693 Are Virtual Clinics the New ‘Normal’? – A Single-Institution Comparative Analysis of Outcomes and Cost-Effectiveness of Virtual and Face-To-Face Clinics

Introduction

The coronavirus (COVID-19) pandemic has had a profound impact on clinicians, hospital resources and patients. Urology Virtual clinics (VCs) were initiated at our institution to ensure continued provision of service during the pandemic. The study aim was to analyse outcomes and cost-effectiveness of VCs compared to pre-COVID-19 face-to face (F2F) clinics.

Method

We retrospectively analysed the VCs from 18^th March 2020 to 1st July 2020 and compared them to F2F clinics in the same period in 2019. Clinical outcomes were compared, and potential financial savings were estimated to see if VCs can be incorporated into future practice.

Results

1317 patients were reviewed in 2020 as compared to 1941 in 2019. We noted similar rates of discharges [25.4% (2020) v/s 24.1% (2019)], follow-ups (48.7% (2020) v/s 48.4% (2019)] and patients who did not attend/answer (6.8% (2020) v/s 6.6% (2019)]. Potentially, over £100,000 can be saved by changing 50% appointments to VCs.

Conclusions

Our data shows that VCs are non-inferior to F2F clinics and have allowed continued effective service provision during the COVID-19 pandemic. There is potential to incorporate VCs into future practice without compromising on efficacy. Further data collection and analysis is ongoing at our institution on a larger scale.

Oral dissolution therapy for radiolucent kidney stones. An old treatment revisited

Objective:

We present our experience using oral bicarbonate as a dissolution therapy for radiolucent kidney stones in the pre-dual energy CT era.

Methods:

A retrospective analysis of dissolution therapy was undertaken over a four-year period. Stones were diagnosed as radiolucent on conventional KUB X-ray in combination with either ultrasound or CT KUB. Oral bicarbonate was given at a dose of 2 g tds orally, increased to 2 g five times daily according to urinary pH. Patients monitored their own urine dipstick daily to achieve a pH of at least seven.

Results:

Altogether 27 patients were identified with radiolucent stones. Stone size varied from 4–40 mm. Average length of therapy was nine weeks. Of the patients, 17 had renal U/S and six had CT KUB as end point imaging. We found that 39% had complete dissolution, 18% had a partial response and 43% showed no response. A high serum uric acid level correlated with a higher incidence of dissolution. Cost-benefit analysis shows bicarbonate therapy to be more cost-effective than lithotripsy, ureteroscopy or nephrolithotomy.

Conclusions:

Bicarbonate therapy remains an attractive option for the treatment of radiolucent kidney stones. The presence of hyperuricaemia or hyperuricosuria appears to influence the success rate. Further prospective randomised studies are needed to identify the most tolerable and effective treatment regime as well as the optimal duration of treatment. Dual-energy CT may hold the key to identifying patients most likely to benefit from treatment.

Development of an outpatient finger-prick glomerular filtration rate procedure suitable for epidemiological studies

Development of an outpatient finger-prick glomerular filtration rate (GFR) procedure suitable for epidemiological studies. In clinical practice, reference GFR procedures are rarely used; in large-scale research studies, a great deal of effort and experience is required to obtain them, which is a considerable disincentive to using GFR as an end point. The major problem for both clinical staff and the subject is the length of time that the procedure takes, requiring continuous attendance in the outpatient clinic or its vicinity. Using iohexol as a marker, we therefore propose an alternative approach, which addresses this fundamental deterrent to a more widespread use of GFR measurement. Eighty-two GFR measurements were performed in a mixture of healthy subjects and patients with differing degrees of renal impairment with a wide range of GFRs. Serum was obtained from blood samples to enable a reference GFR to be calculated. Blood spots were collected on filter paper at the same intervals (120, 180, and 240 min), allowed to dry, and then sent through the post. Serum and blood spots were analyzed simultaneously for each individual by automated reverse-phase high-pressure liquid chromatography. Standard linear regression analyses confirmed a good agreement (r2 = 0.953) between the iohexol serum GFR and iohexol blood spots GFR. Bland-Altman analysis confirmed that there was no concentration bias. Paired comparisons (Wilcoxon's paired signed rank test) showed no significant difference between the two measurements. Capillary sampling is simple, effective, and significantly reduces the time and costs of performing plasma clearance GFR measurements. This approach will make the GFR measurement more accessible for clinical practice and large-scale epidemiological studies may become feasible.

Morbidity of transrectal ultrasonography-guided prostate biopsies in patients after the continued use of low-dose aspirin

OBJECTIVE

To determine whether low-dose aspirin increases morbidity after transrectal ultrasonography-guided sextant prostate biopsy.

PATIENTS AND METHODS

In a single-centre prospective cohort study of 200 patients who underwent sextant prostate biopsies, those routinely taking low-dose aspirin were encouraged to continue to do so before and after biopsy. The morbidity in each case was assessed using a standardized questionnaire that patients completed in the 7 days after biopsy. The presence of haematuria, rectal bleeding and haematospermia were recorded. The questionnaire also directed the patient to record fevers, use of analgesia and any further treatment received.

RESULTS

In all, 36 patients took aspirin whilst the other 141 did not. There were no major complications in either group. Of the patients on aspirin, 20 (56%) had haematuria, compared with 83 (59%) of those not taking aspirin (difference 3%, 95% confidence interval, CI, -15 to 21). Overall bleeding (haematuria, rectal bleeding and haematospermia) occurred in 22 patients (61%) of the aspirin group and 105 (74%) of the other group (difference 13%, 95% CI -4 to 31). Comparisons of other morbidities between the groups are also discussed.

CONCLUSIONS

There was no statistically significant difference in the incidence of haematuria or overall bleeding after biopsy between the groups. There is no evidence that aspirin needs to be discontinued before sextant prostate biopsy.