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Simson N. Tackling health inequalities in prostate cancer: the Man Van project. Trends Urol & Men's Health 2023. [DOI: 10.1002/tre.901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Nick Simson
- Epsom and St Helier University Hospitals London UK
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Simson N, Mehan N, Abu-Ghanem Y, McDermott K, de Luyk N, Catterwell R, Namdarian B, O’Brien T, Fernando A, Nair R, Challacombe B. Robotic partial nephrectomy in solitary kidney: Feasibility and outcome. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)02269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Stroman L, Russell B, Kotecha P, Kantartzi A, Ribeiro L, Jackson B, Ismaylov V, Debo-Aina AO, MacAskill F, Kum F, Kulkarni M, Sandher R, Walsh A, Doerge E, Guest K, Kailash Y, Simson N, McDonald C, Mensah E, June Tay L, Chalokia R, Clovis S, Eversden E, Cossins J, Rusere J, Zisengwe G, Fleure L, Cooper L, Chatterton K, Barber A, Roberts C, Azavedo T, Ritualo J, Omana H, Mills L, Studd L, El Hage O, Nair R, Malde S, Sahai A, Fernando A, Taylor C, Challacombe B, Thurairaja R, Popert R, Olsburgh J, Cathcart P, Brown C, Hadjipavlou M, Di Benedetto E, Bultitude M, Glass J, Yap T, Zakri R, Shabbir M, Willis S, Thomas K, O'Brien T, Khan MS, Dasgupta P. Safety of "hot" and "cold" site admissions within a high-volume urology department in the United Kingdom at the peak of the COVID-19 pandemic. BJUI Compass 2021; 2:97-104. [PMID: 33821256 PMCID: PMC8013895 DOI: 10.1002/bco2.56] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/25/2020] [Accepted: 10/10/2020] [Indexed: 01/13/2023] Open
Abstract
Objectives To determine the safety of urological admissions and procedures during the height of the COVID‐19 pandemic using “hot” and “cold” sites. The secondary objective is to determine risk factors of contracting COVID‐19 within our cohort. Patients and methods A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high‐volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a “cold” site requiring a negative COVID‐19 swab 72‐hours prior to admission and patients were required to self‐isolate for 14‐days preoperatively, while all acute admissions were admitted to the “hot” site. Complications related to COVID‐19 were presented as percentages. Risk factors for developing COVID‐19 infection were determined using multivariate logistic regression analysis. Results A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44‐70) were admitted under the urology team; 101 (16.5%) on the “cold” site and 510 (83.5%) on the “hot” site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID‐19 postoperatively with one (0.2%) postoperative mortality due to COVID‐19. Overall, COVID‐19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID‐19 in our cohort (OR 1.25, 95% CI 1.13‐1.39). Conclusions Continuation of urological procedures using “hot” and “cold” sites throughout the COVID‐19 pandemic was safe practice, although the risk of COVID‐19 remained and is underlined by a postoperative mortality.
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Stonier T, Simson N, Shah T, Lobo N, Amer T, Lee SM, Bass E, Chau E, Grey A, McCartan N, Acher P, Ahmad I, Arumainayagam N, Brown D, Chapman A, Elf D, Hartington T, Ibrahim I, Leung H, Liyanage S, Lovegrove C, Malthouse T, Mateen B, Mistry K, Morrison I, Nalagatla S, Persad R, Pope A, Sokhi H, Syed H, Tadtayev S, Tharmaratnam M, Qteishat A, Miah S, Emberton M, Moore C, Walton T, Eddy B, Ahmed HU. The "Is mpMRI Enough" or IMRIE Study: A Multicentre Evaluation of Prebiopsy Multiparametric Magnetic Resonance Imaging Compared with Biopsy. Eur Urol Focus 2020; 7:1027-1034. [PMID: 33046412 DOI: 10.1016/j.euf.2020.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 08/19/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) is now recommended prebiopsy in numerous healthcare regions based on the findings of high-quality studies from expert centres. Concern remains about reproducibility of mpMRI to rule out clinically significant prostate cancer (csPCa) in real-world settings. OBJECTIVE To assess the diagnostic performance of mpMRI for csPCa in a real-world setting. DESIGN, SETTING, AND PARTICIPANTS A multicentre, retrospective cohort study, including men referred with raised prostate-specific antigen (PSA) or an abnormal digital rectal examination who had undergone mpMRI followed by transrectal or transperineal biopsy, was conducted. Patients could be biopsy naïve or have had previous negative biopsies. