Introduction Evaluating the safety and acceptability of reusing catheters for intermittent catheterisation (IC) is one of the top 10 continence research priorities identified by the UK James Lind Alliance Priority Setting Partnership in 2008. There are an estimated 50 000 IC users in England and this number is rising. Globally, both single-use catheters (thrown away after use) and multi-use/reusable ones (cleaned between uses) are used. Using multi-use catheters as well as single-use ones (mixed-use) could bring benefits (eg, reducing plastic waste and patients never running out of catheters) and offer more choice to users. Evidence is needed that mixed-use is at least as safe and acceptable as using only single-use catheters.Methods The MultICath Trial is a non-inferiority randomised controlled trial involving 578 participants. The aim is to compare mixed-use catheter management with single-use catheter management over 12 months. Participants are randomised on a 1:1 basis to either mixed-use catheter management, which includes an evidence-based cleaning method for the multi-use catheters (intervention) or single-use catheter management (control). Following randomisation, participants are followed up for 12 months. The primary outcome is at least one episode of microbiologically confirmed symptomatic urinary tract infection with help-seeking or self-help behaviour over the 12-month follow-up period. Laboratory analysis of patient-initiated urine samples is blind. Secondary outcomes include antibiotic use, microhaematuria, visible blood on catheter/in urine, quality of life and health economics. A qualitative sub-study to examine participant experiences using mixed-use is included.Ethics and dissemination Ethical review was undertaken by South Central-Hampshire A Research Ethics Committee and favourable opinion was granted on 12 July 2019 (reference: 19/SC/0334). Written, informed consent to participate was obtained from all participants. Results will be disseminated in peer-reviewed publications, in the National Institute for Health and Care Research journal library and to participants and the public via a lay summary published on the trial website.Trial registration number ISRCTN42028483.

Upper urinary tract urothelial cancer is a rare, aggressive variant of urinary tract cancer. There is often delay to diagnosis and management for this entity in view of diagnostic and staging challenges needing additional investigations and risk stratifications for improved outcomes. In this article, we share our experience in developing a dedicated diagnostic and treatment pathway for UTUC and assess its impact on time lines to radical nephroureterectomy (RNU). We also evaluate the impact of diagnostic ureteroscopy (DUR) on UTUC care pathways timelines. A prospective database was maintained for all patients who underwent a RNU from January 2015 to August 2022 in a high-volume single tertiary care centre in the UK. In 2019, a Focused UTUC pathway (FUP) was implemented at the centre to streamline diagnostic and RNU pathways. A retrospective analysis of the database was conducted to compare time lines and diagnostic trends between the pre-FUP and FUP cohorts. Primary outcome measures were time to RNU from MDT. Secondary outcome measures were: impact of DUR on time to RNU from MDT and negative UTUC rates between DUR and non-DUR cohorts. Differences in continuous variables across categories were assessed using the independent sample t test. Categorical variables between cohorts were analysed using the chi-square (χ2). Statistical significance in this study was set as p < 0.05. A total of 500 patients with complete data were included in the analysis. The pre-FUP and FUP cohorts consisted of 313 patients and 187 patients, respectively. The overall cohort had a mean age (SD) of 70 years (9.3). 66

INTRODUCTION:Calyceal diverticula (CD) are traditionally diagnosed by contrast studies. However, non-contrast CT is the standard imaging modality for kidney stones. Therefore, we aimed to determine if the lack of contrast imaging affected outcomes of the management of symptomatic CD with stone.MATERIALS AND METHODS:This is a retrospective study of patients diagnosed with CD with intracalyceal stone from 2000 to 2017 analyzing demographics, clinical data, and success of different treatment options. The timing of CD diagnosis is correlated to the success of the first treatment.RESULTS:Forty-eight patients were found. CD was diagnosed prior to intervention in 20 (42%) cases and intraoperatively during flexible ureteroscopy in 17 (35%) and 11 (23%) cases were diagnosed after failed intervention, mainly ESWL. We found that the success rate of treatment was highly affected by the timing and modality of diagnosis. Preoperative diagnosis of CD was associated with 69% success rate of the first intervention. In contrast, there was a 0% success rate of first treatment if CD was not diagnosed with contrast imaging. Furthermore, univariate analysis showed no significant association between sociodemographics and clinical variables and success treatment (p > 0.05).CONCLUSIONS:The delay in diagnosing CD with stone contributes significantly to the success rate and the number of treatments.

