Journal of Clinical Urology

To describe the short and long-term complications of over 1000 cases of Holmium laser enucleation of the prostate (HoLEP) in a single centre.

A prospective database of all HoLEP procedures performed between December 2003 and March 2017 was analysed.

A total of 1016 HoLEP procedures were performed. Median patient age was 72 years (range 41–95). There was a significant improvement in urinary flow, post-void residual volume, IPSS and QoL score (p < 0.0001). Pre-operative acute urinary retention was present in 403 patients (39.7%). Post-operatively five patients (1.2%) continued with a long-term catheter. Early and late complications consisted of failed initial voiding trial (10.6%), stress incontinence (transient 6.5%; persistent 0.3%), frequency/dysuria (5.6%), urinary tract infection (5.3%), urethral stricture (4.8%), submeatal stenosis (1.9%), return to theatre (1.5%), bladder neck stenosis (1.3%), bleeding (1.2%), epididymitis (0.7%), confusion (0.3%), transurethral resection of the prostate conversion (0.2%), ureteric obstruction (0.2%), vomiting (0.2%), anuric renal failure (0.1%), chest infection (0.1%), chest pain (0.1%), myocardial infarction (0.1%), rectoprostatic fistula (0.1%), supraventricular tachycardia (0.1%) and urinary sepsis (0.1%). Five-year reoperation rate was 3.7%.

HoLEP is a safe treatment for bladder outflow obstruction secondary to an enlarged prostate. It is associated with few early and late complications and has a low reoperation rate.

4

This case series aimed to demonstrate that flexible cystoscopy and laser stone fragmentation via a Mitrofanoff stoma is possible and an effective treatment for symptomatic bladder stones in complex patients with inaccessible urethras and challenging anatomy.

We present three cases which were managed in a tertiary centre. The procedure involved using a flexible cystoscope via the Mitrofanoff stoma and laser stone fragmentation without the need for an access sheath.

This technique was performed safely and demonstrated successful bladder stone clearance on follow-up, with no postoperative complications.

Our case series illustrates a technique that can be performed in this select group of patients in specialist centres with the relevant surgical exposure and expertise.

Level 4.

This study aimed to describe a UK institution’s experience with local anaesthetic (LA) transperineal (TP) prostate biopsies (PB), and to report 30-day complications following LATPPB, including a large cohort that did not receive antibiotic prophylaxis.

A prospective database of 313 consecutive patients undergoing LATPPB was maintained, describing patient and disease characteristics, and complications. From September 2019 to January 2020, antibiotic prophylaxis was given before LATPPB (n=149). Following a change to routine care, from January 2020 to July 2020, prophylactic antibiotics were not given before LATPPB (n=164). A comparative analysis was performed to determine complication rates following antibiotic prophylaxis discontinuation using electronic hospital and primary care records.

Patient and disease characteristics were comparable in antibiotic and non-antibiotic cohorts, and representative of PB and prostate cancer cohorts described in the urological literature. The infection-related complication rate was 0.32% across all patients, and 0% for those not receiving antibiotic prophylaxis. The overall complication rate was 0.64%, and 0.61% for those not receiving antibiotic prophylaxis. There were no severe (Clavien–Dindo 3–5) complications. The unplanned hospital admission rate was 0.64%.

The complication rate after LATPPB was low, with no infection-related complications in patients who did not receive antibiotic prophylaxis. This provides further evidence supporting the discontinuation of routine prophylactic antibiotics before TPPB.

Level of evidence: Level 2b.

The objective was to unveil the relationship between different relevant patient and kidney stone characteristics and the stone-free status post extracorporeal shockwave lithotripsy (ESWL) treatment.

Kidney stones cases referred for ESWL from October 2019 to January 2020 were collected. A total of 225 adult patients who met the criteria of being new cases of single radio-opaque kidney stones measuring 5 to 20 mm were included. We were looking for disintegrated stones down to 4 mm or less as a marker for stone-free (SF) status. The studied parameters were gender, laterality (right or left kidney), location of the stone within the kidney, stone’s density measured in Hounsfield units (HU), stone’s size, and stone-to-skin distance (SSD).

Out of the 225 cases treated, only 175 (77.8%) became SF after or during the study timeframe. SF status was achieved after the first session in 131 cases (58.2%). The bivariate analysis of the factors associated with higher SF rates found to be statistically significant were left kidney (p-value of < 0.01), low stone density (p-value of < 0.01), short stone–skin distance (p-value of < 0.01), and small stone size (p-value of < 0.01). On the other hand, gender and stone location within the kidney showed no association with ESWL outcomes.

Kidney laterality, SSD, stone density, and size are influencing parameters on ESWL outcomes and achievement of stone-free status.

