BJUI compass最新文献

Background: Simulation-based education (SBE) is widely adopted in high-income countries to enhance surgical training, but opportunities remain limited in low- and middle-income countries (LMICs). Emergency Urology Simulation Training (EUST) was developed to address knowledge and skill gaps in managing urological emergencies in sub-Saharan Africa.

Methods: EUST courses were delivered in Ethiopia, Uganda and Malawi using a single-day format combining pre-course online learning, didactic teaching with hands-on simulation. Locally, sourced animal tissue models were employed to replicate ureteric, bladder, renal, scrotal and penile injury repairs. Pre- and post-course assessments included multiple-choice questions (MCQs) and confidence surveys. Post-course composite scores were compared across sites using the Kruskal-Wallis test. Faculty feedback evaluated preparedness and sustainability.

Results: A total of 46 participants completed EUST across four sites, baseline knowledge was low (mean pre-course MCQ scores: 8.0-10.75/15). Post-course scores improved (10.63-12.72/15), with knowledge gains of 15%-32%. Confidence in managing rare emergencies, such as penile fracture and ureteric reimplantation, increased universally; 100% of delegates recommended integrating EUST into national training curricula. Faculty anxiety about SBE delivery decreased post-training, and senior trainees transitioned well into faculty roles, supporting ongoing sustainability. Cost-effectiveness was achieved by using animal tissue and donated instruments, reducing reliance on expensive synthetic models.

Conclusion: EUST is an affordable, scalable and effective model for surgical education in LMICs. The 'See one, run one' approach enables replication across both specialty and international boundaries and fosters sustainable local faculty development. EUST demonstrates a significant positive educational impact and offers a sustainable programme for improving emergency urology care in resource-limited settings. Partnering with COSECSA facilitates a reduction in UK faculty requirement long-term.

Introduction and objective: This study aims to evaluate the learning curve and perioperative outcomes of single-port extraperitoneal robotic radical prostatectomy (SP-EP-RARP) performed by a single surgeon at a high-volume academic institution.

Methods: A retrospective review of a prospectively maintained database was conducted for patients who underwent SP-EP-RARP from September 2023 to August 2025. Key metrics included operative time, estimated blood loss, conversion rate, nerve-sparing status, pathological margin status and continence (0-1 pad for safety), and 30-day complication rate. Descriptive statistics were used, and outcomes were analysed chronologically to assess for trends suggesting a learning curve.

Results: The cohort included 53 patients who underwent extraperitoneal SP-EP-RARP. Median operative time was 213 min (IQR: 145-281). Median estimated blood loss was 100 mL (IQR: 75-125). Nerve-sparing was attempted in 75.5% of cases. No assist or plus one ports were utilized. Final pathology revealed pT2 disease in 64.1% (34 cases), pT3a in 32.1% (17 cases) and pT3b in 3.7% (2 cases). Overall positive margin rate was 26.4%. Thirty-day Clavien-Dindo Grades I-II complication rates were 11.3%, and no major complications or 90-day complications were reported. Continence rates at 6 weeks, 3 months and 6 months were 72%, 72% and 75%, respectively. Stabilization of operative times and intraoperative outcomes occurred after approximately 25-30 cases.

Conclusion: SP-EP-RARP can be safely implemented by a newly graduated fellowship-trained robotic surgeon with acceptable oncologic and functional outcomes. Initial learning can be estimated at approximately 25-30 cases.

Objectives: This study aims to develop and clinically evaluate EarlyTect BCD Plus, a urine-based assay measuring two methylation sites of the PENK gene, and to assess its diagnostic performance and clinical utility according to haematuria risk stratification.

Materials and methods: A dual-target quantitative methylation-specific PCR assay was optimized using the PENK gene and evaluated in 892 patients with haematuria from Korea and the United States who underwent cystoscopy and histopathology. Urine DNA was analysed for two PENK methylation markers, and test results were interpreted using a combined algorithm. Diagnostic accuracy was assessed, and clinical utility was further analysed for patients stratified by the 2025 AUA/SUFU haematuria guideline risk categories.

Results: In the pooled cohort (gross haematuria, n = 509; microhaematuria, n = 366; unspecified haematuria, n = 17), EarlyTect BCD Plus achieved a sensitivity of 87.7% (95% CI, 81.5%-92.5%), specificity of 82.5% (95% CI, 79.6%-85.2%) and negative predictive value (NPV) of 97.0% (95% CI, 95.5%-98.0%). Sensitivity for Ta-LG tumours improved to 60.5% compared with the original single-marker assay, while high-grade tumours were detected with 96.6% sensitivity. In the intermediate-risk group, NPVs were 99.1% for all BC and 100% for high-grade BC.

