduction: While the development, delivery, and implementation of the mRNA vaccines have been spectacular, consideration for potential rare side effects on organ systems was not clear. Although emergency use authorization trials of these vaccines in the USA did not demonstrate major safety concerns, unique side effects after massscale vaccination are now being reported more frequently. Here, we describe a case of new-onset crescentic & sclerosing GN with linear basement membrane staining for IgG, kappa, and lambda by Immunofluorescence in a 30-yo healthy female three days after receiving her Tozinameran (Pfizer-BioNTech) booster vaccine. Case Description: 30 y/o Caucasian female with no PMH presented with a CC of gross hematuria 3 days after receiving her booster of Tozinameran. Retrospectively reported symptoms of pedal edema, generalized athralgia, tinnitus, and paresthesia of lower limbs. UA revealed dysmorphic RBCs and proteinuria. CT urethrogram, & cystoscopy revealed left hydronephrosis, no nephrolithiasis or urothelial lesions. Kidney biopsy revealed crescentic & sclerosis GN, with linear GBM staining for IgG, Kappa, & Lambda on IF. Several glomeruli showed segmental scars & fibrous crescents in addition to focal cellular crescents of varying ages raising the possibility of concurrent ANCA vasculitis. Her GBM antibody was 25. Additional workup of ANCA, PLA2R, PR3, ana, c3/c4 levels, dsDNA, and hepatitis studies returned negative. On admission, BP was 175/103, and HR 104. Labs were notable for hemoglobin 13.3, WBC 16.6k, & BUN/creatinine 16/1.5. The PE was unremarkable. She received pulse IV steroid therapy, cyclophosphamide, Lupron, and daily plasma exchange (PLEX) for 5 days until her GBM antibody cleared. She responded well to treatment. Her renal function improved, and she was discharged without requiring dialysis. Discussion(s): Our case demonstrates a possible correlation & causation scenario after receiving a Tozinameran booster shot activating anti-GBM disease with concurrent ANCA-negative vasculitis demonstrated by kidney biopsy. Although the mechanism of de novo anti-GBM disease & ANCA-negative vasculitis post-SARS-CoV-2 vaccine remains to be explained, pharmacovigilance is vital in our efforts to ascertain answers.
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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.
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Introduction &Objective: Acute renal colic due to obstructing stones has been a challenge for urologists to manage during the COVID-19 pandemic. Due to overwhelmed hospital resources, operating room (OR) time and staff became scarce, resulting in prolonged pain and suffering for patients. Early during the pandemic, we instituted an office-based ureteral stent placement protocol to relieve immediate discomfort. Later with less constrained OR availability, we extended this protocol to patients undergoing chronic stent changes. Method(s): Patients who presented with severe renal colic due to obstructing stones were offered immediate office-based ureteral stent placement under minimal sedation. Patients filled a prescription of diazepam 10mg and were brought to the procedure suite 2 hours later. Intramuscular ketorolac 15mg was given and 2% lidocaine lubricant jelly was inserted per urethra. Flexible cystoscopy was performed with a standard 16Fr scope, and the stent was placed through the cystoscope. For the first two cases, a 0.038" hybrid wire and 4.8fr stent were used while subsequently, a 0.035" stiff hydrophilic nitinol wire and 4.5fr stent were used. No intraoperative fluoroscopy was used. After stent placement, KUB X-Ray was done to confirm stent placement. Result(s): Seven patients (4 females, 3 males) with a mean age of 62.5 years and a mean BMI of 31.3 underwent an office-based procedure. Five stent insertions were done for obstructing ureteral stone (unilateral = 4, Bilateral = 1) and 2 stent changes for ureteral stricture and ureteral obstruction due to fibroids. In most cases, it was clear when the wire had gone past the stone, as there was immediate efflux of urine into the bladder. The efficiency of the procedure was greatly increased by changing the wire and stent size. Stent placement failed in one case due to overfilling of the bladder causing acute angulation of the ureteral orifice. The stent was later inserted under general anesthesia. Conclusion(s): Office-based ureteral stent insertion and exchange are safe and effective even in the absence of fluoroscopy. Further studies are needed to investigate predictors of success of office-based stent insertion, along with cost analysis to expand its use routinely.
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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.
