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Background and Objective: Surgical management of bladder outflow obstruction (BOO) caused by benign prostatic enlargement (BPE) has proven challenging, with increased pressure on National Health Service (NHS) resources. Traditionally, transurethral resection of prostate (TURP) was performed requiring an average inpatient stay of 2-4 days. If complications occur, the patient's stay in the urology ward is extended. Limited bed availability can result in the cancellation of elective surgeries. This continues to pose a challenge with the surge of COVID and respiratory infections during the winter season, resulting in a very limited bed availability. In recent decades, multiple new interventions for bladder outflow obstruction have emerged and proven safe and efficacious in multiple large studies. Our study's aim was to demonstrate GreenLight Laser Prostatectomy's (GLLP) feasibility as a 'true' day-case procedure. Materials and methods: Data collection for both GLLP and bipolar TURP was done as a retrospective observational cohort study in a single institution. Both cohorts underwent primary operation; primary GLLP cases were performed in 2021/2022, and primary bipolar TURP between 2023/2024. Greenlight laser prostatectomy was performed using the 180 W GreenLight XPS (TM) laser therapy system, and bipolar TURP using standard Olympus/Richard Wolf resectoscopes. Multiple preoperative, operative, and postoperative parameters were collected, with a primary focus on day-case discharge after the procedure. Results: A total of 180 patients underwent bladder outflow surgery, of which 90 patients (50%) had GLLP and the other 90 patients (50%) had TURP. The mean age for the GLLP group was 73.9 and for the TURP group was 71.9. We have observed a statistically significant difference in prostate volume between the two groups, with a mean volume of 98.9 cc for the GLLP group and 76.9 cc for the TURP group (p = 0.01). Even though prostates in the GLLP group were larger in size, the operation time was significantly shorter in the GLLP group, with a mean of 57.3 minutes, compared to 66.9 minutes for TURP (p = 0.01). In terms of hospital stay postoperatively, we observed a significant difference in the day-case discharge rate: 94.4% of patients in the GLLP group were discharged as day cases compared to only 4.4% in the TURP group (p < 0.001). Both the GLLP group (72 participants, 80%) and the TURP group (83 participants, 92.2%) achieved successful Trial to Void Without Catheter (TWOC), representing a significant difference in favour of TURP (p = 0.018). A survey regarding the patients' experience was conducted with the operative and postoperative processes has shown that 71.1% of participants in the GLLP group were satisfied, compared to 51.1% in the TURP group, which was statistically significant in favour of the GLLP (p < 0.001). Conclusion: Based on our observations, GLLP is a safe day-case operation with a good patient satisfaction rate and an acceptable success rate. It effectively addresses bladder outflow issues in hospitals with limited bed capacity. When implemented via a well-designed pathway, it can help reduce the waiting times in the NHS.
Background: Obesity and chronic kidney disease (CKD) often coexist and compound the risk of adverse health outcomes including dysglycemia and accelerated CKD progression. Obesity also limits access to kidney transplantation. The objectives of this study were to (1) understand current weight-management practices in CKD centres across Canada and (2) describe the availability of weight-management services nationwide. Methods: We conducted a cross-sectional, quantitative, online survey of English-speaking nephrologists practicing in Canada in 2025. The 23-question survey was developed based on a literature review and the content expertise of investigators. It was reviewed by nephrologists to ensure clarity, appropriateness, and ease of completion. Survey questions focused on the availability of dietitian services, exercise supports, behavioural counselling, weight-management consultations, and use of weight-loss medications in kidney outpatient clinics and dialysis units (including hemodialysis and peritoneal dialysis). The survey was administered via Qualtrics and distributed through the Canadian Society of Nephrology to nephrologists who care for patients with advanced CKD. Results: Between April 7 and June 12, 2025, 56 valid and complete responses were received, an estimated 15% response rate. Respondents primarily practised in Ontario (36%), Quebec (20%), British Columbia (18%), and Alberta (14%), with fewer respondents from the Territories and Atlantic provinces. Clinicians reported initiating weight-management discussions with patients when they felt obesity was contributing to poor health or impacting eligibility for transplant. While almost all nephrologists reported having access to a dietitian, over 60% were uncertain about the specific role of the dietitian in weight management. Gaps in the availability and coordination of behavioural coaching, physiotherapy, and exercise services were frequently cited. Over 60% of nephrologists reported prescribing weight-loss medications despite limited evidence supporting their efficacy and safety in patients with advanced CKD. Conclusions: Weight management is a recognized health priority in patients with advanced CKD, yet there are gaps in management. The nephrology community would benefit from weight-management services that reduce morbidity and improve transplant access for patients with CKD.
