Author(s) Hosny K.; Clark J.; Srirangam S.J.
Source Translational Andrology and Urology; Sep 2019; vol. 8
DOI 10.21037/tau.2019.07.08
Flexible ureteroscopy is an important therapeutic and diagnostic procedure and has seen rapid rise in its utilisation in recent years. There have been numerous developments in flexible ureteroscope (fURS) technology but scope fragility, and the associated high maintenance costs, remains a concern. A comprehensive Medline search for related publications from the last 20 years was undertaken to identify common causes of fURS damage and ascertain practices to minimise this. Flexible ureteroscopy can be due to intraoperative causes (loss of the deflection mechanism, damage to the working channel due and fibreoptic bundle injury) and non-operative damage which occur during cleaning, sterilisation and handling of the fURS. The review summarises the available literature to help highlight common mechanisms of scope damage, and outlines evidence-based measures to reduce the risk of damage and maximise durability. Scope fragility remains a problem with significant associated cost implications. In a culture of rising fURS use and reducing re-imbursement for endourologists, prolonging the longevity of the fURS is imperative for maintaining profitability. There are simple and inexpensive practices which can be immediately adopted to maximise fURS use and reduce the need for repairs.Copyright © Translational Andrology and Urology. All rights reserved.

• Available in full text at Translational andrology and urology from Europe PubMed Central - Open Access

Author(s): Hosny K.; Aboelsoud M.
Source: Arab Journal of Urology; Nov 2018; vol. 16
Publication Date: Nov 2018
Publication Type(s): Conference Abstract
Available  at Arab Journal of Urology
Abstract:Objective: To assess the usefulness of the R.E.N.A.L nephrometry score in surgical decision making in patients with renal cell carcinoma (RCC). The R.E.N.A.L nephrometry score parameters are radius, exophytic/endophytic properties, nearness of the tumour to the collecting system or sinus, anterior or posterior location, and location relative to the polar lines. Classification of RCC according to nephrometry score: low complexity score 4-6, moderate complexity 7-9, and high complexity score 10-12 points. Methods: We looked retrospectively at the imaging of 70 cases of RCC against the operative procedure that was performed.

​Results: There were 20 cases with low complexity scores: seven (35%) underwent radical nephrectomy (RN) and 13 (65%) underwent partial nephrectomy (PN). There were 32 cases of moderate complexity: 24 (75%) underwent RN and eight (25%) underwent PN. There were 18 cases of high complexity and all of them (100%) underwent RN. Conclusion: Of the 20 (35%) cases with low complexity scores the T1a RCC tumours should have been offered PN. Of the 32 cases with moderate complexity scores, 24 (75%) patients with T1b RCC tumours should have been offered PN after discussion of an 8% risk of positive surgical margins. Nephron-sparing surgery should be offered to patients with low or moderate complexity and the R.E.N.A.L nephrometry score can used to aid this decision.Copyright © 2018
Database: EMBASE

Author(s): Hosny K.; Abdelhafez A.
Source: Arab Journal of Urology; Nov 2018; vol. 16
Publication Date: Nov 2018
Publication Type(s): Conference Abstract
Available  at Arab Journal of Urology -  from Europe PubMed Central - Open Access
Abstract:Objective: To review the usefulness of prostate-specific antigen (PSA) testing in men presenting to an urgent clinic with haematuria in our practice in a District hospital in the UK.

Methods: We reviewed the retrospective data of 200 patients who presented with visible haematuria (VH) and non-visible haematuria (NVH), aged between 50 and 79 years, between January 2016 and June 2017. All patients underwent digital rectal examination (DRE) and PSA testing as part of our standard investigation for haematuria.

Results: In all, 200 cases were included. A total of 155 cases had VH, 134 of them had a benign DRE and normal PSA level. One of the other 21 cases had an abnormal DRE and elevated PSA level and was diagnosed with Gleason 8 prostate cancer. Three of 21 cases had abnormal DREs and normal PSA levels, two of these patients underwent transrectal ultrasonography (TRUS)-guided prostate biopsy, which revealed Gleason 6 prostate cancer in one of them but showed no evidence of malignancy in the other patient. Whilst, 17 of the 21 cases had normal DREs and elevated PSA levels, 11 of the 17 cases had a repeat PSA test which came back normal, while the other six cases were further investigated with magnetic resonance imaging of the prostate and/or TRUS biopsies, but no malignancy was found. A total of 45 cases presented with NVH, all of them had benign DREs. Only four cases with elevated PSA levels with no malignancy were detected in further investigations. Overall, the number of patients who underwent further investigations was 14/200 (7%). Overall, the rate of prostate cancer diagnosis was 1%; the rate of diagnosis with VH was 1.29% and 0% with NVH.