Conclusions: EarlyTect BCD Plus significantly enhances detection of Ta-LG bladder cancer while maintaining high specificity. Its high NPV supports use as a non-invasive adjunct and triage tool, allowing deferral of cystoscopy in selected haematuria patients.

Objectives: Kidney stones affect 12% of the population over their lifetime. Recurrent kidney stones lead to repeated interventions and excessive healthcare costs. Despite progress in imaging and metabolic evaluations, models to accurately identify patients at high risk are missing. In this study, we investigate whether machine learning methods can facilitate early identification of recurrent kidney stone formers.

Patients and methods: This observational study included data from the single-centric Bern Kidney Stone Registry. Each participant had at least one stone episode. Different data imputation techniques, such as kernel density estimation (KDE) imputation, median imputation and k-nearest neighbour (KNN) imputation, were evaluated in a logistic regression model. Feature selection with recursive feature elimination was applied. A fivefold cross-validation was conducted using an 80/20 split. The classification criterion was recurrent kidney stone event.

Results: A total of 706 patients (median age, 47, 71.2% male) were included, and 563 (79.7%) had recurrent stone events. The median imputation yielded the best-performing models. A mean receiver operating characteristic curve area under the curve (AUC) of 0.71 ± 0.03 was achieved on the held-out test set. Estimated glomerular filtration rate (OR = 0.45, 95% CI: 0.42-0.49), age at first stone episode (OR = 0.50, 95% CI: 0.46-0.56), oxalate (OR = 1.83, 95% CI: 1.43-2.23) and pH (OR = 1.74, 95% CI: 1.47-1.89) were among the most descriptive features.

Conclusion: Routinely collected clinical and laboratory variables can be potentially exploited to identify recurrent stone formers, and our machine learning approach achieved better performance than previously reported work. With further validation on external datasets, our routine could support clinicians in designing dietary, medical or surveillance strategies, thereby reducing recurrence rates and improving long-term outcomes for patients with stone-forming conditions.

Objectives: This work aimed to assess treatment outcomes in patients with recurrent urinary tract infections (rUTIs) managed in a dedicated multidisciplinary complex-UTI clinic. In addition, this work aimed to evaluate the impact of tailored interventions on patient-reported outcomes, including quality of life (QoL) and symptomatic improvement.

Materials and methods: A 2-year, single-centre, prospective observational cohort study was conducted in a dedicated tertiary care UTI clinic. A multidisciplinary team comprising urologists, microbiologists and specialist nurses developed individualized management plans based on thorough assessments, including patient history, physical examination and necessary investigations. Data variables included patient demographics, urine culture results with antibiotic sensitivities, investigations performed and the treatment options administered. The minimum follow-up period was 6 months after the implementation of treatment in the clinic. Pretreatment and posttreatment QoL were assessed, along with posttreatment Patient Global Impression of Improvement (PGI-I) scores.

Results: A total of 211 patients (mean age: 58.3 years, 89.6% female) were included. First- and second-line treatments were effective for 71% of patients, while 29% required tertiary interventions. Post-treatment, 81% of patients reported good-to-excellent improvement on the PGI-I scale, and 70% achieved good-to-excellent QoL. Overall treatment success, defined as reduced UTI frequency or symptom resolution, was reported in 87.7% of patients. Factors such as immunosuppression and history of hospital admission for urosepsis were associated with poor treatment outcomes with statistical significance.

Conclusion: Dedicated multidisciplinary UTI clinics significantly improve treatment outcomes and QoL for patients with rUTIs. The findings support broader adoption of multidisciplinary approaches, emphasizing early intervention and tailored care to optimize clinical efficiency and enhance the patient experience.

Objectives: This work aimed to evaluate the long-term impact of standardized care pathway (SCP) implementation for urinary bladder cancer (UBC) on tumour characteristics, diagnostic and treatment intervals and guideline adherence.

Materials and methods: A retrospective cohort study was conducted including all patients with newly diagnosed UBC at the NU Hospital Group, Sweden, between 2010 and 2024. Patients were grouped into pre-SCP (2010-2015) and during-SCP (2016-2024) cohorts. Patient demographics, tumour characteristics, adherence to guideline-recommended care and diagnostic and treatment time intervals were analysed. Overall survival was assessed using Kaplan-Meier analysis and Cox proportional hazards regression.

