Feasibility of outpatient daycase local anaesthestic Rezūm™ without sedation

BACKGROUND

Rezūm™ is a relatively new bladder outflow obstruction (BOO) procedure that uses thermal energy through water vapour to cause necrosis of prostatic tissue. The standard delivery of this treatment is in an operating theatre under a general or spinal anaesthetic, or under local anaesthetic with sedation that requires patient monitoring.

METHODS

We propose an outpatient daycase method of delivering Rezūm™ under local anaesthetic without sedation, using a prostatic local anaesthetic block and cold local anaesthetic gel instillation into the urethra.

RESULTS

Preliminary results of our first thirteen patients demonstrate the feasibility of this new technique, with a mean pain score of 2.1 out of 10 on a visual analogue scale, a successful trial without catheter in all 13 patients (one patient voided successfully on second trial), a reduction in mean International Prostate Symptom Score (IPSS) from 20.6 to 5.4, and improvement in maximum flow from 8.8 ml/s to 14.4 ml/s. The complications were minor (Clavien-Dindo less than III) and included a UTI, minor bleeding not requiring admission, and retrograde ejaculation.

CONCLUSIONS

We demonstrate that an outpatient local anaesthetic daycase service without sedation is feasible. This can be delivered in a clinic setting, reduce waiting times for BOO surgery, and increase availability of operating theatre for other general anaesthetic urological procedures.

Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study

INTRODUCTION

Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population.

PATIENTS AND METHODS

An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018.

RESULTS

A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer.

CONCLUSION

This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

1160 LEARN (Urological Teaching in British Medical Schools Nationally): A Multicentre Cross-Sectional Study

Introduction

Urology is a common rotation for UK Foundation Year (FY) doctors, and accounts for &gt;25% of acute surgical referrals. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology to be covered during medical school. However, its national uptake remains unknown. LEARN aims to assess undergraduate urology teaching across UK medical schools.

Method

LEARN is the largest ever multicentre cross-sectional study of undergraduate urology teaching. Year 2-5 medical students and FY1 doctors were invited to complete a survey between 3rd October-20th December 2020. The primary objective is to compare current undergraduate urology teaching against the BAUS syllabus. Secondary objectives investigate the type and quantity of teaching provided, the reported performance rate of GMC mandated urological procedures, and the proportion of those considering urology as a career.

Results

A total of 7,611/8,346 (91.2%) responses from 39 medical schools that met the inclusion criteria were analysed. 16.5% of responses were newly appointed FY1 doctors. In their undergraduate training, the most commonly taught topics were urinary tract infection, acute kidney injury and haematuria; the least taught topics were male urinary incontinence, male infertility and erectile dysfunction. 90.6% and 86.3% had reported performing catheterisation as undergraduates on male and female patients respectively, and 16.9% had considered a career in urology.

Conclusion

LEARN provides the largest evaluation of any undergraduate specialty teaching. It has identified areas to improve teaching, to equip the future workforce with the competencies to manage urological pathology, irrespective of future career choice.

92 Reshaping the Diagnostic Pathways for Investigation of Haematuria During and After The COVID-19 Pandemic: Diagnostic Accuracy of Strategies for Detection of Bladder Cancer from The IDENTIFY Cohort Study

Introduction

Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway.

Method

The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway.

Results

8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer.

Conclusions

We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

377 Global Recruitment for The RESECT Study (Transurethral Resection and Single-Instillation Intravesical Chemotherapy Evaluation in Bladder Cancer Treatment): An International Observational Cohort Study Aiming to Improve the Quality of Surgery for Non-Muscle Invasive Bladder Cancer

Introduction

Non-muscle invasive bladder cancer (NMIBC) can be curatively treated with ‘good quality’ transurethral resection of the bladder tumour (TURBT). However, despite evidence-based international guidelines, there is anecdotal evidence that practice varies widely, and this may affect oncological outcomes. Launching in 2020, RESECT aims to measure and report variation in TURBT quality globally, and determine if outcome reporting improves outcomes.