BackgroundPeople carrying out clean intermittent self-catheterisation (CISC) to empty their bladder often suffer repeated urinary tract infections (UTIs). Continuous once-daily, low-dose antibiotic treatment (antibiotic prophylaxis) is commonly advised but knowledge of its effectiveness is lacking.ObjectiveTo assess the benefit, harms and cost-effectiveness of antibiotic prophylaxis to prevent UTIs in people who perform CISC.DesignParallel-group, open-label, patient-randomised 12-month trial of allocated intervention with 3-monthly follow-up. Outcome assessors were blind to allocation.SettingUK NHS, with recruitment of patients from 51 sites.ParticipantsFour hundred and four adults performing CISC and predicted to continue for ≥ 12 months who had suffered at least two UTIs in the previous year or had been hospitalised for a UTI in the previous year.InterventionsA central randomisation system using random block allocation set by an independent statistician allocated participants to the experimental group [once-daily oral antibiotic prophylaxis using either 50 mg of nitrofurantoin, 100 mg of trimethoprim (Kent Pharmaceuticals, Ashford, UK) or 250 mg of cefalexin (Sandoz Ltd, Holzkirchen, Germany);n = 203] or the control group of no prophylaxis (n = 201), both for 12 months.Main outcome measuresThe primary clinical outcome was relative frequency of symptomatic, antibiotic-treated UTI. Cost-effectiveness was assessed by cost per UTI avoided. The secondary measures were microbiologically proven UTI, antimicrobial resistance, health status and participants’ attitudes to antibiotic use.ResultsThe frequency of symptomatic antibiotic-treated UTI was reduced by 48% using prophylaxis [incidence rate ratio (IRR) 0.52, 95% confidence interval (CI) 0.44 to 0.61;n = 361]. Reduction in microbiologically proven UTI was similar (IRR 0.49, 95% CI 0.39 to 0.60;n = 361). Absolute reduction in UTI episodes over 12 months was from a median (interquartile range) of 2 (1–4) in the no-prophylaxis group (n = 180) to 1 (0–2) in the prophylaxis group (n = 181). The results were unchanged by adjustment for days at risk of UTI and the presence of factors giving higher risk of UTI. Development of antimicrobial resistance was seen more frequently in pathogens isolated from urine andEscherichia colifrom perianal swabs in participants allocated to antibiotic prophylaxis. The use of prophylaxis incurred an extra cost of £99 to prevent one UTI (not including costs related to increased antimicrobial resistance). The emotional and practical burden of CISC and UTI influenced well-being, but health status measured over 12 months was similar between groups and did not deteriorate significantly during UTI. Participants were generally unconcerned about using antibiotics, including the possible development of antimicrobial resistance.LimitationsLack of blinding may have led participants in each group to use different thresholds to trigger reporting and treatment-seeking for UTI.ConclusionsThe results of this large randomised trial, conducted in accordance with best practice, demonstrate clear benefit for antibiotic prophylaxis in terms of reducing the frequency of UTI for people carrying out CISC. Antibiotic prophylaxis use appears safe for individuals over 12 months, but the emergence of resistant urinary pathogens may prejudice longer-term management of recurrent UTI and is a public health concern. Future work includes longer-term studies of antimicrobial resistance and studies of non-antibiotic preventative strategies.Trial registrationCurrent Controlled Trials ISRCTN67145101 and EudraCT 2013-002556-32.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full inHealth Technology AssessmentVol. 22, No. 24. See the NIHR Journals Library website for further project information.