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary definition for csPCa was International Society of Urological Pathology (ISUP) grade group (GG) ≥2 (any Gleason ≥7); the accuracy for other definitions was also evaluated. RESULTS AND LIMITATIONS Across ten sites, 2642 men were included (January 2011-November 2018). Mean age and PSA were 65.3yr (standard deviation [SD] 7.8yr) and 7.5ng/ml (SD 3.3ng/ml), respectively. Of the patients, 35.9% had "negative MRI" (scores 1-2); 51.9% underwent transrectal biopsy and 48.1% had transperineal biopsy, with 43.4% diagnosed with csPCa overall. The sensitivity and negative predictive value (NPV) for ISUP GG≥2 were 87.3% and 87.5%, respectively. The NPVs were 87.4% and 88.1% for men undergoing transrectal and transperineal biopsy, respectively. Specificity and positive predictive value of MRI were 49.8% and 49.2%, respectively. The sensitivity and NPV increased to 96.6% and 90.6%, respectively, when a PSA density threshold of 0.15ng/ml/ml was used in MRI scores 1-2; these metrics increased to 97.5% and 91.2%, respectively, for PSA density 0.12ng/ml/ml. ISUP GG≥3 (Gleason ≥4+3) was found in 2.4% (15/617) of men with MRI scores 1-2. They key limitations of this study are the heterogeneity and retrospective nature of the data. CONCLUSIONS Multiparametric MRI when used in real-world settings is able to rule out csPCa accurately, suggesting that about one-third of men might avoid an immediate biopsy. Men should be counselled about the risk of missing some significant cancers. PATIENT SUMMARY Multiparametric magnetic resonance imaging (MRI) is a useful tool for ruling out prostate cancer, especially when combined with prostate-specific antigen density (PSAD). Previous results published from specialist centres can be reproduced at smaller institutions. However, patients and their clinicians must be aware that an early diagnosis of clinically significant prostate cancer could be missed in nearly 10% of patients by relying on MRI and PSAD alone.
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Affiliation(s)
- Thomas Stonier
- King's College Hospital, London, UK; Princess Alexandra Hospital, Harlow, UK.
| | - Nick Simson
- Princess Alexandra Hospital, Harlow, UK; Guy's and St Thomas' Hospital, London, UK
| | - Taimur Shah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Niyati Lobo
- Kent and Canterbury Hospital, East Kent Hospital University Foundation Trust, Kent, UK
| | - Tarik Amer
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Su-Min Lee
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Edward Bass
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Edwin Chau
- Southend University Hospital NHS Foundation Trust, Southend, UK
| | - Alistair Grey
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK; Division of Surgical and Interventional Sciences, University College London, London, UK; Department of Urology, Barts Health NHS Trust, London, UK
| | - Neil McCartan
- Division of Surgical and Interventional Sciences, University College London, London, UK
| | - Peter Acher
- Southend University Hospital NHS Foundation Trust, Southend, UK
| | - Imran Ahmad
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | | | - Alex Chapman
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | - Thomas Hartington
- Division of Surgical and Interventional Sciences, University College London, London, UK
| | | | - Hing Leung
- Queen Elizabeth University Hospital, Glasgow, UK
| | - Sidath Liyanage
- Southend University Hospital NHS Foundation Trust, Southend, UK
| | - Catherine Lovegrove
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Theo Malthouse
- Kent and Canterbury Hospital, East Kent Hospital University Foundation Trust, Kent, UK
| | | | - Kiki Mistry
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Iain Morrison
- Kent and Canterbury Hospital, East Kent Hospital University Foundation Trust, Kent, UK
| | | | - Raj Persad
- Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Alvan Pope
- The Hillingdon Hospitals NHS Foundation Trust, Hillingdon, UK
| | - Heminder Sokhi
- The Hillingdon Hospitals NHS Foundation Trust, Hillingdon, UK; Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Hira Syed
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | - Sergey Tadtayev
- Ashford and St Peter's Hospitals NHS Foundation Trust, Chertsey, UK
| | | | | | - Saiful Miah
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Mark Emberton
- Division of Surgical and Interventional Sciences, University College London, London, UK
| | - Caroline Moore
- Division of Surgical and Interventional Sciences, University College London, London, UK
| | - Tom Walton
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Ben Eddy
- Kent and Canterbury Hospital, East Kent Hospital University Foundation Trust, Kent, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK; Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
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Simson N, Stonier T, Challacombe B, Wheatstone S. When things go wrong: A surgeon's guide to iatrogenic injury (Perspective). Int J Surg 2019; 72:93-95. [PMID: 31683039 DOI: 10.1016/j.ijsu.2019.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nick Simson
- Guy's and St Thomas' Hospital, Great Maze Pond, London, United Kingdom.
