Staff Publication

Association Between Stone Composition and Recurrence Rates Following Ureteroscopy: A Scoping Review (2025)

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Type of publication:

Journal article

Author(s):

George, Althea O; Adefehinti, Mayowa; Lee, Minwook; Adebisi, Ajibola A; *Odedara, Ayodele; Omiko, Raymond; Akinwale, Mobolaji; Ndonga, Steven; Olalekan, Adeyeye; Yusuf, Abdulhameed; Ali, Sahar; Ononye, Reginald; Onobun, Daniel E.

Citation:

Cureus. 17(7):e87602, 2025 Jul.

Abstract:

Urolithiasis remains a significant global health burden, with high recurrence rates following intervention. Ureteroscopy is increasingly preferred due to its safety and efficacy; however, recurrence after ureteroscopy is common and may be influenced by stone composition. This scoping review aims to explore the relationship between stone composition and recurrence rates post-ureteroscopy and to identify gaps in current evidence that could inform clinical practice and research. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines, we conducted a structured literature search (2014-2024) across PubMed, Scopus, MEDLINE, and Google Scholar. Studies were eligible if they reported on adult patients (>=18 years) undergoing ureteroscopy for renal or ureteric stones, provided stone composition data, and reported recurrence (defined radiologically, symptomatically, or via reintervention). Retrospective/prospective cohort studies, clinical trials, and case series (n >10) in English were included. Non-English, paediatric-only studies, case reports, and those lacking recurrence or composition data were excluded. In total, 13 studies met the inclusion criteria. Calcium oxalate was the most frequently reported stone type and appeared to be associated with higher recurrence rates. Reported recurrence ranged from 25.8% at 32 months to nearly 60% at 36 months, particularly in patients without metabolic follow-up. Reporting of uric acid, struvite, and cystine stones was inconsistent, limiting firm conclusions. The majority of studies were retrospective, small-scale, and lacked standardised definitions of recurrence, often conflating residual fragments with true recurrence. Language restriction and lack of granular metabolic data further limited synthesis. Stone composition appears to influence recurrence risk post-ureteroscopy, particularly for calcium-based stones. However, variability in study design, recurrence definitions, and underreporting of metabolic data reduce the strength of current evidence. Future prospective research with standardised reporting and broader linguistic inclusion is essential.

DOI: 10.7759/cureus.87602

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Implementing Quick Response (QR)-Coded Patient Information Leaflets to Reduce Environmental Impact in Urology Outpatient Clinics: A Pilot Study (2025)

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Type of publication:

Journal article

Author(s):

Matei, Ana; *Chin, Yew Fung; Hughes, Thomas; Mahmalji, Wasim.

Citation:

Cureus. 17(7):e87891, 2025 Jul.

Abstract:

Background and aim Patient information leaflets (PILs) printed in paper form are a commonly used adjunct tool in urology clinics. These help to facilitate the information transfer between doctor and patient. They are detrimental to the environment and costly. Quick response (QR) codes can be used as another option for delivering the leaflets and would reduce the environmental burden. The aim of this paper is to evaluate patient response to the introduction of QR codes as a replacement for paper-based PILs. Methods This pilot study followed the introduction of QR codes of commonly used leaflets sourced from the British Association of Urological Surgeons (BAUS). The study was conducted in a urology clinic at the Hereford County Hospital over a one-month period. The acceptability of the QR codes was recorded. Data such as patient demographics and the type of leaflet were also documented and tabulated. Results Thirty-one patients required PILs, out of which 80% agreed to PILs via QR codes. The mean age of the participating patients was 76. The replacement of paper with QR codes for the one-month period reflects an average estimated saving of 1.88 kg of carbon dioxide emissions and around 238 sheets of paper. Discussion The introduction of QR codes has seen an increase in most sectors, including, more recently, the medical industry. They can be used with a wide range of functions within the industry ranging from medical education to patient identification. These can also be more easily distributed in various forms to cater to all needs. Limitations, such as the currently limited variety of urology PILs available, also need to be considered. Conclusion QR codes of the PILs are a generally accepted alternative. The widespread introduction of QR codes reduces the total environmental impact of paper documents while also reducing production costs.

