Deepak Batura

Objectives: We aimed to evaluate the nature and timing of catheter-related complications, identify factors influencing trial without catheter (TWOC) outcomes and determine a preferred interval to TWOC. Methods: Data from 672 patients referred for TWOC over 16 months included patient demographics, indication for catheterisation, urological history, interval to TWOC and TWOC outcome. Complication-free survival was assessed using Kaplan–Meier methods, predictors of complications by Cox regression, and factors associated with TWOC outcome by univariable and multivariable logistic regression. Results: The indication for catheterisation significantly influenced complication risks; patients catheterised for urinary retention were most likely to present with complications (p=0.02). No association was observed between TWOC timing and attendance at Accident and Emergency. Descriptive analysis demonstrated a substantial increase in complications from 6.9% at 7 days to 57% at 28 days postcatheterisation. TWOC success was unaffected by timing. Independent predictors of TWOC failure included age, sex and indication for catheterisation. Each ten-year increase in age was associated with a 24% higher risk of failure. Women were more likely to fail TWOC than men, and failure rates were highest in patients catheterised for urinary retention. In contrast, younger patients catheterised for monitoring or following surgery demonstrated more favourable outcomes. Conclusions: Catheter-related complications occur most frequently within four weeks, suggesting TWOC within this timeframe. Older age, female sex and urinary retention as the cause for catheterisation are associated with greater risks of failure. Catheterisation in these groups should therefore be reserved for strict indications. Younger and postoperative patients may undergo TWOC once clinically safe.

Fournier’s gangrene is a rare, rapidly progressive necrotizing soft tissue infection of the genitals and perineum that continues to carry a high mortality rate. Hyperbaric oxygen therapy has been proposed as an adjunctive treatment, but its efficacy remains uncertain. We conducted a systematic review and meta-analysis of studies comparing hyperbaric oxygen therapy with standard care in adults with Fournier’s gangrene. A comprehensive search of PubMed/MEDLINE, Embase, Cochrane Library, Scopus, and Web of Science identified thirteen retrospective studies including 322 patients treated with hyperbaric oxygen therapy and 366 controls. Hyperbaric oxygen therapy was associated with a significantly lower mortality rate compared with control groups. Secondary outcomes, including hospital length of stay and number of debridements, showed inconsistent results and did not differ significantly between groups. These findings suggest that hyperbaric oxygen therapy may reduce mortality in patients with Fournier’s gangrene and could be considered as an adjunctive therapy.

Background Artificial intelligence (AI) has emerged as a promising avenue for improving patient care and surgical outcomes in urological surgery. However, the extent of AI’s impact in predicting and managing complications is not fully elucidated. Objectives We review the application of AI to foresee and manage complications in urological surgery, assess its efficacy, and discuss challenges to its use. Methods and materials A targeted non-systematic literature search was conducted using the PubMed and Google Scholar databases to identify studies on AI in urological surgery and its complications. Evidence from the studies was synthesised. Results Incorporating AI into various facets of urological surgery has shown promising advancements. From preoperative planning to intraoperative guidance, AI is revolutionising the field, demonstrating remarkable proficiency in tasks such as image analysis, decision-making support, and complication prediction. Studies show that AI programmes are highly accurate, increase surgical precision and efficiency, and reduce complications. However, implementation challenges exist in AI errors, human errors, and ethical issues. Conclusion AI has great potential in predicting and managing surgical complications of urological surgery. Advancements have been made, but challenges and ethical considerations must be addressed before widespread AI implementation.