| | - Thomas Stonier
- King's College Hospital, Denmark Hill, London, United Kingdom
| | - Ben Challacombe
- Guy's and St Thomas' Hospital, Great Maze Pond, London, United Kingdom
| | - Sarah Wheatstone
- Guy's and St Thomas' Hospital, Great Maze Pond, London, United Kingdom
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Simson N, Stonier T, Suleyman N, Hendry J, Salib M, Peacock J, Connor M, Jones O, Schuster-Bruce J, Bottrell O, Lovegrove C, English L, Hamami H, Horn C, Bagley J, Bareh A, Jaikaransingh D, Mohamed N, Ukwu U, Shanmugathas N, Batura D, McDonald J, Charitopoulos K, Graham A, Zakikhani P, Taneja S, Sells H, Bolgeri M, Wiseman O, Bycroft J, Qteishat A, Aboumarzouk O. Defining a national reference level for intraoperative radiation exposure in urological procedures: FLASH, a retrospective multicentre UK study. BJU Int 2019; 125:292-298. [PMID: 31437345 DOI: 10.1111/bju.14903] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Nick Simson
- Department of Urology; Guy's Hospital; London UK
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Stonier T, Simson N, Davis J, Challacombe B. Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) vs standard RARP: it's time for critical appraisal. BJU Int 2018; 123:5-7. [DOI: 10.1111/bju.14468] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Stonier
- Department of Urology; Princess Alexandra Hospital; Harlow UK
| | - Nick Simson
- Department of Urology; Princess Alexandra Hospital; Harlow UK
| | - John Davis
- Urology Centre; Guy's Hospital; London UK
| | - Ben Challacombe
- Department of Urology; MD Anderson Cancer Center; Houston TX USA
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Abstract
Incisional hernia follows midline laparotomy in 8 to 20 per cent of cases, but the rate following lateral incision is not well documented. This systematic review summarizes incisional hernia rate after open renal transplant. We searched EMBASE, MEDLINE, and the Cochrane Library databases from January 2000 to November 2016 inclusive. The outcomes included in our analysis were the posttransplant incisional hernia rate, significant patient risk factors for incisional hernia, the definition of incisional hernia used, the method used to detect incisional hernia, and the incision used for transplantation. Eight retrospective case series were identified, three describing renal transplant recipients and five describing incisional hernia repairs postrenal transplant. All reported the incisional hernia rate postrenal transplant at the host institution. The hernia rate ranged from 1.1 to 7.0 per cent, with a mean of 3.2 per cent. Factors associated with incisional hernia were body mass index >30, age >50, cadaveric graft, and reoperation through the same incision. Despite the significant comorbidity of renal transplant recipients, the incisional hernia rate postrenal transplant is significantly lower than that of post-midline laparotomy. The reasons for this are discussed. This demonstrates the importance of operative technique, local tissue quality and biomechanical factors in the formation of incisional hernia.
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Affiliation(s)
- Nick Simson
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, Essex, United Kingdom and
| | - Parker Samuel
- University College London Hospital, London, United Kingdom
| | - Thomas Stonier
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, Essex, United Kingdom and
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Simson N, Parker S, Stonier T, Halligan S, Windsor A. Incisional Hernia in Renal Transplant Recipients: A Systematic Review. Am Surg 2018; 84:930-937. [PMID: 29981627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Incisional hernia follows midline laparotomy in 8 to 20 per cent of cases, but the rate following lateral incision is not well documented. This systematic review summarizes incisional hernia rate after open renal transplant. We searched EMBASE, MEDLINE, and the Cochrane Library databases from January 2000 to November 2016 inclusive. The outcomes included in our analysis were the posttransplant incisional hernia rate, significant patient risk factors for incisional hernia, the definition of incisional hernia used, the method used to detect incisional hernia, and the incision used for transplantation. Eight retrospective case series were identified, three describing renal transplant recipients and five describing incisional hernia repairs postrenal transplant. All reported the incisional hernia rate postrenal transplant at the host institution. The hernia rate ranged from 1.1 to 7.0 per cent, with a mean of 3.2 per cent. Factors associated with incisional hernia were body mass index >30, age >50, cadaveric graft, and reoperation through the same incision. Despite the significant comorbidity of renal transplant recipients, the incisional hernia rate postrenal transplant is significantly lower than that of post-midline laparotomy. The reasons for this are discussed. This demonstrates the importance of operative technique, local tissue quality and biomechanical factors in the formation of incisional hernia.
