Maximilian Joseph Johnston

Objectives: To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology. Materials and Methods: A panel of 16 expert urologists, representing adult, paediatric, general and andrological urology used the RAND Corporation / University of California, Los Angeles (RAND/UCLA) Appropriateness Consensus Methodology to score a 184‐statement pre‐meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face‐to‐face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology. Items were scored for agreement and consensus and the items scored with consensus were used to derive a set of best practice guidelines. Results: Statements scored with consensus increased from Round 1 (122/184, 66.3%) to Round 2 (149/200, 74.5%). Recommendations were generated in 10 categories: consent; assessment under anaesthetic; initial incision; intra‐operative decision making; fixation; medical photography; closure; operation note; logistics; and follow‐up after scrotal exploration. Our statements assume that the decision to operate has already been made. Key recommendations in the consent process included discussion of the possibility of orchidectomy and the possibility of subsequent infection of the affected testis or wound requiring antibiotic therapy. If after the examination under anaesthesia, the index of suspicion of testicular torsion is lower than previously thought, then the surgeon should still proceed to scrotal exploration as planned. A flow chart guiding decision making dependent on intra‐operative findings has been designed. If no torsion is present on exploration and bell clapper deformity is absent, the testis should not be fixed. When fixing a testis using sutures, a three‐ or four‐point method is acceptable and non‐absorbable sutures are preferred. Conclusions: We have produced consensus recommendations to inform best practice in the conduct of scrotal exploration for suspected testicular torsion.

The Central European Journal of Urology is an open access quarterly-issued journal, which provides a forum for the presentation of original clinical, experimental and other research studies...

Objective: The aim of this study was to prioritize key factors contributing to safety on the surgical ward Background: There is a variation in the quality and safety of postoperative care between institutions. These variations may be attributed to a combination of process-related issues and structural factors. The aim of this study is to reach a consensus, by means of Delphi methodology, on the most influential of these components that may determine safety in this environment. Methods: The Delphi questionnaire was delivered via an online questionnaire platform. The panel were blinded. An international panel of safety experts, both clinical and nonclinical, and safety advocates participated. Individuals were selected according to their expertise and extent of involvement in patient safety research, regulation, or patient advocacy. Results: Experts in patient safety from the UK, Europe, North America, and Australia participated. The panel identified the response to a deteriorating patient and the care of outlier patients as error-prone processes. Prioritized structural factors included organizational and environmental considerations such as use of temporary staff, out-of-hours reduction in services, ward cleanliness, and features of layout. The latter includes dedicated areas for medication preparation and adequate space around the patient for care delivery. Potential quality markers for safe care that achieved the highest consensus include leadership, visibility between patients and nurses, and nursing team skill mix and staffing levels. Conclusion: International consensus was achieved for a number of factors across process-related and structural themes that may influence safety in the postoperative environment. These should be championed and prioritized for future improvements in patient safety at the ward-level.

Penile cancer is a rare condition and can be very complex to manage. Advances in surgical techniques, imaging, pathological classification and patient pathways have led to improved patient care. The diagnosis of pre-malignant change, penile cancer and metastatic disease along with advances in their treatment are detailed in this review which aims to update clinicians from multiple specialties and countries on penile cancer.

Introduction: Basingstoke was a participating centre in the MRC funded PROMIS trial between 2013 and 2015 recruiting 130 patients. In response to a perceived change in prostate biopsy histological grading following the introduction of pre-biopsy magnetic resonance imaging at our centre, we decided to undertake a retrospective analysis of prostate histology before and after participation in the study. Methods: We identified 206 patients in both 2012 and 2016 who had undergone prostate biopsy. We reviewed the type of biopsy performed (transrectal or transperineal), the number of cores sampled, the number of positive cores and the cancer grade. The proportion of men who had pre-biopsy multiparametric magnetic resonance imaging was also recorded. Results: Although the total numbers undergoing biopsy were equivalent in 2012 and 2016, 37% of all patients undergoing biopsy underwent a transperineal template biopsy in 2012, increasing to 54% in 2016. The overall percentage of positive biopsy results (Gleason score ⩾3+3) increased from 70% to 83.0% (χ²=9.83, P=0.002). While the number of grade group 1 cancers significantly decreased from 63.9% (2012) to 22% (2016), there was a corresponding increase in the number of grade group 3 or higher cancers detected from 11% to 51%. In 2012, 33% of patients had multiparametric magnetic resonance imaging prior to biopsy compared with 90% in 2016. The pre-biopsy magnetic resonance imaging improved the cancer detection rates for both methods of biopsy sampling. Conclusion: Our study has confirmed that the introduction of pre-biopsy multiparametric magnetic resonance imaging can improve diagnostic accuracy and reduce the number of insignificant cancers detected. This overall upgrading of the biopsied population, and the resulting shift towards detecting an increased number of significant cancers, is likely to have a positive impact on treatment allocation and longer-term outcomes for our patients. This effect should be reproducible in other centres. Level of evidence: Not applicable for this multicentre audit.