Compared with two-dimensional (2D) laparoscope systems, conventional three-dimensional (3D) systems provide a superior understanding of depth. However, they are operator limited due to difficulties with resolution and illumination. A novel third-generation (3G) 3D system may resolve these problems. We prospectively compared the operative performance and perioperative safety results of 2D and 3G 3D systems in laparoscopic radical nephrectomy (LRN).

A single experienced surgeon performed 3G 3D LRN for 19 patients and 2D LRN for 16 patients. After the insertion of the access ports, the execution times of each step in the surgical procedure in the two groups were measured and compared, along with the perioperative complications.

Patients in the 3D group were associated with fewer complications than those in the 2D group. In particular, no peritoneal injury was observed in the 3D group (0% vs. 25%, p=0.04). Logistic regression analysis showed no significant differences between the times of each surgical step and the amount of bleeding.

The 3G 3D laparoscope system provided a detailed anatomical view for the operator during LRN and may reduce laparoscopic complications.

Level of evidence: III.

Synchronous renal cell carcinoma (RCC) and pancreatic tumors are rare clinical events and have been described scarcely in the literature. Our institution has recently encountered one case. This review aims to summarize and present the diagnostic and therapeutic approaches that have been presented in the literature for these synchronous solid malignancies.

After reviewing the literature using PubMed, 16 papers were collected that showed a total of 21 patients with a synchronous solid renal and pancreatic mass. The diagnostic and treatment data were then evaluated and analyzed.

Overall, 13 patients (59%) had two independent primary malignancies consisting of RCC and a pancreatic tumor, seven (31%) were diagnosed with primary RCC with synchronous metastasis to pancreas, one (5%) was found to have a primary pancreatic adenocarcinoma with synchronous metastasis to the kidney, and one (5%) was diagnosed with primary RCC with a benign solid pancreatic lesion. Of the 22 patients that were treated, 18 (81%) underwent surgery, one (5%) had no treatment, and three (14%) underwent chemotherapy without surgery. In the cohort of patients with surgical treatment 12 (66%) had no adjuvant therapy, one (6%) had adjuvant chemotherapy, four (22%) had adjuvant immunotherapy, and one (6%) had adjuvant radiation treatment.

The occurrence of synchronous malignancies of the kidney and pancreas is rare. No clear guidelines have evolved in the literature in regard to diagnostics and treatment of these patients. This review presents recommended diagnostic and treatment guidelines for these rare clinical cases.

Not applicable for this multicenter review.

We aimed to develop and compare the utility of an automated registry of all patients undergoing surveillance for non-muscle invasive bladder cancer (NMIBC) during the severe acute respiratory virus coronavirus 2 (SARS-CoV-2) pandemic.

We populated an electronic register of all patients undergoing bladder tumour surveillance (July–September 2019). The computerised ‘traffic-light’ system was implemented in September 2019 marking the beginning of phase 2. The register was audited at two- and six-months intervals during phase 2 (November 2019 and April 2020). Audit of the system In April 2020 allowed review of care given during the peak of the SARS-CoV-2 pandemic in Ireland. The primary outcome variable was the number of patients who had delayed surveillance cystoscopy in each group.

A total of 278 cases were reviewed, 96 in the first cohort and 91 at both intervals of second phase. During the first phase of the audit 17 patients (17.7%) had a missed cystoscopy. Phase 2 showed a sustained decrease in the number of patients with missed surveillance, with eight (8.8%) missing their procedure in both the November and April (SARS-CoV-2) cohorts (17 v. 8, X² = 10.76, p = 0.0004). Overall, most patients had their procedure done within the recommended time interval (245, 88%).

A centralised accessible computerised registry of patients with NMIBC undergoing surveillance is superior to traditional manual surveillance methods, especially during the period of SARS-CoV-2. Going forward we aim to have all patients undergo surveillance within schedule with a long-term goal of a centralised national registry.

Level 2c: “Outcomes Research”.

To examine the readability of urology webpages to assess their suitability for the general population and their inclusivity for varied levels of health literacy.

We accessed all urology department websites from NHS trusts in England. A standard framework was used to assess these for ease of navigation, availability and quality of urology-specific information. Text was analysed using Flesch–Kincaid Grade Level and Ease Score to measure readability.

From the 132 NHS trust websites investigated, 117 (88.6%) had a urology-specific webpage, a considerable increase from 98 trusts (68%) in 2010. However, a smaller proportion of websites explained their services and procedures, and only 23.9% explained common urological conditions. Websites still appeared outdated, 23.9% had spelling errors, and 75.2% made none or poor use of images. The mean reading grade level was 13.40, equivalent to a UK reading age above 18 years, and the mean reading ease score was 30.35, in the range of ‘difficult’ text.

Our data suggest that urology-specific webpages are not providing useful content for patients and are too complex for the general population to understand. Improvement would allow patients to be able to utilise such resources to aid decision making and to navigate complex NHS pathways.

Not applicable