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Shah TT, Gao C, O' Keefe A, Manning T, Peacocke A, Cashman S, Nambiar A, Lamb B, Cumberbatch M, Ivin N, Maw J, Ali Abdaal C, Al Hayek S, Christidis D, Bolton D, Lawrentschuk N, Khan S, Demirel S, Graham S, Lee JCM, Evans S, Koschel S, Badgery H, Brennan J, Wang L, Nzenza T, Ruljancich P, Begum R, Hamad S, Shetty A, Swallow D, Jessica S M, Curry D, Young M, Abboudi H, Jalil R, Dasgupta R, Cameron F, Shingles C, Ho C, Parwaiz I, Henderson J, Mackenzie KR, Reid K, Umeni-Eronini N, Assaf N, Oyekan A, Sriprasad S, Hayat Z, Morrison-Jones V, Steen C, Alberto M, Rujancich P, Laird A, Sharma A, Phipps S, Harris A, Rogers A, Ngweso S, Nyandoro M, Hayne D, Hendry J, Kerr L, Mcilhenny C, Rodger F, Docherty E, Ng A, Seaward L, Eldred-Evans D, Bultitude M, Abdelmoteleb H, Hawary A, Tregunna R, Ibrahim H, Mc Grath S, O’ Brien J, Campbell A, Cronbach P, Paget A, Suraparaj L, O' Brien J, Gupta SK, Tait C, Sakthivel A, Pankhania R, Al-Qassim Z, Rezacova M, Edison E, Sandhu S, Foley R, Akintimehin A, Khan A, Nkwam N, Grice P, Khan M, Kashora F, Manson-Bahr D, Mc Cauley N, Nehikhare O, Bycroft J, Tailor K, Saleemi A, Al-Dhahir W, Abu Yousif M, O' Rourke J, Chin AOL, Pearce I, Olivier J, Tay J, Cannon A, Akman J, Hussain Z, Coode-Bate J, Natarajan M, Irving S, Murtagh K, Carrie A, Miller M, Malki M, Burge F, Ratan H, Bedi N, Kavia R, Stonier T, Simson N, Singh H, Hatem E, Arya M, Sadien I, Miakhil I, Sharma S, Olaniyi P, Stammeijer R, Mason H, Symes A, Lavan L, Rowbotham C, Wong C, Al-Shakhshir S, Belal M, Mc Kay AC, Graham J, Simmons L, Khadouri S, Withington J, Ajayi L, Ajayi L, Tay LJ, Ward A, Parys B, Liew M, Simpson R, Ross D, Adams R, Mirza AB, Acher P, Gallagher M, Premakumar Y, Ager M, Ayres B, Pang K, Patterson J, Kozan AA, Jaffer A, Din W, Biyani CS, Tam JPH, Tudor E, Probert JL, Matanhelia M, Hegazy M, Quinlan D, Ness D, Gowardhan B, Bateman K, Wozniak S, Ellis G, Smith D, Derbyshire L, Chow K, Mosey R, Osman B, Kynaston H, Clements J, Hann G, Gray S, Yassaie O, Weeratunga G, Udovicich C, Mbuvi J, Stewart H, Samsudin A, Hughes-Hallet A, Kum F, Symes R, Frymann R, Chappell B, Rezvani S, Ahmed I, Shergill I, Lee SM, Hussain A, Pickard R, Erotocritou P, Smith D, Kasivisvanathan V. PD17-08 THE EFFECTS OF MEDICALLY EXPULSIVE THERAPY (MET) ON SPONTANEOUS STONE PASSAGE (SSP) IN PATIENTS PRESENTING WITH ACUTE URETERIC COLIC. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gemma Hann
- Belfast, Northern Ireland, United Kingdom
| | - Sam Gray
- Belfast, Northern Ireland, United Kingdom
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Abstract
A previously healthy 61-year-old Caucasian woman presented to the emergency department after collapsing at home with associated abdominal pain radiating to her back. An urgent CT angiogram was requested to rule out a ruptured aortic aneurysm. This showed a large 21 cm fat-containing lesion arising from the mid-pole of the left kidney, with an adjacent 4 cm perirenal haematoma. An initial diagnosis of a ruptured angiomyolipoma was made. Her haemoglobin was 105 g/L, with a creatinine of 104 mmol/L and an eGFR of 47 mL/min. Her clotting profile was normal. Following resuscitation, she was taken to the operating room and underwent an emergency open left radical nephrectomy via a left flank incision. Her recovery was uneventful and she was discharged home after 6 days. The histopathology confirmed a well-differentiated liposarcoma.