Purpose Patients with ureteric stents have symptoms that overlap with infection symptoms. Thus, clinicians unnecessarily give antibiotics to stented patients with bacteriuria despite guidelines. In stented patients, little is known about risk factors for developing bacteriuria or urosepsis. The objectives were to identify the frequency and risk factors for developing bacteriuria and urosepsis in patients with stents. Methods In this retrospective cohort study, we reviewed patients with ureteric stents placed or exchanged over 1 year. We examined associations between bacteriuria or urosepsis and host risk factors. Univariable and multivariable logistic analyses were performed. Results Of 286 patients (mean age: 57.2 years), 167 (58.4%) were male. The main stent indications were stone, stricture, cancer and extrinsic compression. The median stented period was 61 days. The frequency of bacteriuria was 59/286 (21%). ASA status 3 and 4 had 5 times the odds of having bacteriuria relative to ASA status 1. Stent duration > 2 months had 5.5 times the odds relative to ≤ 2 months. Urosepsis was infrequent, 13/286 (4.5%). Five patients had bacteraemia. A stent duration over 2 months had nearly 6 times the odds of urosepsis. Conclusion ASA status higher than 2 and stent time greater than 2 months raise the odds of developing bacteriuria. A stent duration longer than 2 months was the only predictor of urosepsis. Though 21% of patients had bacteriuria, 4.5% had urosepsis. Hence, bacteriuria without sepsis should not be treated with antibiotics, thus aiding antimicrobial stewardship.

Purpose It is recognised that there are ethnic variations in prostate cancer (PCa) epidemiology, affecting outcomes. South Asians (SA) are less likely to be diagnosed with PCa than others, although recent evidence shows PCa is rising amongst SA. This study examines the differences between ethnicities in PCa presentation, progression risk and prostate-specific antigen (PSA) testing use. Methods This retrospective study is on biopsy-diagnosed PCa patients from a multi-ethnic area in London. We grouped ethnicities as SA, White, Black and others, compared presenting symptoms, PSA, Gleason score (GS), and clinical stage, and estimated the D'Amico risk across ethnicities. We also evaluated if the presentation was due to symptoms or an elevated PSA. Results We studied 1176 patients with biopsy-proven PCa. Black patients were diagnosed about 3 years before others (65 ± 8.8 years, p = < 0.001). There was no significant difference between ethnicities in presenting PSAs. At presentation, 65–71% were in the high-risk D’Amico category across all ethnicities. SA were least likely to have PSA test-detected cancers (38%, p = 0.001) and had the highest proportion with advanced GS (30.6%). There was no significant difference in the risk of disease progression between groups. Conclusion Black men were diagnosed youngest. SA had the highest proportion with advanced GS. Most ethnicities had a high risk of progression. SA had the least PSA test-detected cases. The significance of the study lies in understanding ethnic variations in PCa, which could direct targeted prevention and management. We recommend further ethnicity studies and interventions encouraging SA men to embrace PSA testing.

Introduction: Fournier’s gangrene is a necrotizing infection of the external genitalia, perineal or perianal regions and is mainly seen in males. Its main risk factors include diabetes, chronic alcoholism, HIV and other immune-compromised states. Fournier’s gangrene has an aggressive course associated with a mortality rate of 20%−30%, making early diagnosis and management very important. The Fournier Gangrene Severity Index (FGSI) has been traditionally used to predict the severity and prognosis. More recently, simplified FGSI (sFGSI) has been proposed and is helpful. However, timely diagnosis, supportive medical management and complete surgical debridement are still the cornerstones of treatment. These must be complemented with early and timely re-look debridements and appropriate reconstruction to cover soft tissue defects. This literature review aims to look at recent relevant research regards risk factors and prognostic features of Fournier’s gangrene. Methods: A search was conducted on Google Scholar and PubMed databases for all articles related to Fournier’s Gangrene. These included clinical reviews, case reports, case series and retrospective studies. Reports or studies which were not published in English were not reviewed. Various reconstructive techniques to cover the defects have also been revisited. Results: Broad-spectrum antibiotics and urgent surgical debridement are the core management principles of Fournier’s gangrene. Repeat debridement after 24 h is also recommended. Adjunctive therapies such as hyperbaric oxygen and vacuum-assisted closure are supported in most aspects of recent literature. Expectedly, there is a lack of randomised controlled studies in such emergency surgical conditions, which limits the widespread use of newer therapies to patients unresponsive to conventional management. Conclusion: Fournier’s gangrene is a urological emergency with a high mortality rate. The aggressive nature of the infection necessitates early recognition and immediate surgical intervention. Negative pressure dressing and occasional hyperbaric oxygen as adjuncts should be used more routinely, especially if there is a delayed response to conventional treatment or in severe infections.