DOI: 10.7759/cureus.87891

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Safety of pembrolizumab in advanced head and neck squamous cell carcinoma: A systematic review and meta-analysis of RCTs (2025)

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Type of publication:

Conference abstract

Author(s):

Ahad A.; Kumar S.; Kolomar H.; Wang J.; Mylavarapu M.; *Yateem D.; Sadeghzadegan A.; Abdallah A.; Chowdhury D.; Alnajar F.; Hassan M.J.; Kharel P.; Ali M.;

Citation:

Journal of Clinical Oncology. Conference: 2025 ASCO Annual Meeting I. Chicago, IL United States. 43(16 Supplement) (no pagination), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background: Pembrolizumab, a checkpoint inhibitor, has demonstrated safety and efficacy in various cancers, primarily melanomas and non-small cell lung cancers. However, its safety profile in Head and Neck Squamous Cell Carcinoma (HNSCC) remains inadequately studied. This meta-analysis aims to evaluate adverse events (AEs) associated with pembrolizumab in patients with advanced HNSCC. Method(s): A systematic search was conducted using PubMed, Embase, Cochrane Library, Web of Science, and clinicaltrials.gov. Randomized controlled trials (RCTs) evaluating pembrolizumab monotherapy in patients with advanced HNSCC were included. Primary outcomes included overall AEs, grade 3-5 AEs, immune-related AEs, and treatment discontinuation due to AEs. Random effects models were used for analysis. Statistical analysis was performed using Review Manager 5.4 (RevMan). A p-value <= 0.05 was considered statistically significant. Result(s): A total of 1,900 patients (mean age: 59.86 +/- 9.1 years; females: 16.73%) with advanced HNSCC were included from three RCTs. Patients receiving pembrolizumab monotherapy had higher odds of experiencing overall AEs (OR 2.00, 95% CI 1.04-3.83, p = 0.04), grade 3-5 AEs (OR 1.13, 95% CI 0.68-1.86, p = 0.63), immune-related AEs (OR 1.49, 95% CI 0.44-5.08, p = 0.53), and lower odds of treatment discontinuation due to AEs (OR 0.77, 95% CI 0.34-1.75, p = 0.53) compared to the control group. However, only overall AEs were statistically significant. Conclusion(s): Pembrolizumab is associated with a higher risk of AEs in patients with advanced HNSCC compared to the control group. Interestingly, the likelihood of treatment discontinuation due to AEs was lower in the pembrolizumab group; however, this difference was not statistically significant. Further research, including larger RCTs with longer follow-up periods, is necessary to evaluate the safety profile of pembrolizumab in patients comprehensively. Additionally, studies should focus on identifying specific patient subgroups at greater risk for AEs and exploring strategies to mitigate these risks.

Developing a Triage Rag Tool to Standardise the Triage of Referrals Received by the Palliative Care Team in the Hospital Setting (2025)

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Type of publication:

Conference abstract

Author(s):

*Shellis K.; *Corbett E.; *West D.;

Citation:

BMJ Supportive and Palliative Care. Conference: Palliative Care Congress. Belfast Ireland. 15(Supplement 2) (pp A56), 2025. Date of Publication: 01 Mar 2025.

Abstract:

Background During 2022 we realised that we needed to standardise our approach to managing the referrals received to the specialist palliative care team in the acute hospital trust. This was something that had been highlighted in our previous CQC inspection and we understood the importance of assessing patients according to their acuity in a timely manner. Prior to the development of this tool there was no standardised way of triaging patients and often there would be variation in the responsiveness of the service. Aim of the triage RAG The purpose of this tool was to ensure we offered an equitable service to our patients across both of our hospital sites ensuring that those with the highest acuity had an urgent response time of 4 hours (red), those with moderate symptoms/concerns were seen in within 24 hours and those with low acuity were seen within 48 hours. Method The palliative care team worked together through our team meetings to review current literature and best practice. We devised the tool based on most common symptom presentations and most prevalent reasons for referral. We initially trialled this alongside our electronic referral form but we found that we also need a series of question prompts and therefore, this was added to our tool. The tool was trialled for an initial period of six months and following this the final version was presented at out Palliative and End of Life Steering group and subsequently adopted by the whole team. Results We are now able to monitor and report our triage times via our dashboard, we have a standardised way of prioriting our caseload and ensuring the right patients get the correct response from the acute specialist palliative care team, therefore improving patient outcomes.