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Affiliation(s)
- Mohammed Al Sheikh
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Nick Simson
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Obinna Obi-Njoku
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Ahmed Qteishat
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
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Wilson E, Stonier T, Simson N, Stergios C. Bowel Perforation Presenting Three Months After Suprapubic Catheter Insertion. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Simson N, Stonier T, Singh H, Coscione A, Qteishat A. Are We Over-Radiating Our Patients? An Audit of CT KUB Scan Length. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Singh H, Simson N, Stonier T, Ivanov B. Urinalysis and Pregnancy Testing in the Acute Abdomen: A Prospective Audit. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.08.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
An 82-year-old male with multiple comorbidities, including previous laparotomies, had a suprapubic catheter (SPC) inserted under guidance with ultrasound and a flexible cystoscope. Three months following the procedure, having returned for a flexible cystoscopy for ongoing bladder pain syndrome, he became peritonitic postoperatively.A CT scan and subsequent laparotomy confirmed the SPC to be passing through a section of terminal ileum. The bowel was resected and he recovered well after a long hospital admission. A literature search found this delayed presentation of bowel perforation following SPC insertion to be rare, with only a few other cases reported. In particular, previous abdominal surgery increases the risk of this complication. This case serves as a reminder of the rare but potentially significant risk of SPC insertion and unusually highlights that this may not present immediately.
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Affiliation(s)
- Thomas Stonier
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Nick Simson
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Elizabeth Wilson
- School of Medicine and Dentistry, University of Bristol, Bristol, UK
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Simson N, Stonier T, Coscione A, Qteishat A. A rare urological presentation of appendicitis. BMJ Case Rep 2017; 2017:bcr-2017-220546. [PMID: 28798242 DOI: 10.1136/bcr-2017-220546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 17-year-old boy with no medical comorbidities, but a significant family history of malignancy, presented to Accident and Emergency following 3 days of increasing rectal pain, symptoms of bladder outflow obstruction (poor flow, intermittent stream and hesitancy) and dysuria. Notably he had no abdominal pain. Digital rectal examination revealed a tender, enlarged prostate. Inflammatory markers were significantly raised (white cell count 17.7, C reactive protein 191). He was diagnosed clinically as prostatitis and commenced on intravenous antibiotics. Despite this his pain and inflammatory markers deteriorated, necessitating a CT of his abdomen and pelvis. This demonstrated multiloculated large thick-walled abscesses in the pelvis closely related to the rectum, prostate and seminal vesicles with some bowel wall thickening. Laparoscopy demonstrated a large colonic mass adherent to surrounding structures. The procedure was converted to laparotomy to enable resection of the mass via a limited right haemicolectomy. He recovered well and was discharged. Histopathological analysis of the specimen revealed appendicitis.
