This work aimed to evaluate the implementation and impact of a pre-multidisciplinary team (MDT) triage model using Standards of Care (SoC) for streamlining in a urology cancer service.
An SoC framework was developed by the cancer lead in line with national guidance. Using this, the Urology MDT at Dartford and Gravesham NHS Trust (DGT) introduced a pre-MDT triage model. Each week, a consultant urologist, clinical nurse specialist, and MDT coordinator reviewed referrals and allocated them for either full MDT discussion or protocolised management. Data were collected over 50 weeks, including meeting duration, case numbers, plan changes, and a clinician survey.
Average MDT duration reduced from 158 to 135 min (p < 0.001), allowing more focused discussion of complex cases. Of 50 MDT members invited, 25 responded to the survey (50%): 79% were confident that SoC-aligned cases received appropriate management without full discussion, 84% supported ongoing streamlining, and most reported time savings. Suggested improvements included artificial intelligence (AI) decision-support and clearer timelines. Overall, streamlining improved both the operational efficiency and clinician satisfaction.
The initiative enhanced MDT efficiency, maintained oversight, and strengthened clinician confidence in protocolised care pathways. Challenges remain, including reliance on a single consultant for triage and occasional gaps in the availability of radiology or histopathology reports, which may affect sustainability. Overall, these findings support wider adoption of pre-MDT streamlining in cancer services.
This study aimed to evaluate the diagnostic accuracy of artificial intelligence (AI)–enhanced micro-ultrasound (micro-US) for detecting clinically significant prostate cancer (csPCa) in men referred for prostate biopsy.
We retrospectively analysed 145 men undergoing micro-US-guided biopsy (79 with csPCa, 66 without). Deep features were extracted from 2D micro-US slices using a self-supervised convolutional autoencoder and classified with a random forest model under fivefold cross-validation. Patients were considered csPCa-positive if ≥8 consecutive slices were predicted positive. Diagnostic performance was assessed against biopsy pathology using receiver operating characteristic (ROC) analysis.
The AI–micro-US model achieved an area under the ROC curve (AUC) of 0.871. At a fixed threshold, sensitivity was 92.5% and specificity 68.1%, outperforming a clinical model based on prostate-specific antigen (PSA), digital rectal examination (DRE), age, and prostate volume (AUC 0.753; sensitivity 96.2%, specificity 27.3%).
AI-enhanced micro-US reduces false positives from conventional screening tools while preserving high sensitivity. It shows promise as a point-of-care alternative to MRI, integrating risk stratification and biopsy guidance into a single platform.
This study aimed to evaluate the diagnostic accuracy of artificial intelligence (AI)–enhanced micro-ultrasound (micro-US) for detecting clinically significant prostate cancer (csPCa) in men referred for prostate biopsy.
We retrospectively analysed 145 men undergoing micro-US-guided biopsy (79 with csPCa, 66 without). Deep features were extracted from 2D micro-US slices using a self-supervised convolutional autoencoder and classified with a random forest model under fivefold cross-validation. Patients were considered csPCa-positive if ≥8 consecutive slices were predicted positive. Diagnostic performance was assessed against biopsy pathology using receiver operating characteristic (ROC) analysis.
The AI–micro-US model achieved an area under the ROC curve (AUC) of 0.871. At a fixed threshold, sensitivity was 92.5% and specificity 68.1%, outperforming a clinical model based on prostate-specific antigen (PSA), digital rectal examination (DRE), age, and prostate volume (AUC 0.753; sensitivity 96.2%, specificity 27.3%).
AI-enhanced micro-US reduces false positives from conventional screening tools while preserving high sensitivity. It shows promise as a point-of-care alternative to MRI, integrating risk stratification and biopsy guidance into a single platform.
This study aims to evaluate the safety, efficacy and clinical outcomes of elective flexible ureteroscopy using flexible and navigable suction ureteral access sheaths (FANS) in patients with upper tract infectious stones following initial management of systemic urinary tract infections (UTIs).