Summary Background Repeated symptomatic urinary tract infections (UTIs) affect 25% of people who use clean intermittent self-catheterisation (CISC) to empty their bladder. We aimed to determine the benefits, harms, and cost-effectiveness of continuous low-dose antibiotic prophylaxis for prevention of recurrent UTIs in adult users of CISC. Methods In this randomised, open-label, superiority trial, we enrolled participants from 51 UK National Health Service organisations. These participants were community-dwelling (as opposed to hospital inpatient) users of CISC with recurrent UTIs. We randomly allocated participants (1:1) to receive either antibiotic prophylaxis once daily (prophylaxis group) or no prophylaxis (control group) for 12 months by use of an internet-based system with permuted blocks of variable length. Trial and laboratory staff who assessed outcomes were masked to allocation but participants were aware of their treatment group. The primary outcome was the incidence of symptomatic, antibiotic-treated UTIs over 12 months. Participants who completed at least 6 months of follow-up were assumed to provide a reliable estimate of UTI incidence and were included in the analysis of the primary outcome. Change in antimicrobial resistance of urinary and faecal bacteria was monitored as a secondary outcome. The AnTIC trial is registered at ISRCTN, number 67145101; and EudraCT, number 2013-002556-32.

Clean intermittent self-catheterisation is an important management option for people who cannot empty their bladder effectively. Recurrent urinary tract infections are common in these patients. Data from recent studies suggest that antibiotic prophylaxis may be beneficial in reducing infection risk, but the effectiveness of this intervention remains uncertain.

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder I1 Apr 2015PD8-04 TRANSMOGRIFYING INFECTION STONES: ARE CALCIUM STONES NOW THE COMMONER INFECTION STONES IN PCNL? Ivo Dukic, Ayo Kalejaiye, Kim Jacobson, Francis Keeley, Anthony Timoney, and Joe Philip Ivo DukicIvo Dukic More articles by this author , Ayo KalejaiyeAyo Kalejaiye More articles by this author , Kim JacobsonKim Jacobson More articles by this author , Francis KeeleyFrancis Keeley More articles by this author , Anthony TimoneyAnthony Timoney More articles by this author , and Joe PhilipJoe Philip More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.919AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) is the standard surgical treatment for large renal calculi. A preponderance for struvite stones have been reported but with significant regional variations. This study reviewed the stone composition in patients undergoing PCNL and the associated infection parameters. METHODS Over a two-year period ending October 2014, microbiological [mid-stream urine (MSU) and stone cultures] and biochemical (stone analysis) parameters for all patients undergoing PCNL were assessed in comparison to the number of septic episodes and length of stay. RESULTS 93 PCNL procedures were performed with 2/3rds having a positive stone culture (SC) and a quarter having had post-operative septic episodes. 62% SC positive patients had predominately calcium phosphate stones, 18% calcium oxalate stones and 21% rare stone types. In SC negative patients, 38% had calcium phosphate stones, 41% calcium oxalate stones and 27% rare stone types. Among the SC positive patients with calcium phosphate stones, 29% of patients had a febrile episode. In those with calcium oxalate, 45% had a febrile episode. The most common type of stone culture bacteria were mainly mixed growths (26%), E. coli (20%), and staphylococcus (15%) There was a 63% concordance between the pre-operative MSU and stone culture positive stones. CONCLUSIONS 80% of the patients had a calcium stone, with two thirds having a stone colonised with bacteria. A positive MSU and stone culture were associated with increased risks of sepsis. A high incidence of infected calcium stones and febrile episodes suggests changing patient stone demographics. Early identification of these patients should enable pre-emptive antibiotic therapy, thereby reducing septic episodes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e191 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ivo Dukic More articles by this author Ayo Kalejaiye More articles by this author Kim Jacobson More articles by this author Francis Keeley More articles by this author Anthony Timoney More articles by this author Joe Philip More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVE:To review our experience in the management of secondary pelvi-ureteric junction obstruction (PUJO) comparing endopyelotomy with pyeloplasty.PATIENTS AND METHODS:We retrospectively analysed our database of 58 patients having undergone operative management of PUJO after failed primary management, including 41 with failed pyeloplasty and 17 failed endopyelotomy. Outcomes included mercapto-acetyltriglycine (MAG3) drainage capacity, symptomatic control and need for further intervention. Success was defined as freedom from failure in all three.RESULTS:Patients undergoing secondary pyeloplasty had better outcomes than endopyelotomy for symptomatic success (87.5% vs 74%), resolution of obstruction on MAG3 renography (96% vs 74%), and no need for further intervention (96% vs 71%). Overall success was 87.5% for pyeloplasty compared with 44% after secondary endopyelotomy.CONCLUSION:Outcomes of pyelopasty for secondary PUJO were superior when compared with endopyelotomy.

