ObjectivesTo investigate the burden of infectious complications following ureteroscopy (URS) for ureteric stones on a national level in England using data from the Hospital Episodes Statistics (HES) ...data warehouse.Materials and MethodsA retrospective cohort was identified and followed up in HES during the period April 2013 to March 2020 for all procedure codes relating to ureteroscopic stone treatment (M27.1, M27.2, M27.3). Treatment episodes relating to the first URS (‘index ureteroscopy’) for each patient were further analysed. All subsequent admissions within 30 days were also captured. The primary outcome was diagnosis of urinary tract infection (UTI; including all codes relating to a UTI/sepsis within the first 30 days of index URS). Secondary outcomes were critical care attendance, attendance at the accident and emergency department (A&E) within 30 days, and mortality.ResultsA total of 71 305 index ureteroscopies were eligible for analysis. The median age was 55 years, and 81% of procedures were elective and 45% were undertaken as day‐cases. At the time of index URS, 16% of patients had diabetes, 0.5% had coexisting neurological disease and 40% had an existing stent/nephrostomy. Overall, 6.8% of the cohort (n = 4822) had a diagnosis of UTI within 30 days of index URS (3.9% immediately after surgery). A total of 339 patients (0.5%) required an unplanned stay in critical care during their index URS admission; 8833 patients (12%) attended A&E within 30 days. Overall mortality was 0.18% (60 in‐hospital, 65 within 30 days); 40 deaths (0.056%) included infection as a contributing cause of death.ConclusionWe present the largest series evaluating infectious complications after ureteroscopic stone treatment. The procedure is safe, with low inpatient infective complication and critical care admission rates.
The Department of Energy uses the metric Cost-of-Energy to assess the financial viability of wind farms. Non-hardware costs, termed soft costs, make up approximately 21% of total cost for a ...land-based farm, yet are only represented with general assumptions in models of Cost-of-Energy. This work replaces these assumptions with a probabilistic model of the costs of land lease and noise disturbance compensation, which is incorporated into a wind-farm-layout-optimization-under-uncertainty model. These realistic representations are applied to an Iowa land area with real land boundaries and house locations to accentuate the challenges of accommodating landowners. The paper also investigates and removes a common but unnecessary term that overestimates cost-savings from installing multiple turbines. These three contributions combine to produce COE estimates in-line with industry data, replacing “soft” assumptions with specific parameters, identify noise and risk concerns prohibitive to the development of profitable wind farm. The model predicts COEs remarkably close to real-world costs. Wind energy policy-makers can use this model to promote new areas of soft-cost-focused research.
•We model noise disturbance compensation and landowners’ noise acceptances.•This is housed within a system-wind-farm-layout-optimization-under-uncertainty model.•Modeling performed on 22 real land plots with 12 residences, GIS data available.•The model predicts COEs remarkably close to real-world costs.•Accurate soft-costs modeling opens doors for new wind energy policy and research.
Objective
To look at best evidence and expert opinion to provide advice in the form of a consensus statement lead by Female, Neurological and Urodynamic Urology (FNUU) section of the British ...Association of Urological Surgeons (BAUS) in conjunction with the British Association of Urological Nurses (BAUN).
Methods
Initially a literature search was performed with incorporation of aspects of the existing guidance and further informed by UK best practice by core members of the group. The document then underwent reviews by the FNUU Executive Committee members, the BAUN executive committee, a separate experienced urologist and presented at the BAUS annual meeting 2020 to ensure wider feedback was incorporated in the document.
Results
Complications of long‐term indwelling catheters include catheter‐associated urinary tract infections (CAUTI), purple urine bag syndrome, catheter blockages, bladder spasms (causing pain and urinary leakage), loss of bladder capacity, urethral erosion (“catheter hypospadias”)/dilatation of bladder outlet and chronic inflammation (metaplasia and cancer risk).
Conclusions
We have provided a list of recommendations and a troubleshooting table to help with the management of the complications of long term catheters.
Objectives
To analyse the results of the stress urinary incontinence (SUI) audit conducted by the British Association of Urological Surgeons (BAUS), and to present UK urologists’ contemporary ...management of SUI.
Patients and Methods
The BAUS audit tool is an online resource, to which all UK urologists performing procedures for SUI are invited to submit data. The data entries for procedures performed during 2014–2016 were collated and analysed.
Results
Over the 3‐year period analysed, 2917 procedures were reported by 109 surgeons, with a median of 20 procedures reported per surgeon. A total of 2 366 procedures (81.1%) were recorded as a primary surgery, with 548 procedures (18.8%) performed for recurrent SUI. Within the time period analysed, changes were noted in the frequency of all procedures performed, with a trend towards a reduction in the use of synthetic mid‐urethral tapes, and a commensurate increase in the use of urethral bulking agents and autologous fascial slings. A total of 107 (3.9% of patients) peri‐operative complications were recorded, with no association identified with patient age, BMI or surgeon volume. Follow‐up data were available on 1832 patients (62.8%) at a median of 100 days postoperatively. Reduced pad use was reported in 1311 of patients (84.5%) with follow‐up data available and 86.3% reported a pad use of one or less per day. In all, 375 patients (85%) reported being satisfied or very satisfied with the outcome of their procedure at follow‐up, although data entry for this domain was poor. De novo overactive bladder (OAB) symptoms were reported by 15.2% of patients (263/1727), and this was the most commonly reported postoperative complication. For those reporting pre‐existing OAB prior to their SUI surgery, 28.7% (307/1069) of patients reported they got better after their procedure, whilst 61.9% (662/1069) of patients reported no change and 9.4% of patients (100/1 069) got worse.