We conducted a multicentre prospective analysis of patients with infectious ureteral or kidney stones (struvite or calcium carbonate-apatite) who underwent flexible ureteroscopy using FANS between March 2024 and March 2025. All patients had prior systemic UTI management with a minimum 6-week interval before definitive stone treatment. Stone-free rate was assessed at 30 days using a CT scan.
The cohort included 144 patients (median age 51 years, 70.1% female) with a median stone diameter of 1.9 cm. 20.1% had initially received only antibiotic treatment, whereas 79.9% had also received emergency drainage. Forty-seven patients (32.6%) had emphysematous pyelonephritis at initial presentation. Median operative time was 40 min with a 1-day hospital stay. Notable findings included zero cases of sepsis and a 29.9% rate of postoperative fever requiring extended antibiotics up to 2 weeks. Zero residual fragments were achieved in 48.6% and a single fragment up to 2 mm in 43.8% of patients (92.4% combined stone-free rate). Renal function improved at 30 days (median creatinine decrease −15 μmol/L) and 3 months (−18 μmol/L). Fever rate was 29.8% in the emphysematous pyelonephritis subgroup.
Elective flexible ureteroscopy using FANS for upper tract infectious stones is feasible for its excellent safety profile with no sepsis cases and high stone-free rates. FANS technology appears to offer significant advantages in this challenging patient population by mitigating postoperative sepsis due to debris aspiration, reduction of pyelovenous backflow of contaminated irrigation fluids and improved stone fragment evacuation.
To measure the effects of varying configurations of nephroscope sheath, irrigation, instruments, and suction on intrarenal pressure (IRP) during percutaneous nephrolithotomy (PCNL).
Kidney and ureter 3D printed models from a deidentified patient's CT scan were placed in a plaster and foam mould, simulating the torso of a prone patient. An Amplatz sheath was inserted into the kidney model. Fourteen different rigid nephroscope sheath (RNS), irrigation, instrument and suction configurations were compared. IRP was measured in a retrograde fashion. Comparisons were performed using the Wilcoxon Signed-Rank test followed by Bonferroni correction.
The mean IRP with and without the RNS was 19.1 and 14.7 mm Hg, respectively (p < 0.001). Using the inflow port of the RNS for irrigation created a lower IRP (19.1 mm Hg) compared to the outflow port (32.7 mm Hg; p < 0.001). Addition of suction to all working scenarios significantly reduced IRP (p < 0.001). Insertion of instruments did not significantly alter IRP.
In situations where the IRP should be low, removal of the RNS, irrigating through the inflow port, and frequent use of suction maintain the lowest pressures. If temporary increases in IRP are necessary to improve visualisation in the setting of bleeding, irrigating through the outflow port, minimising drainage and use of the RNS can be used to raise IRP.
The weight of adenoma removed during benign prostatic hyperplasia (BPH) surgery is commonly used as a surgical landmark. During endoscopic procedures, prostatic tissue is exposed to heat generated by electric current, resulting in tissue vaporization that may affect the final specimen weight. This study aimed to quantify tissue loss due to vaporization during TURP, comparing monopolar and bipolar techniques.
Surgical specimens from 32 patients undergoing open simple prostatectomy were analysed. After enucleation, adenomas were weighed and then completely resected in vitro simulating TURP using monopolar or bipolar energy. The weight of the resected fragments was measured to estimate tissue loss associated with each energy source and compared with preoperative MRI-estimated transition zone volumes.