Objectives: To assess the ease of insertion and removal of a temporary prostatic stent (the Spanner™) following the use of a prostatic urethral measuring device (the Surveyor™). Patients and Methods: Patients with bladder outflow obstruction or urinary retention awaiting definitive surgery were fully consented. Data were collected pre- and post-insertion and patients followed-up until definitively treated. Results: 16 patients had the Spanner inserted following use of the Surveyor. All insertions were uncomplicated. 14 patients were able to void satisfactorily immediately post-insertion with a mean Qmax of 15.0 ml/s and post-void residual of 51.3 ml. No symptomatic infection was reported. The stents stayed in situ for a median of 10 days. 12 stents were removed prematurely due to severe symptoms or retention. A total of 12 stents had to be removed endoscopically. Conclusions: The Spanner is easy to insert. Stent removal via the retrieval suture has been difficult necessitating the use of endoscopy in the majority of cases. Possible causes of stent failure include underestimation of the prostatic urethral length by the Surveyor leading to obstruction by apical prostatic tissue, excessive suture length between the stent and distal anchor permitting proximal migration or inadequate suture length leading to urinary incontinence. Further design modifications are suggested.

OBJECTIVE:This study aimed to explore the relationship between stone density and outcomes of percutaneous nephrolithotomy (PCNL) using the Clinical Research Office of the Endourological Society (CROES) PCNL Global Study database.MATERIAL AND METHODS:Patients undergoing PCNL treatment were assigned to a low stone density [LSD, ≤ 1000 Hounsfield units (HU)] or high stone density (HSD, > 1000 HU) group based on the radiological density of the primary renal stone. Preoperative characteristics and outcomes were compared in the two groups.RESULTS:Retreatment for residual stones was more frequent in the LSD group. The overall stone-free rate achieved was higher in the HSD group (79.3% vs 74.8%, p = 0.113). By univariate regression analysis, the probability of achieving a stone-free outcome peaked at approximately 1250 HU. Below or above this density resulted in lower treatment success, particularly at very low HU values. With increasing radiological stone density, operating time decreased to a minimum at approximately 1000 HU, then increased with further increase in stone density. Multivariate non-linear regression analysis showed a similar relationship between the probability of a stone-free outcome and stone density. Higher treatment success rates were found with low stone burden, pelvic stone location and use of pneumatic lithotripsy.CONCLUSIONS:Very low and high stone densities are associated with lower rates of treatment success and longer operating time in PCNL. Preoperative assessment of stone density may help in the selection of treatment modality for patients with renal stones.