​Conclusion: Despite using PSA as a standard investigation for patients who presented to the urgent clinic with haematuria, the rate of cancer diagnosis was very low (1%) and detected in patients with abnormal DRE rather than elevated PSA levels. Our cancer detection rate of 1% is less than those from the European Randomized Study of Screening for Prostate Cancer (ERSPC; 8.2%), Prostate Testing for Cancer and Treatment (ProtecT; 2.2%) and the Prostate, Lung, Colorectal, and Ovarian cancer screening trial (PLCO; 1.4%). PSA level measurement should not be considered as a useful test in standard investigations of haematuria, unless an abnormal DRE is found during examination.Copyright © 2018
Database: EMBASE

​Author(s): Al-Mula Abed, Omar W. S.; Srirangam, Shalom J.; Wemyss-Holden, Guy D.
Source: Oman Medical Journal; Sep 2018; vol. 33 (no. 5); p. 374-379
Publication Date: Sep 2018
Publication Type(s): Academic Journal
Available  at Oman Medical Journal -  from Europe PubMed Central - Open Access
Abstract:Objectives: Visible hematuria (VH) is a common urological complaint. A history of initial or terminal VH in men is indicative of a lower urinary tract (LUT) source. A careful clinical history could limit unnecessary extensive upper tract imaging in this group of patients with VH. We conducted a single-center prospective study to examine the usefulness of investigating the upper tract in patients with a history of VH likely from a LUT source (initial and/or terminal VH) with specific reference to the incidence of demonstrable significant upper tract abnormalities. Methods: We conducted a single-center prospective study of consecutive male patients presenting with VH over eight months. All patients underwent standard investigations including physical examination, flexible cystoscopy (FC), and radiological imaging (ultrasound scan (USS) and/or computed tomography urogram (CTU)). Those with a clear history of initial or terminal VH were identified for further scrutiny with regards to detectable upper tracts abnormalities. Results: In total, 57 patients (aged 23--95 years) with initial or terminal VH were identified. Of these, 56 had FC and nine patients were subsequently diagnosed with a LUT malignancy. With regards to upper urinary tract (UUT), 35 patients (61.4%) had an USS, 46 (80.7%) underwent a CTU, and 25 (43.9%) patients had both. In this group, no UUT malignancy was identified on upper tract imaging. Conclusions: Initial or terminal VH patients may not need extensive upper tract imaging. FC is recommended, but a non-invasive USS can be a safe initial investigation for the UUT, with a CTU subsequently considered in those with abnormalities on USS and those with ongoing bleeding. Further combined multicenter analysis will help corroborate these findings and could have several beneficial outcomes including a reduction in investigations cost, patient inconvenience, and ionizing radiation.
Database: CINAHL

​Author(s): Stewart H.; Abed O.; Wemyss-Holden G.; Srirangam S.
Source: Journal of Clinical Urology; Jun 2018; vol. 11 ; p. 66
Publication Date: Jun 2018
Publication Type(s): Conference Abstract
Abstract:Introduction: We investigated the incidence of upper urinary tract (UUT) abnormalities in males with initial and/or terminal visible haematuria (VH) suggesting a lower urinary tract (LUT) cause. Is extensive UUT imaging really necessary? Materials/Method: Two-armed (retrospective (n=419) and prospective (n=1173)) study of all consecutive male patients with VH over 5 years. All patients underwent flex-ible cystoscopy (FC) and UUT imaging (USS+/-IVU/CT urogram). Those with initial and/or terminal VH were scrutinised further. Results: 62/419 (14.8%) of patients in the retrospective group (R-G) and 183/1173 (15.6%) in the prospective group (P-G) presented with initial and/or terminal VH. In the R-G, FC revealed these LUT abnormalities: 4 bladder calculi; 3 bladder tumours; 1 urethral stricture. Only one UUT malignancy was identified (single case of renal cell carcinoma detected on USS and IVU). 