Mean patient age was 68.2 ± 5.75 years. There was a strong correlation between MRI-estimated transition zone weight and enucleated specimen weight (97.5 ± 40.1 g vs. 90.5 ± 38 g; r = 0.998, p < 0.001). Of the 32 enucleated adenomas, 16 were resected in vitro using monopolar energy and 16 using bipolar energy. After in vitro resection of the adenoma, a significant decrease in the enucleated specimen weight was observed (from 90.5 ± 38 g to 64.25 ± 25.6 g; p < 0.001). Overall, the mean decrease in weight after resection was 26.3 g, corresponding to a 29% reduction. Bipolar resection showed a greater reduction in tissue weight compared to monopolar resection, with a decrease of 36.8% and 19.4%, respectively (p < 0.001).
The weight of the adenoma removed during surgical treatment of BPH differs depending on the technique used and, therefore, cannot be used comparatively between techniques. Resection surgeries result in tissue vaporization and dehydration, reducing adenoma weight by approximately 28%. Adenoma volume determination by MRI shows a strong correlation with the volume to be removed during surgery.
Prostate-Specific Membrane Antigen Positron Emission Tomography Computed Tomography (PSMA PET/CT) has shown a higher diagnostic accuracy in prostate cancer imaging when compared to conventional modalities, with improved sensitivity and specificity rates when combined with multiparametric prostate Magnetic Resonance Imaging (mpMRI). We evaluated the cost-effectiveness of a combined PSMA PET/CT and mpMRI biopsy-free diagnostic approach for clinically significant prostate cancer (csPCa).
A decision tree model was designed to compare two diagnostic strategies for csPCa in men with raised Prostate Specific Antigen (PSA)—the first with conventional mpMRI followed by transperineal prostate biopsy versus a second biopsy-free, PSMA PET/CT plus mpMRI combined imaging strategy. We evaluated the impact of each strategy on costs and Quality-Adjusted-Life-Years (QALYs). Willingness-to-pay thresholds were set at 1× and 3× Gross Domestic Product (GDP). One-way sensitivity analysis and probabilistic sensitivity analyses were performed.
A combined mpMRI and PSMA PET/CT diagnostic strategy was 0.04 QALY more effective but SGD$4088.03 more expensive than the conventional mpMRI and biopsy strategy. The incremental cost-effective ratio (ICER) was SGD$92782.87 per quality-adjusted life year (QALY). In the combined imaging strategy, 3.5% of the cohort had a missed diagnosis of prostate cancer versus 13.9% in the conventional mpMRI and biopsy strategy. Probabilistic analyses showed that the combined imaging strategy was cost-effective at willingness-to-pay thresholds of SGD$121160 and SGD$363480, respectively.
Combined mpMRI and PSMA PET/CT for csPCa diagnosis are a cost-effective strategy in terms of health utility over the conventional approach for diagnosing csPCa in men with raised PSA, potentially reducing the need for invasive diagnostic procedures.
To investigate how patient-specific factors, including race and socioeconomic status, impact time to treatment initiation (TTI) for patients with small renal masses (SRMs).
We retrospectively reviewed 275 patients with SRMs ≤ 4 cm at Atrium Health Carolinas Medical Center who underwent treatment for their renal mass. TTI was defined by the time between office visit (TTI-OV) or between initial imaging (TTI-Imaging) and procedure date. Statistical analysis was employed to determine patient-specific factors associated with TTI.
We found that TTI was significantly associated with race as Black patients experienced longer TTI than non-Hispanic White patients (OV: HR = 0.637, 95% CI [0.479–0.848], p = 0.0048; Imaging: HR = 0.541, 95% CI [0.402–0.727], p = 0.0002). TTI, however, was not significantly associated with socioeconomic status as defined by Area Deprivation Index, income or insurance status. TTI-OV was also significantly associated with procedure year, and TTI-Imaging was associated with procedure year, Charlson Comorbidity Index (CCI) and tumour size when first seen on imaging. On multivariable analysis, TTI-Imaging was not independently associated with race (p = 0.1775), suggesting procedure year, CCI and tumour size are more significant predictors of TTI.
Black patients experienced a treatment delay from initial clinical presentation to procedure, but treatment delays from initial imaging identification to procedure may be tied more strongly to clinical factors.
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