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Purpose: Cystoscopy procedures can cause distress among patients. Patient perspectives on health services are essential inputs in decision-making. This study investigated the patient preferences in Spain regarding single-use cystoscopes (SUC) compared to reusable cystoscopes and their willingness to pay (WTP) for cystoscopy procedures. Patients and Methods: Between May and June 2021, an anonymous survey was distributed to Spanish patients who had previously undergone a cystoscopy. The survey included patient preference measures on reusable cystoscopes compared to SUCs and a discrete choice experiment. The survey was distributed through a human data science company (IQVIA), collected using an online survey tool (QuestionPro®), and analyzed using Stata/MP, StataCorp. Results: Of 300 respondents, 148 (49.33%) were female and 150 (50%) were male, and mainly between 18-49 years (247, 82.33%). Most (265, 88%) preferred to have their procedure performed with a SUC rather than a reusable cystoscope. Among these patients, 215 (80%) could imagine asking their doctor to use a SUC. A total of 231 (77%) respondents indicated an increased level of concern about the risk of exposure to contamination related to their cystoscopy following the COVID-19 pandemic. Patients would pay 62 EUR to have their initial consultation and cystoscopy procedure on the same day (p < 0.001), 59 EUR to reduce the environmental impact, and 57 EUR to reduce the risk of contamination (p < 0.001). Conclusion: Patients prefer to undergo cystoscopy using an SUC on the same day as their initial consultation. The increased contamination concerns due to the COVID-19 pandemic and WTP to reduce the risk of cystoscope contamination may explain patients' preferences for SUCs. The most important attributes related to their cystoscopy procedure are the ability to have their procedure performed on the same day as their initial consultation, the reduction of the environmental impact, and the reduction of the contamination risk.
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Introduction: The COVID-19 pandemic has had a considerable and evolving impact on delivery of surgical care to patients. During the early stages of the pandemic, resource scarcity was experienced by many healthcare systems. This led to the implementation of a surgical moratorium on elective surgeries in New York State between the months of March through June 2020. Certain specialties, specifically those performing elective surgeries, experienced significant strain and transformation. Objective: This study aims to describe perioperative and intraoperative characteristics of patients undergoing hysterectomy for pelvic organ prolapse (POP) with and without concomitant urogynecology procedures between 2019-2021 at a multi-hospital healthcare system that experienced significantly strain and a subsequent moratorium on elective surgery during the first peak of the pandemic. Methods: This is a retrospective cohort analysis of all patients in a multi-hospital healthcare system in New York City who underwent hysterectomy for POP from August 19th, 2019 through August 11th, 2021. Cases were identified using procedural and diagnostic codes for hysterectomy and POP, respectively. Patients were separated into three cohorts based on dates corresponding to phases of the COVID-19 pandemic. The 'early peak' was defined from March through June 2020, coinciding with the New York State moratorium. The primary outcome was the stage of POP for patients undergoing surgery. Secondary outcomes included concomitant urogynecologic procedures, route of surgery, time from indication to procedure, length of inpatient stay, and utilization of pre-operative medical assessment/clearance (POMA). Results: A total of 253 cases were included: 106 (41.90%), 15 (5.93%), and 132 (52.17%) patients in the 'pre-pandemic','early peak pandemic', and 'stable pandemic' groups, respectively. Although not statistically significant, vaginal hysterectomy approach was performed less frequently during the 'early peak pandemic' and 'stable pandemic' cohorts (P = 0.0544). The 'early peak pandemic' cohort had significantly more stage IV POP compared to other cohorts (P = 0.0021). Rates of concomitant urogynecology procedures including slings, anterior or posterior repair, or apical repair did not differ between the cohorts. Further, cystoscopy was utilized intraoperatively more frequently in the 'stable pandemic' cohort (P = 0.0272). Time from surgical indication to operation was also significantly different with patients most frequently waiting at least 3 months in the 'early peak pandemic' group (P = 0.0132). Length of inpatient stay did not demonstrate a significant difference (P = 0.3982). The most frequent postoperative complication was transient voiding dysfunction, and this was observed more commonly in the 'stable pandemic' cohort (P = 0.0236), though overall no cases were complicated by persistent voiding dysfunction or urinary retention requiring surgical intervention in any group. Conclusions: In late spring 2020, when the moratorium was lifted, surgical volume returned to pre-peak numbers. However, time from booking to day of surgery remained significantly longer during and after the 'peak'. There was a statistically significant increase in patients with stage IV POP during the 'early peak' and 'stable' pandemic periods. There was a statistically significant increase in use of precautionary measures peri and intra-operatively during the 'peak' and 'stable pandemic' periods with significant increases in use of POMA performed outpatient by anesthesia and an increased utilization of intraoperative cystoscopy.
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INTRODUCTION: In response to the COVID-19 pandemic, multiple lockdown measures were enforced scattered across March 2020 to November 2021. A part of this included restrictions to elective surgical procedures in order to mitigate the spread of the virus. An unintended consequence of these lockdowns is a potential decrease in treatment of bladder cancer and diagnosis. We aim to explore the effects of COVID-19 on the number of cystoscopies and bladder biopsies performed in Australia secondary to these restrictions. We hypothesise that the number of biopsies and cystoscopies would be lower earlier into the pandemic, however would increase as the country adjusted to operating within pandemic restrictions. METHODS: The number of cystoscopies and bladder biopsies occurring in Australia were collected from publicly listed sources from Medicare Item Reports. RESULTS: The average number of bladder biopsies per month performed Australia wide between December 2018 to November 2019 was 215, which decreased to 213 in 2020, increasing to 230.5. Compared to 2019, there was a 7.2% increase and compared to 2020, an 8.2% increase compared to 2021. The number of overall bladder biopsies in 2021 2766, an increase from 2020 and 2019 which were 2556 and 2580 respectively. Bladder biopsies in Victoria increased by 7.8 and 11.8% from 2020 and 2019 respectively, however had a notable decrease in August to November 2021 coinciding with a lockdown. The average number of cystoscopies had a marked increase in 2021 with a total of 88,090 compared to 2020 (79,892) and 2019 (84,023) representing a 10.3% and 4.8% increase from 2020 and 2019 respectively. CONCLUSION: The data presented supports the evidence that Australia had learnt to adapt in the presence of COVID lockdowns and the marked increase in biopsies and cystoscopies compared to pre-pandemic times suggest an appropriate compensation for decrease in procedures in 2020 due to pandemic restrictions.