Conclusions
This review identified that, despite urological surgeons undertaking a relatively low volume of procedures per year, SUI surgery by UK urologists is associated with excellent short‐term surgeon‐ and patient‐reported outcomes and low numbers of low grade complications. Complications do not appear to be associated with surgeon volume, nor do they appear higher in those undergoing mesh surgery. Shortfalls in data collection have been identified, and a longer follow‐up period is required to comment adequately on long‐term complications, such as chronic pain and tape extrusion/erosion rates.
To test and compare the efficacy of methenamine hippurate for prevention of recurrent urinary tract infections with the current standard prophylaxis of daily low dose antibiotics.
Multicentre, open ...label, randomised, non-inferiority trial.
Eight centres in the UK, recruiting from June 2016 to June 2018.
Women aged ≥18 years with recurrent urinary tract infections, requiring prophylactic treatment.
Random assignment (1:1, using permuted blocks of variable length via a web based system) to receive antibiotic prophylaxis or methenamine hippurate for 12 months. Treatment allocation was not masked and crossover between arms was allowed.
Absolute difference in incidence of symptomatic, antibiotic treated, urinary tract infections during treatment. A patient and public involvement group predefined the non-inferiority margin as one episode of urinary tract infection per person year. Analyses performed in a modified intention-to-treat population comprised all participants observed for at least six months.
Participants were randomly assigned to antibiotic prophylaxis (n=120) or methenamine hippurate (n=120). The modified intention-to-treat analysis comprised 205 (85%) participants (antibiotics, n=102 (85%); methenamine hippurate, n=103 (86%)). Incidence of antibiotic treated urinary tract infections during the 12 month treatment period was 0.89 episodes per person year (95% confidence interval 0.65 to 1.12) in the antibiotics group and 1.38 (1.05 to 1.72) in the methenamine hippurate group, with an absolute difference of 0.49 (90% confidence interval 0.15 to 0.84) confirming non-inferiority. Adverse reactions were reported by 34/142 (24%) in the antibiotic group and 35/127 (28%) in the methenamine group and most reactions were mild.
Non-antibiotic prophylactic treatment with methenamine hippurate might be appropriate for women with a history of recurrent episodes of urinary tract infections, informed by patient preferences and antibiotic stewardship initiatives, given the demonstration of non-inferiority to daily antibiotic prophylaxis seen in this trial.
ISRCTN70219762.
This article addresses supranational governance of EU criminal justice agencies from the perspective of the various agencies of policy and rulemaking who have contributed to the impressive ...developments in the field of EU criminal law. Taking as a working hypothesis the happenstance and haphazard character of this field of policy and law, it suggests that there is an absence of design. In the discussion the article proposes the Platonic analogy of the ‘ship of fools’ (Plato, Republic, Book VI) as an explanatory tool. The ship's captain is the guiding spirit of criminal law, but the crew of the ship, who have the power to take control, have diverse interests and ideas about how the ship should be taken to sea and navigated. The article addresses thematically and chronologically the development of EU criminal policy by means of this framework. Subsequently it discusses the extent to which the ‘ship of fools’ analogy is relevant to the development of EU criminal justice agencies, and to the emergence of a European Public Prosecutor. Underlying all this discussion is the uneasy sense that the true pilot of EU criminal law and policy has been displaced, in particular by ‘instrumental’ pilots of securitisation and effectiveness.
Smartphones offer a potential alternative to collect high-quality information on the travel patterns of individuals without burdening the respondents with reporting every detail of their travel. ...Smartphone apps have recently become a common tool for travel survey data collection around the world, especially for multiday surveys. However, there still exists a lack of systematic assessment of issues related to smartphone app-based surveys, such as the impact of app design or the recruitment method on the collected data. Through a large-scale experiment (named the City Logger), this paper assesses the data produced by the City Logger app, to better understand recruitment avenues (targeted invitation versus crowdsourcing), and examine differences in respondents’ travel behavior recruited through crowdsourcing methods. The paper also examines how app design, and particularly the user input method for trip validation, influences participants’ responses. The results indicate that, while crowdsourcing recruitment is promising, it might not yet be the best way to capture a true representation of the population. For app design, a combination of real-time and travel diary approaches is recommended. An ideal app would prompt users real-time and create a travel diary, so users can validate, edit, or delete the recorded information.
Objectives
To report the British Association of Urological Surgeon's (BAUS) guidance on the assessment and management of female voiding dysfunction.
Methods
A contemporary literature search was ...conducted to identify the evidence base. The BAUS Section of Female, Neurological and Urodynamic Urology (FNUU) Executive Committee formed a guideline development group to draw up and review the recommendations. Where there was no supporting evidence, expert opinion of the BAUS FNUU executive committee, FNUU Section and BAUS members, including urology consultants working in units throughout the UK, was used.
Results
Female patients with voiding dysfunction can present with mixed urinary symptoms or urinary retention in both elective and emergency settings. Voiding dysfunction is caused by a wide range of conditions which can be categorized into bladder outlet obstruction (attributable to functional or anatomical causes) or detrusor underactivity. Guidance on the assessment, investigation and treatment of women with voiding dysfunction and urinary retention, in the absence of a known underlying neurological condition, is provided.
Conclusion
Wa have produced a BAUS approved consensus on the management pathway for female voiding dysfunction with the aim to optimize assessment and treatment pathways for patients.
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