Method

RESECT was advertised internationally through social media, mailing lists, websites, and in person. Collaborators at each registered site will collect data about current practice and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators.

Results

As of August 27, 508 collaborators have registered to participate. Collaborators represent 321 centres from 54 countries, with the highest number from the United Kingdom (54.5%), Spain (5.9%), and Argentina (3.7%). 51.2% are trainees, 29.9% consultants, and 17.5% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.

Conclusions

RESECT has attracted a large number of collaborators globally and from all training levels. Therefore, the RESECT study has the potential to improve the quality of TURBT surgery across the world.

P73 LEARN: uroLogical tEAching in bRitish medical schools Nationally - a national retrospective multi-centre audit of urology teaching across British medical schools

Introduction

Urological conditions account for approximately 25% of acute surgical referrals and 10-15% of general practitioner appointments. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology that must be covered during undergraduate medical training. However, its uptake nationally remains unknown. This project aims to assess undergraduate urology teaching across UK medical schools.

Methods

A targeted advertising drive using social media, medical school societies, websites and newsletters was performed over 4 weeks. Collaborators are responsible for recruiting survey respondents (year 2 medical students to foundation year 1 (FY1) doctors). Survey respondents will complete a REDCap survey retrospectively assessing their urology teaching to date. The primary objective is to compare current urology teaching in medical schools across the United Kingdom with the BAUS undergraduate syllabus.

Results

Currently, 522 collaborators have registered from 36 medical schools nationally. Of these collaborators, 6.32% (33/522) are FY1s and 93.68% (489/522) are medical students. Each collaborator will be responsible for recruiting at least 15 survey respondents to be eligible for PubMed-indexed collaborator authorship.

Conclusion

LEARN has recruited successfully to date, with all collaborators from the medical student and FY1 cohort. With the role of collaborators to further recruit survey respondents, LEARN will provide the most representative and thorough evaluation of UK undergraduate urological teaching to date. It will provide evidence to support changes in the medical school curriculum, and allow re-evaluation of the current national undergraduate BAUS syllabus.

P57 Global recruitment for the RESECT study (transurethral REsection and Single-instillation intravesical chemotherapy Evaluation in bladder Cancer Treatment) - an international observational cohort study aiming to improve the quality of surgery for non-muscle invasive bladder cancer

Introduction

Non-muscle invasive bladder cancer (NMIBC) is one of the most expensive cancers to treat, driven by high recurrence rates and disease progression. Mortality rates in the UK for all bladder cancers have remained relatively stable over the past decade. NMIBC can be curatively treated with transurethral resection of the bladder tumour (TURBT). Despite international evidence-based guidelines on the TURBT procedure and postoperative single instillation of mitomycin-C, TURBT quality continues to vary widely. RESECT will be the first ever international study of TURBT surgery evaluating the achievement of TURBT quality indicators globally and assessing if audit and performance feedback can improve surgical outcomes.

Methods

RESECT is a prospective, multicentre international observational cohort study. Collaborators at each site will collect data using REDCap about local TURBT practice, early recurrence rates and the experience of local TURBT surgeons. The primary outcome is the rate of achievement of key TURBT quality indicators. Advertisement for the study launched in 2020.

Results

As of October 1st, 2020, 524 collaborators have registered to participate. Collaborators represent 334 centres from 54 countries, with the highest number of centres from the United Kingdom (133), Spain (17), and India (16). 50.8% are trainees, 30.3% consultants, and 17.2% medical students. Based on current registrations, patient recruitment will far exceed initial projections and considerably improve statistical power.

Conclusion

RESECT has attracted many collaborators internationally from consultants and trainees at all stages. RESECT has significant potential to positively impact TURBT practice, health economics and ultimately improve outcomes for patients with NMIBC globally.