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Introduction & Objectives: Double J ureteric stents are commonly used in acute and elective urology practice. Ureteric stents with external strings offer an alternative solution to extraction compared to the standard of requiring cystoscopy and stent removal at an additional cost. Our aim was to review the usage of double J stents on extraction strings in our institution and whether this was increasing over time and the potential cost savings. Methods: All ureteric stent insertions in Auckland Hospital between 2015 and 2019 (5 years) were reviewed from the hospital stent register. Results: A total of 4016 ureteric stents were inserted over 5 years. Of the total number of stents inserted 33.2% were stents on strings, with a significant increase in the trend towards stent on strings per year (Cochran-Armitage test p<0.0001). Procedures for stone disease were the most common indication for stent insertion making up 66% of all cases. 45% of stents inserted in management of stone disease were stents on strings. The number of stents on strings and total number of stents inserted for ureteric calculi increased each year. If a Covid test cost and subsequent flexible cystoscopy removal of ureteric stent was applied to stent on strings in our study period, a cost saving of $1.15 million would be seen, and is an important consideration for future practice worldwide. Conclusions: The use of stents on strings appears to be higher in our centre than previously reported in the literature. This is likely to be associated with reduced patient discomfort from stent removal and significantly reduced stent removal costs with implications for future planning and resource distribution in our centre. Potential risks associated with stents on strings - in particular stent dislodgement - need to be considered, and consideration given to case selection and patient counselling.
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There was no statistical difference in rates of adverse pathology or metastatic disease between ISUP 2 and ISUP 1 patients on active surveillance. B Results: b 81 patients were enrolled in the study - 42 patients undertook self-removal;22 patients underwent removal by a nurse;and 17 via a flexible cystoscopy. Presentation Type: Keith Kirkland Presentation Theme: Endourology/Stones Ureteric Stent Removal - should it be left in the patient's hands following stone surgery dur... CAMERON PARKIN SP 1 sp , JAMES KOVACIC SP 3 sp , CECILE PHAM SP 2 sp , MARK LOUIE-JOHNSUN SP 3 sp , KRIS RASIAH SP 1,2 sp , VENU CHALASANI SP 1,2 sp , AMANDA CHUNG SP 1,2 sp SP I 1 i sp I Royal North Shore Hospital, St. Leonards, Australia;i SP I 2 i sp I Northern Beaches Hospital, Frenchs Forrest, Australia;i SP I 3 i sp I Central Coast Local Health District, Gosford, Australia i B Introduction & Objectives: b Since the COVID-19 pandemic, there has been an attempt to rationalise and minimise patient presentations to hospital and surgical clinics. One way to minimise patient's presentations to healthcare settings during this time could be to advocate patient self-removal of ureteric stents via string extraction. [Extracted from the article] Copyright of BJU International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has impacted various clinical and research processes in urologic care. As part of a pragmatic clinical trial in bladder cancer, we collected information regarding the impact of COVID-19 at participating sites, which provides insight into how the pandemic has imposed constraints on clinical bladder cancer care and research. METHODS: Starting in May 2020, we distributed a monthly survey to sites participating in CISTO (Comparison of Intravesical Therapy and Surgery as Treatment Options for Bladder Cancer, NCT0393382). The survey included questions about interruptions in routine clinical bladder cancer care, specifically assessing elective surgery restrictions, impact on radical cystectomy, TURBT, office cystoscopies, intravesical therapy, and intravesical bacillus Calmette- Guerin (BCG) supply. We report survey responses for sites that responded to > 50% of the monthly surveys from May 2020 to October 2021. RESULTS: From May 2020 through October 2021, 21 sites (66%) had > 50% monthly response rate. The time periods of greatest limitations on bladder cancer procedures (Figure 1) were May-July 2020, Dec-Jan 2020/2021, and Sept-Oct 2021, corresponding to the peak waves of COVID-19 infections. Elective surgery was most affected, with limitations or holds in those time periods at up to 76%, 38%, and 28% of CISTO sites, respectively. Most of the restrictions involved surgeries that required inpatient stays, potential intensive care unit admission, and staffing shortages. 9 sites (28%) experienced transient BCG shortages during the survey period. CONCLUSIONS: Clinical activity was most limited during the initial COVID-19 surge in Spring/Summer 2020. Despite higher COVID- 19 infection rates in subsequent waves, bladder cancer clinical activity has been maintained at CISTO sites throughout the COVID pandemic. Periodic BCG shortages continue to affect bladder cancer care across the US. (Figure Presented).