Atherosclerotic cardiovascular disease (ASCVD), particularly myocardial infarction (MI), is the leading cause of mortality and morbidity worldwide. The pathophysiology of MI involves atherosclerotic plaque rupture with thrombus formation, interrupting myocardial blood supply with subsequent myocardial necrosis. Despite advances in primary prevention and acute revascularization strategies for MI, recurrent ischemic events and stent thrombosis continue to pose challenging issues for clinicians. Consequently, effective secondary prevention, specifically antiplatelet therapy (aspirin and P2Y12 inhibitors), is the cornerstone of the prevention of recurrent ischemia and cardiovascular death to improve long-term prognosis. However, the optimal choice and duration of antiplatelet therapy should be individualized depending on risk factors and comorbidities. This review will explore the mechanisms of thrombosis in MI, the role of antiplatelet therapy in secondary prevention after MI, and the clinical evidence supporting various antiplatelet agents, focusing on their pharmacological profiles, efficacy, safety considerations, guideline recommendations, and application in special populations based on available clinical trial data while highlighting key controversies, knowledge gaps, and emerging strategies such as biomarker-guided and genotype-guided therapy.
Total elbow arthroplasty (TEA) is an established treatment for inflammatory arthropathy, osteoarthritis and trauma sequelae, but concerns remain regarding longevity and revision risk. This study evaluated revision-free survival, cumulative revision incidence accounting for death, and factors associated with failure. Primary TEAs recorded in the Scottish Arthroplasty Project from 1 January 2001 to 31 December 2023 were linked to hospital admissions, procedures and mortality. Implant type was confirmed using clinical portal records and PACS imaging. Failure was defined as first revision or removal. Revision-free survivorship was estimated using Kaplan-Meier methods, cumulative revision incidence using competing-risks analysis, and risk factors using multivariable cause-specific Cox and Fine-Gray models. Of 1491 TEA procedures, 1162 primary TEAs were included. Median age was 67 years (interquartile range 58 to 75), and 891 patients (76.7%) were female. The commonest implants were Coonrad/Morrey (n = 551), Discovery Elbow System (n = 271) and Souter-Strathclyde (n = 154). Overall revision-free survivorship was 87.2% (95% CI 84.3 to 90.1) at 15 years. Fifteen-year survivorship differed by implant: Coonrad/Morrey 88.6% (95% CI 83.8 to 92.1), Discovery 94.7% (95% CI 88.2 to 97.7) and Souter-Strathclyde 78.4% (95% CI 69.8 to 84.8) (log-rank p = 0.0017). Increasing age reduced revision risk (adjusted hazard ratio (aHR) 0.98 per year, 95% CI 0.96 to 0.996; p = 0.018), while Souter-Strathclyde had higher revision risk than Coonrad/Morrey (aHR 2.10, 95% CI 1.21 to 3.64; p = 0.008). Primary TEA showed good long-term survival in Scotland. Younger age and implant type were associated with revision risk, supporting careful selection and counselling.
Abstract Background Impacted fetal head (IFH) at full dilatation caesarean section (CS) is an increasingly recognised obstetric emergency associated with significant maternal and neonatal morbidity. Despite its importance, there is limited evidence to guide management, particularly the use of disimpaction devices. Methods LIFT is a prospective observational trial comparing the use of two commercially available disimpaction devices—the Fetal Pillow ® and the Tydeman ® Tube —for the management of IFH at full dilatation caesarean section. Discussion The LIFT study will compare the performance of the Fetal Pillow ® and Tydeman ® Tube in the management of IFH and contribute to the development of an evidence base to support best practice. As awareness of the clinical significance and implications of IFH continues to grow, generating robust data on available management options is essential. This study represents an important step toward optimising the safe and effective management of this challenging obstetric emergency. Trial registration NCT07372768, registered 28/01/2026, https://clinicaltrials.gov/study/NCT07372768 .