This study aims to evaluate the outcome of ureteroscopy/ureterorenoscopy (URS) as a salvage procedure for stones resistant to extracorporeal shock wave lithotripsy (ESWL). Between January 2009 and January 2012, 313 patients with upper tract lithiasis were treated by URS. Among them, 87 (27.8 %) had undergone URS after prior ESWL failed to achieve stone clearance (Salvage group). These patients were matched with a group of patients who underwent URS as first-line modality (Primary group). Stone-free rates and adjuvant procedures represented the primary points for comparison. Secondary points for comparison included complications, procedure duration, total laser energy used and length of hospitalization. Matching was possible in all cases. Stone clearance rates were 73.6 and 82.8 % for the Salvage and Primary group, respectively. The difference in stone clearance rates between the two groups was not statistically significant (p = 0.186). A total of 11 patients (12.6 %) in the Primary group and 18 patients (20.7 %) in the Salvage group underwent an adjuvant procedure (p = 0.154). No statistically significant differences were noted in terms of complications, procedure duration and length of hospitalization. In the Primary group, the laser energy used for stone fragmentation was higher (p = 0.043). The rate of ureteric stenting at the end of the procedure was higher for the Salvage group (p = 0.030). Previous failed ESWL is not a predictor for unfavorable outcome of URS. Salvage URS is associated, however, with an increased need for ureteric stenting at the end of the procedure.

We review the literature about the impact of shock wave lithotripsy (SWL) on male reproduction. Studies investigating the in vitro effect of shock waves on semen samples indicate that spermatozoa are vulnerable to SWL. According to animal studies, intratesticular bleeding is common, but pregnancy rates are not affected by shock waves. In the clinical setting, SWL causes an acute deterioration in sperm quality, but semen parameters return to baseline 3 months later. Long-term data on male fertility (ie, pregnancy rates) after SWL have yet to be reported and the significance of preexisting infertility has not been elucidated to date.

What's known on the subject? and What does the study add? One of the suggested factors for stent‐related symptoms is that excess distal intravesical stent mass may cause bladder irritation. There is a lack of studies investigating this in a randomised controlled fashion using a validated questionnaire. This study compared two of the most commonly used length of stents (a 30 cm multi‐length vs a 24 cm long stent) and showed no significance difference in stent‐related symptoms in patients with either of these stents. Objective To investigate whether excessive redundant intravesical stent component contributes to the severity of stent‐related symptoms in patients with a ureteric stent. We compared stent‐related symptoms in patients who had either a standard 24 cm or multi‐length ureteric stent. Patients and Methods I n all, 162 patients with upper urinary tract calculi requiring ureteric stent insertion were randomised to receive either a 6 F × 24 cm Contour TM or multi‐length 6 F × 22–30 cm C ontour VL TM stent. Patients were requested to complete the validated B ristol U reteric S tent S ymptom Q uestionnaire ( USSQ ) at 1 and 4 weeks after stent insertion and 4 weeks after removal. The mean scores for each domain of the USSQ for both groups were compared using the Student's t ‐test. Any adverse events, e.g. stent migration, early removal of stent due to stent‐related symptoms and failure of stent insertion, were also recorded. Results In all, 153 patients who had successful stent insertion were requested to complete the USSQ and 74% of patients returned at least the week 1 questionnaire. At 1 and 4 weeks with the stent in situ , comparison of the mean scores showed no significant difference in urinary symptoms, pain, general health, work performance, sexual dysfunction and number of days patients stayed in bed or reduced their routine activities. Three (2%) patients had their stent removed early due to stent‐related symptoms and five (3%) had failed stent insertion. Conclusions This study did not find any difference in symptoms between the 24 cm or multi‐length C ontour stents. However, the study was not powered to detect small differences particularly for the pain symptom domain. Stents should only be used sparingly and the stent dwell‐time should be minimised.

