Objective: This study compared radiation exposure and fluoroscopy time between intermittent flash fluoroscopy and continuous screening during endourological procedures. The principle of As Low As Reasonably Achievable was employed to minimise radiation doses. Methods: A quasi-experimental before-after study was conducted on rigid and flexible ureteroscopies, collecting data on cumulative dose, fluoroscopy time, dose–area product, and effective dose (ED) of radiation. Retrospective data from continuous-screening cases were also analysed. Results: The intermittent screening cohort showed a reduction in fluoroscopy time of 66.4% and a reduction in effective radiation dose of 68.4% when compared to continuous fluoroscopy. The average radiation dose per flash was low at 0.31 mGy, and no intraoperative complications were observed. Conclusion: This study demonstrates that intermittent flash fluoroscopy is a safe approach that significantly reduces radiation exposure during endourological procedures. Level of evidence: 3
Background: Supine mini-percutaneous nephrolithotomy is an established minimally invasive treatment for large renal calculi. Percutaneous renal access is a critical but technically demanding component of the procedure, with limited structured hands-on training opportunities available within the United Kingdom. This study evaluated the feasibility, educational value and clinical outcomes of the UK’s only live hands-on course designed to teach independent percutaneous renal access during supine mini-percutaneous nephrolithotomy. Methods: Participants were recruited through social media, professional referral and industry sponsorship. The 2-day course included case-based discussions, supine mini-percutaneous nephrolithotomy technical considerations, live operative demonstrations and supervised hands-on training in supine mini-percutaneous nephrolithotomy. A retrospective analysis of patient demographics, stone characteristics, operative outcomes and peri-operative complications was performed. A participant questionnaire regarding pre- and post-course exposure was obtained. Results: Fourteen participants attended this course between December 2019 and December 2024. Twelve responded to the questionnaire, with 100% ( n = 12) stating the course was educational and 91.7% performing independent supine percutaneous renal access after the course. This study included 31 patients, with a mean age of 56.8 years. The post-operative stone-free rate was 83.9%, and the mean hospital stay was 2.7 days. No visceral or major soft tissue injuries occurred. Complications were observed in 6 out of 31 patients, including Clavien–Dindo Grade II (2/31), Grade III (2/31) and Grade IV (2/31). Most of these complications were infection-related. Conclusion: A structured live hands-on training course in supine mini-percutaneous nephrolithotomy appears feasible and an effective teaching method for independent percutaneous renal access. This is highlighted by comparable clinical outcomes to established standards and candidate feedback. Level of evidence: IV
Burnout is an important concern within the urological workforce, with implications for trainee well-being, career satisfaction and workforce retention. UK studies have reported burnout rates among urology trainees ranging from 28.4% to 56%, with workload, rota gaps, limited protected training time and organisational culture identified as important contributors. However, these pressures may not be experienced equally by all clinicians. As the urological workforce becomes more diverse, attention should also be paid to workplace experiences that may compound existing occupational pressures. Microaggressions, stereotyping, exclusion, discrimination and reduced psychological safety may create additional psychosocial demands for some clinicians. We propose the concept of a ‘double burden’ to describe the potential interaction between the occupational demands of urological practice and these additional workplace pressures. This article considers the available evidence linking workplace culture, microaggressions and burnout, while acknowledging the current lack of robust urology-specific data. It highlights important research gaps and outlines practical approaches to improving psychological safety, inclusion and workforce well-being. Understanding not only the prevalence of burnout but also how workplace experiences are distributed across the workforce may be important in developing a more inclusive and sustainable future for UK urology.
Background: Renal stones are a common finding on ultrasound in primary care, often detected incidentally or during investigation for abdominal pain. Patients are frequently then referred to secondary care for further investigations. However, small (<5 mm) or asymptomatic stones may be safely managed in primary care without specialist intervention. As computed tomography of the kidneys, ureters and bladder remains the gold standard for diagnosing urinary tract stones, general practitioners within our Trust are advised by a consultant-led triage team to arrange computed tomography of the kidneys, ureters and bladder. This is prior to being accepted to secondary care in order to try and improve the efficiency of the patient pathway. Objectives: This study aimed to: (1) assess the accuracy of ultrasound in detecting clinically significant renal calculi (⩾5 mm) compared to computed tomography of the kidneys, ureters and bladder, (2) determine the proportion of patients who could be managed without specialist clinical review and (3) evaluate the impact of triage team advice and guidance on patient pathways. Methods: A retrospective review of 100 patients referred by general practitioners for computed tomography of the kidneys, ureters and bladder following ultrasound and advice and guidance input was conducted over 12 months (December 2023–November 2024). Data included stone size, number, laterality and timing between scans. Patients were included if they had had a prior ultrasound and were referred via urology e-consult. Results: Computed tomography findings differed from ultrasound in 85% of cases. Clinically significant stones (⩾5 mm) were confirmed in 47% of computed tomographies. Ultrasound overestimated stone size in 53% and underestimated it in 21%. Ultrasound overestimated stone number in 17% and underestimated it in 34%. The advice and guidance pathway reduced unnecessary clinic referrals by 53%, improving patient experience and service capacity. Conclusion: Ultrasound demonstrated limited accuracy in assessing renal calculi in this patient cohort. Early computed tomography of the kidneys, ureters and bladder, guided by advice and guidance, improves diagnostic precision, optimises patient flow and enhances resource allocation.