Results: Following SCP implementation, emergency presentations declined significantly (15% pre-SCP to 10% SCP, p = 0.003). Tumour characteristics shifted towards earlier-stage disease, with increased detection of small tumours ≤30 mm (56% to 71%, p < 0.001), fewer muscle-invasive cases (27% to 21%, p = 0.003) and a higher proportion of TaG1-2 tumours (42% to 52%, p = 0.003). Adherence to guidelines improved markedly, reflected in cT1 disease by increased second-look resections (36% to 69%, p < 0.001) and multidisciplinary team conference discussions (2% to 88%, p < 0.001). Diagnostic efficiency improved, with median referral-to-TURBT time reduced from 29 to 14 days (p < 0.001). In multivariable analysis, age, emergency admission, higher tumour stage and size and TURBT delay >18 days were independently associated with worse overall survival. Kaplan-Meier analysis revealed a temporal shift: Early rapid TURBT was associated with poorer survival in 2010-2015 but conferred a survival benefit in 2016-2024 (log-rank χ ² = 13.66, p = 0.003).

Conclusions: SCP implementation was associated with earlier detection, improved guideline adherence and sustained reductions in diagnostic delays. However, increasing delays to definitive treatment for muscle-invasive disease highlight emerging system-level constraints, underscoring the need to optimize downstream capacity to fully realize the benefits of early diagnosis.

Objectives: Our objective was to develop algorithms to predict adverse pathology (AP) and recurrence-free survival (RFS) for patients with renal tumours primarily based on multifaceted analysis of preoperative CT imaging.

Patients/methods: Seven hundred forty-eight patients with non-metastatic renal tumours managed with definitive surgery at Cleveland Clinic (2011-2014) were retrospectively evaluated (median follow-up 9.1 years). All patients underwent contrast-enhanced CT and parenchymal volume analysis using semi-automated software. A variety of conventional radiological features were evaluated in addition to parenchymal volume replacement (PVR) due to invasive tumour growth, using the contralateral kidney as a control. Adverse pathology (AP) was defined as stage ≥pT3a, grade 3/4 or sarcomatoid/rhabdoid features. Multivariable logistic regression and Cox proportional hazards regression analyses were used to develop predictive models.

Results: Overall, 339/748 patients (45%) had AP, which significantly associated with reduced RFS. On univariable analysis, tumour-size, degree of vascularity, heterogeneity, irregular contour, sinus margin irregularity, necrosis, non-cystic tumour and increased PVR significantly associated with AP. On multivariable logistic regression, male sex, R.E.N.A.L. Nearness, heterogeneity, necrosis, sinus margin irregularity and PVR ≥ 25% independently associated with AP. Multivariable analysis indicated that tumour size, heterogeneity, necrosis, PVR ≥ 25% and tumour-related symptoms significantly associated with reduced RFS. Models for AP and RFS at 3, 5 and 10 years showed area under the curve (AUC) values of 0.81 and 0.84-0.86, respectively.

Conclusions: These findings confirm that radiological features and PVR are associated with AP and reduced RFS after definitive renal cancer surgery. Our predictive models are entirely based on preoperative parameters and may improve patient counselling and occasionally preclude the need for renal mass biopsy.

Objective: The study aims to assess whether the use of a peritoneal flap (PF) during robotic-assisted radical prostatectomy (RARP) with pelvic lymph node dissection (PLND) reduces the incidence of lymphoceles compared to the standard surgical approach without a flap.

Methods: The review was prospectively registered on PROSPERO (CRD420251052120). A systematic search of PubMed, MEDLINE, Embase, Scopus, Web of Science, CENTRAL and Google Scholar was performed up to May 2025. Eligible studies were randomised controlled trials (RCTs) or observational studies comparing PF use with the standard surgical technique without the flap during RARP with PLND. Primary outcomes were symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. Secondary outcomes included complications, operative time, blood loss, positive surgical margins and hospital stay.

Results: Fourteen studies (six RCTs, eight observational) including 7316 patients were analysed, with 2997 receiving the PF and 4319 receiving the standard technique. PF use was associated with a significantly lower incidence of symptomatic, asymptomatic, total lymphoceles and lymphoceles requiring intervention. PF use reduces overall complications without significantly increasing operative time, hospital stay or positive margins. Intraoperative blood loss was slightly lower in the standard group.

Conclusions: PF use during RARP with PLND significantly reduces the incidence of lymphoceles and postoperative complications without compromising oncological or perioperative outcomes. These findings support PF use as a safe and effective technique for preventing lymphoceles.