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality of Life1 Apr 2011633 A MULTI-CENTRE RANDOMIZED CONTROLLED STUDY TO COMPARE THE IMPACT OF DIFFERENT URETERAL STENT LENGTHS ON PATIENTS' QUALITY OF LIFE USING A VALIDATED QUESTIONNAIRE Robert Calvert, Kee Wong, Sudhanshu Chitale, Stuart Irving, Muthuswamy Nagarajan, Chandra Biyani, Anthony Browning, James Young, Anthony Timoney, Francis Keeley, and Neil Burgess Robert CalvertRobert Calvert Liverpool, United Kingdom More articles by this author , Kee WongKee Wong Liverpool, United Kingdom More articles by this author , Sudhanshu ChitaleSudhanshu Chitale Norwich, United Kingdom More articles by this author , Stuart IrvingStuart Irving Norwich, United Kingdom More articles by this author , Muthuswamy NagarajanMuthuswamy Nagarajan Wakefield, United Kingdom More articles by this author , Chandra BiyaniChandra Biyani Wakefield, United Kingdom More articles by this author , Anthony BrowningAnthony Browning Wakefield, United Kingdom More articles by this author , James YoungJames Young Bristol, United Kingdom More articles by this author , Anthony TimoneyAnthony Timoney Bristol, United Kingdom More articles by this author , Francis KeeleyFrancis Keeley Bristol, United Kingdom More articles by this author , and Neil BurgessNeil Burgess Norwich, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1509AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Insertion of ureteral stent is a common urological procedure in both elective and emergency settings. However, indwelling ureteral stent is often associated with significant pain and urinary symptoms. One suggested factor for this is bladder irritation secondary to a long redundant distal end of ureteral stent. The objective of this study is to compare the impact of multi-length 30cm and single length 24cm ureteral stents on patients' quality of life. METHODS 162 patients with upper urinary tract calculi requiring ureteral stent insertion were randomized into group 1 (6Fr x 24cm, Contour™) or group 2 (6Fr x 22–30cm, Contour VL™). Both stents were different in length but were otherwise identical and manufactured by the same company. Patients were requested to complete the validated Bristol ureteric stent symptom questionnaire (USSQ) at 1 and 4 weeks after stent insertion and 4 weeks after removal. Mean scores for each domain of the USSQ in both groups were compared using 2-tailed unpaired t test. Any adverse events such as stent migration, early removal of stent due to stent-related symptoms and failure of stent insertion were also recorded. RESULTS 153 patients who had successful ureteral stent insertion were requested to complete the USSQ. The response rate was 74% (62 and 51 patients in group 1 and 2 respectively). There were no significant difference in both groups in terms of age (p=0.47) or sex (p=0.22). At 1 and 4 weeks with the stent in situ, comparison of the mean domain scores demonstrated no significant difference in urinary symptoms (p=0.42 and p=0.19), pain (p=0.84 and p=0.39) and general health (p=0.48 and p=0.98). This is also similar for work performance (p=0.87 and p=0.78), sexual dysfunction (p=0.71 and p=0.41) and number of days patients stayed in bed (p=0.11 and 0.65) or reduced their routine activities (p=0.10and p=0.63). There were 3 (2%) patients who had stent removed earlier due to severe stent-related symptoms (all from group 1) and 5 (3%) patients with failed stent insertion. There was no ureteral stent migration noted in this study. CONCLUSIONS Based on this study, there is no difference in the impact on quality of life in patients who had either a multi-length or 24cm ContourTM ureteral stent. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e256 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Robert Calvert Liverpool, United Kingdom More articles by this author Kee Wong Liverpool, United Kingdom More articles by this author Sudhanshu Chitale Norwich, United Kingdom More articles by this author Stuart Irving Norwich, United Kingdom More articles by this author Muthuswamy Nagarajan Wakefield, United Kingdom More articles by this author Chandra Biyani Wakefield, United Kingdom More articles by this author Anthony Browning Wakefield, United Kingdom More articles by this author James Young Bristol, United Kingdom More articles by this author Anthony Timoney Bristol, United Kingdom More articles by this author Francis Keeley Bristol, United Kingdom More articles by this author Neil Burgess Norwich, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...