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Affiliation(s)
- Nick Simson
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Thomas Stonier
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Alberto Coscione
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Ahmed Qteishat
- Department of Urology, Princess Alexandra Hospital NHS Trust, Harlow, UK
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Simson N, Stonier T, Challacombe BJ. Urological complications: learning from the past and preparing for the future. BJU Int 2017; 120:607-609. [PMID: 28672077 DOI: 10.1111/bju.13948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nick Simson
- Department of Urology, Princess Alexandra Hospital, Harlow, Essex
| | - Thomas Stonier
- Department of Urology, Princess Alexandra Hospital, Harlow, Essex
| | - Ben J Challacombe
- Department of Urology, Princess Alexandra Hospital, Harlow, Essex.,Department of Urology, Guy's Hospital, London, UK
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Stonier T, Simson N, Lee SM, Robertson I, Amer T, Somani BK, Rai BP, Aboumarzouk O. Laparoscopic vs robotic nephroureterectomy: Is it time to re-establish the standard? Evidence from a systematic review. Arab J Urol 2017; 15:177-186. [PMID: 29071149 PMCID: PMC5651951 DOI: 10.1016/j.aju.2017.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/26/2017] [Accepted: 05/09/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To conduct a systematic review of comparative studies of laparoscopic nephroureterectomy (LNU), the standard management for upper urothelial tumours, and robot-assisted NU (RANU) that has emerged as a viable alternative. METHODS MEDLINE, EMBASE and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all studies reporting on both LNU and RANU for upper urothelial tract tumours. RESULTS In all, 1630 patients were included, of which 838 underwent LNU and 792 RANU. Three studies reported on mean operative time and found it to be less in LNU, with two reporting this to be significant (RANU 298 vs LNU 251 min, P = 0.03; 306 vs 234 min, respectively, P < 0.001). Both studies reporting on median node count found this to be higher in the robotic groups: RANU 5.5 vs LNU 1.0 and RANU 21 vs LNU 11. Positive surgical margins (RANU 1.69% vs LNU 7.06%, P = 0.18), bladder recurrence (24.6% vs 36.89%, P = 0.09), and distant metastases (27.50% vs 17.50%, P = 0.29) were not significantly different between the two techniques. Disease-specific mortality did not differ between the two techniques (RANU 7.5% vs LNU 12.5%, P = 0.46), but postoperative mortality was reduced in RANU (0.14% vs 1.32%, P = 0.03). Overall complication rates were statistically lower in RANU, at 12.5% vs 18.8% (P < 0.001). CONCLUSIONS This review suggests these techniques are equivalent in terms of perioperative and oncological performance. Furthermore, there may be a lower overall complication rate, as well as postoperative mortality in the robotic group. Further research in the form of a randomised controlled trial is warranted.
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Affiliation(s)
| | - Nick Simson
- Princess Alexandra Hospital, Harlow, Essex, UK
| | - Su-Min Lee
- Weston General Hospital, Weston-Super-Mare, North Somerset, UK
| | | | - Tarik Amer
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Bhaskar K Somani
- University Hospital Southampton NHS Trust, Southampton, Hampshire, UK
| | - Bhavan P Rai
- James Cook University Hospital, Middlesbrough, North Yorkshire, UK
| | - Omar Aboumarzouk
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
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Stonier T, Simson N, Challacombe B. Diagnosing testicular lumps in primary care. Practitioner 2017; 261:13-17. [PMID: 29020728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although the incidence of testicular cancer has increased over the past few decades, testicular tumours are still rare and many GPs will only see one or two new diagnoses in their career. In one UK study, out of 845 patients who had been referred with testicular lumps or pain, only 33 (4%) were diagnosed with testicular cancer. Epididymal cysts, or spermatoceles when containing sperm, were the most common finding, and were found in 228 patients (27%). The second most common finding was hydrocele, a fluid collection between the parietal and visceral layers of the tunica vaginalis, which was found in 96 patients (11%). The vast majority (95-98%) of testicular cancers are germ cell tumours. In Western Europe, five-year survival for testicular cancer is approximately 95%. It is almost 100% for stage 1 seminomas, but falls to 48% in the poorest prognostic group – non-seminomatous tumours with metastases at diagnosis.When examining scrotal swellings, the key question is whether the lump is intra- or extra-testicular, as palpable intra-testicular lesions are highly likely (around 90%) to be malignant, whereas those lying outside the testis are usually benign. NICE recommends that men with non-painful enlargement or change in shape or texture of the testis should be referred via the two-week wait cancer pathway. Any painful or tender mass within the body of the testis which is not suggestive of infection should also be referred. GPs should refer patients for an urgent ultrasound if they are aged 20-40 with a hydrocele; if there is uncertainty as to whether the mass is intra-testicular or extra-testicular; or if the testis cannot be fully palpated.