​Author(s): Hosny K.; Luk A.
Source: Annals of the Royal College of Surgeons of England; Jul 2018; vol. 100 (no. 6)
Publication Date: Jul 2018
Publication Type(s): Article
PubMedID: 29962297
Available  at Annals of the Royal College of Surgeons of England -  from EBSCO (MEDLINE Complete)
Abstract:Schistosoma haematobium is the species primarily responsible for the manifestation of schistosomiasis in the genitourinary tract. It is a parasitic disease caused by flukes (trematodes) of the genus Schistosoma, which can result in acute and chronic manifestation. We report a case of urinary schistosomiasis that initially presented as advanced bladder cancer with pulmonary metastasis on initial computed tomography scan. 

Author(s): Bray R.; Khullar V.; Cartwright R.; Cardozo L.; Hill S.; Guan Z.

Source: Neurourology and Urodynamics; 2017

Publication Date: 2017

Publication Type(s): Article In Press

Available in full text at Neurourology and Urodynamics -  from John Wiley and Sons

Abstract:AIMS: We evaluated the effect of Tolterodine extended release (TER) versus placebo on bladder wall thickness (BWT) using transvaginal ultrasound in women with overactive bladder (OAB). MATERIALS AND METHODS: We recruited 79 women with symptoms of OAB with a mean age of 47 years who had a BWT of at least 5mm and a post-micturition volume of less than 50mL at screening. Subjects received TER 4mg or placebo once daily for the first 12 weeks of the study. For the subsequent 12 weeks, all subjects received TER 4mg once daily. BWT was measured at screening, weeks 12 and 24. Subjects recorded number of micturitions, incontinence episodes and urgency episodes, and volume voided per micturition at regular intervals during the study. RESULTS: Treatment with TER for 12 weeks produced a statistically significant decrease from baseline in BWT (mean [SD]=0.9 [1.4] mm; P<0.05) that was not evident following treatment with placebo (0.2 [1.6] mm; P=0.54). However, the treatment difference did not reach statistical significance (LS Mean=-0.4; 95%CI: -1.2, 0.3; P=0.25). After 12 weeks of treatment, subjects who had taken TER showed an improvement in each bladder diary variable compared to placebo-treated subjects. CONCLUSIONS: TER may have a direct effect on BWT in women with OAB. Larger studies are warranted to further investigate the effect of behavioral interventions and antimuscarinics, such as TER, on BWT in women with OAB and increased BWT.Copyright © 2017 Wiley Periodicals, Inc.
​
Database: EMBASE

Author(s): Luk, Angus Chin On; Cleaveland, Paul; Olson, Louise; Neilson, Donald; Srirangam, Shalom
Source: Journal of endourology; Jan 2017

Publication Date: Jan 2017

Publication Type(s): Journal Article

Abstract:Pelvic phleboliths are commonly encountered on plain and CT imaging and remain a source of frustration when attempting to differentiate them from ureteral calculi. Given their frequency, surprising little is known about their significance. We review the literature on pelvic phleboliths, specifically in relation to their history, demography, clinical significance, and methods to distinguish them from ureteral calculi.           A comprehensive literature search was performed for all articles concerning pelvic phleboliths. Pelvic phleboliths were first described in 19th century when the presence of calcified intravenous nodules was observed in human dissection. With the discovery of X-ray imaging in 1895, they have caused much diagnostic controversies since. Histologically they are composed of calcified laminated fibrous tissue, with a surface layer continuous with vein endothelium. Prevalence of pelvic phleboliths in adults is reported to be 38.9-48%. They are more common in adults aged over 40, and appear to equally affect both genders. They may be associated with diverticulitis, vascular abnormalities, and are more commonly seen in individuals from economically-developed countries. The soft-tissue 'rim' sign (50-77% sensitivity, 92-100% specificity), and a geometric shape (100% positive predictive value(PPV)) are radiological signs predictive of a ureteral calculi on unenhanced CT scanning. Radiological signs suggestive of phleboliths include the presence of central lucency (8-60% sensitivity, 100% specificity), rounded shape (91% PPV) and the comet-tail sign (21-65% sensitivity, 100% specificity). Phleboliths appear to have a significantly lower Hounsfield unit enhancement than ureteric calculi (160 to 350HU).           Pelvic phleboliths are a common radiological finding, especially in the older population, which continue to present diagnostic challenges in those with suspected ureteral calculi. With greater awareness, the uncertainty can be overcome by identifying defining characteristics when interpreting radiological investigations.
​
Database: Medline