Urologists' usage and perceptions of urological apps.

We conducted a survey of urologists to document their patterns of app usage and perceptions of app quality, and to assess their interest in future app usage. The survey was sent to all urologists on the mailing list of the British Association of Urological Surgeons (BAUS) (n=1613). A total of 115 responses were received (a response rate of 7%). Most respondents (89%) owned mobile devices capable of downloading apps. Most respondents (79%) used apps and about half (49%) used urological apps; the latter accessed a mean of 2.4 urological apps per month. Significantly more younger (defined as <45 years old) than older urologists used urological apps (P<0.001). Respondents' perception of the overall quality of apps produced for both urologists and patients was relatively low. The respondents' interest in future app usage was strong. There was greatest interest in apps such as logbooks or revalidation ones (87%), reference apps (86%) and ones which aided decision-making (85%). There was considerable support for the implementation of measures to provide urological app quality assurance; most respondents believed app peer review (78%) and validation (78%) would be beneficial and 48% supported regulatory oversight. There appears to be a need for high quality urological apps and opportunities therefore exist for national urological associations and academic units to lead developments.

Evidence-based drainage of infected hydronephrosis secondary to ureteric calculi.

INTRODUCTION: The obstructed, infected kidney is a urological emergency. It has been accepted that the management of infected hydronephrosis secondary to ureteric stones is through prompt decompression of the collecting system. However, the optimal method of decompression has yet to be established. MATERIALS AND METHODS: A PubMed and Medline search was performed of all English-language articles from 1960 using key words "sepsis," "urosepsis," "obstruction," "obstructive pyelonephritis," "pyonephrosis," "infection and hydronephrosis" "decompression," "stent," "nephrostomy," and "management." The Cochrane database and National Institute for Clinical Effectiveness guidelines were searched using the terms "sepsis," "urosepsis," "stent," "nephrostomy," or "obstruction." Scottish intercollegiate guidelines were reviewed and no relevant guidance was identified. RESULTS: Two randomised trials have compared retrograde stent insertion with percutaneous nephrostomy with one trial reporting specifically on patients with acute sepsis and obstruction. Neither trial showed one superior modality of decompression in effecting decompression and resolution of sepsis. A further literature search regarding the complications of percutaneous nephrostomy and stent insertion was carried out. An overall major complication rate from percutaneous nephrostomy insertion was found to be 4%, although the complication rates from stent insertion are less consistently reported. DISCUSSION: There appears little evidence to suggest that retrograde stent insertion leads to increased bacteraemia or is significantly more hazardous in the setting of acute obstruction. Further region-wide discussion between urologists and interventional radiologists is required to establish management protocols for these acutely unwell patients.

Sequential hydrodistension and intravesical instillation of hyaluronic acid under general anaesthesia for treatment of refractory interstitial cystitis: a pilot study.

Pilot study looking at the combination of general anaesthetic hydrodistension and intravesical hyaluronic acid for treatment of refractory interstitial cystitis. Twenty-three treatment refractory patients were recruited with an average age 53.4 years. All underwent general anaesthetic cystoscopy, hydrodistension and instillation of hyaluronic acid (40 mg/50 ml). The bladder was then subsequently drained with the patient awake. Two initial treatments were carried out a month apart and duration between treatments increased depending upon symptom response. In the responders, the average number of treatments was 6.6 (median 4.5), duration between treatments was 3.1 months (median 2.6) and follow-up 15.8 months (median 16). Seventeen patients (74%) responded with immediate improvement in symptoms. In all responders, healing of ulceration and resolution of inflammation occurred. Average anaesthetic bladder capacity increased in the responder group from an average of 492 ml (median 500 ml) to an average of 776 ml (median 700 ml). Our pilot data suggests sequential hydrodistension and hyaluronic acid treatment under general anaesthesia may be considered for resistant cases of interstitial cystitis, especially those that cannot tolerate the instillation procedure under local anaesthesia. Further prospective trials are required.

The development and audit of a nurse-led urology/oncology clinic.

People with cancer in the UK should have access to a full spectrum of services. The role of the clinical nurse specialist is an important part of this development. In the specialty of urology/oncology, this role is still a relatively new development although the incidence of urological malignancy readily compares with other site-specific cancers.