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Hardman J, Elvey M, Shah N, Simson N, Patel S, Anakwe R. Defining reference levels for intra-operative radiation exposure in orthopaedic trauma: A retrospective multicentre study. Injury 2015; 46:2457-60. [PMID: 26604035 DOI: 10.1016/j.injury.2015.10.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 09/22/2015] [Accepted: 10/05/2015] [Indexed: 02/02/2023]
Abstract
There is currently limited data to define reference levels for the use of ionising radiation in orthopaedic trauma surgery. In this multicentre study, we utilise methodology employed by the Health Protection Agency in establishing reference levels for diagnostic investigations in order to define analogous levels for common and reproducible orthopaedic trauma procedures. Four hundred ninety-five procedures were identified across four Greater London hospitals over a 1-year period. Exposure was defined in terms of both time and dose area product (DAP). Third quartile mean values for either parameter were used to define reference levels. Variations both between centres and grades of lead surgeon were analysed as secondary outcomes. Reference levels; dynamic hip screw (DHS) 1.9225000 Gycm(2)/70.50 s, intramedullary (IM) femoral nail 1.5837500 Gycm(2)/126.00 s, open reduction internal fixation (ORIF) clavicle 0.2042500 Gycm(2)/21.50 s, ORIF lateral malleolus 0.32250500 Gycm(2)/35.00 s, ORIF distal radius 0.1300000 Gycm(2)/56.00 s. Grade of surgeon did not influence exposure in dynamic hip screw, and was inversely related to exposure in intramedullary femoral nails. Less variation was observed with exposure time than with DAP. This study provides the most comprehensive reference to guide fluoroscopy use in orthopaedic trauma to date, and is of value both at the point of delivery and for audit of local practice.
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Affiliation(s)
- J Hardman
- Trauma & Orthopaedics, St Marys Hospital, Praed Street, W2 1NY London, United Kingdom.
| | - M Elvey
- Trauma & Orthopaedics, University College Hospital, 235 Euston Road, NW1 2BU London, United Kingdom
| | - N Shah
- Trauma & Orthopaedics, Basildon University Hospital, Basildon, Essex SS16 5NL, United Kingdom
| | - N Simson
- Trauma & Orthopaedics, Watford General Hospital, Vicarage Road, Watford WD18 0HB, United Kingdom
| | - S Patel
- Trauma & Orthopaedics, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, United Kingdom
| | - R Anakwe
- Trauma & Orthopaedics, St Marys Hospital, Praed Street, W2 1NY London, United Kingdom
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Hammond JS, Humphries S, Simson N, Scrimshaw H, Catton J, Gornall C, Maxwell-Armstrong C. Adherence to enhanced recovery after surgery protocols across a high-volume gastrointestinal surgical service. Dig Surg 2014; 31:117-22. [PMID: 24942596 DOI: 10.1159/000362097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 03/04/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Enhanced recovery after surgery (ERAS) has been shown to improve outcomes for patients following gastrointestinal surgery. Data on protocol adherence and how this impacts on outcome are limited. This study examines how protocol adherence changes over time and determines how this impacts on outcome across a large-volume gastrointestinal surgical service. MATERIALS AND METHODS A prospective review of patients eligible for colorectal, liver and oesophagogastric ERAS over two 3-month periods in 2010 and 2011 was performed. End points included: length of stay (LOS), overall protocol adherence, individual modality adherence, reason for pathway deviation and patient outcomes. RESULTS 172 patients (110 colorectal, 31 liver and 31 oesophagogastric) were evaluated. For each sub-speciality, the introduction of ERAS led to significant reductions in LOS that were sustained for the duration of the study. Adherence was achieved across 60% (colorectal), 75% (liver) and 88% (oesophagogastric) of individual pathway modalities. The major causes of pathway deviation were: post-operative nausea and vomiting (colorectal), pain (liver) and pulmonary complications (oesophagogastric). CONCLUSIONS Large-scale implementation of ERAS at a high-volume centre is feasible and offers many of the benefits demonstrated in controlled trials, but adherence may diminish over time.
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Affiliation(s)
- John S Hammond
- Division of Gastrointestinal Surgery, Nottingham Digestive Diseases Centre NIHR Biomedical Research Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Simson N, Maxwell-Armstrong C. A clinical audit of enhanced recovery after surgery (ERAS) on five surgical wards at NUH. Int J Surg 2011. [DOI: 10.1016/j.ijsu.2011.07.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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