DOI: 10.1136/spcare-2025-PCC.144

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The 3,550 g Challenge: An Atypical Presentation of a 3.5 kg Seminoma Manifesting as Dry Skin (2025)

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Type of publication:

Journal article

Author(s):

Omorphos, Nicolas; Mohsin, Mohamed Shamil; *Mok, Spencer; Kitchen, Mark; Ho, Kuo J.

Citation:

Cureus. 17(7):e87174, 2025 Jul.

Abstract:

A 43-year-old male presented to the emergency department with a seven-year history of progressive left-sided scrotal swelling. On examination, a large mass was palpable in the left hemiscrotum, accompanied by eczema-like skin changes and a decubitus ulcer. Tumor markers were significantly elevated, particularly lactate dehydrogenase, and an urgent ultrasound confirmed the presence of a testicular tumor. CT revealed a scrotal mass originating from the left testis, along with bilateral inguinal lymphadenopathy. The patient underwent a left inguinal orchidectomy, and histopathological analysis confirmed a 3,550 g classical seminoma. He was subsequently referred to oncology for adjuvant chemotherapy.

DOI: 10.7759/cureus.87174

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Barriers to the safe discussion of the experience and management of menopausal symptoms: A systematic literature review (2025)

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Type of publication:

Journal article

Author(s):

Thavabalan, Karish; *Ovenell, Alistair; Pierce, Poppy; Sutaria, Aman; Parkhouse, Annabelle; Baydemir, Numan; Lally, Theodore.

Citation:

Maturitas. 201:108683, 2025 Aug 05.

Abstract:

As the number of women experiencing menopause continues to rise each year, the need for open and supportive discussions around the experience and management of menopausal symptoms becomes more imperative. Although research has identified numerous challenges women face during this life stage, many studies examine these barriers in isolated settings. Furthermore, how these challenges impact women's ability to safely discuss menopause remains poorly understood. This systematic literature review
sought to identify and synthesise the barriers that hinder safe discussions about the experience and management of menopausal symptoms. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, 21 qualitative studies were included. Six themes were identified regarding symptom experience: lack of support from friends and family, lack of workplace support, fear of menopause onset, variation in symptom experience, poor-quality information, and societal judgement. Two themes were identified regarding symptom management: perceived onus to endure symptoms and poor experiences with healthcare professionals. Notably, the themes revealed widespread shortcomings that collectively hinder safe discussions about menopause. Future work should prioritise intersectional approaches that tackle barriers across home, social, work, and healthcare settings. Proactive measures, such as placing a greater emphasis on menopause in medical education and developing culturally relevant resources, are crucial for fostering safe, informed discussions and improving care for all women.

DOI: 10.1016/j.maturitas.2025.108683

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Colorectal Cancer Mortality Rates in UK Shropshire County (2025)

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Type of publication:

Conference abstract

Author(s):

*Shah J.; *Shittu S.; *Goh Y.L.; *Ball W.;

Citation:

British Journal of Surgery. Conference: 49th ASiT Annual Surgical Conference. Belfast United Kingdom. 112(Supplement 10) (pp x64), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Aim: Evaluate outcomes of patients dying within 12 months from diagnosis of colorectal cancer in Shropshire County. Method(s): Single-centre retrospective review of patients who died within 12 months of diagnosis between 2020-2024.Each patient's hospital records were reviewed, and data were collected on patient demographics, performance status, time from referral to imaging, diagnosis, MDT, death and treatment intent. Result(s): A total of 103(44 male: 59 female) patients,with a mean age at referral of 74 (range 32 – 96) years old. Most patients had a performance status of 1 and lived in their own home (92%). 60% of patients lived in Shrewsbury, 34% in Telford and 9% in Wolverhampton. Referral sources were mainly from GP (55%), emergency admission to SAU (20%) and AMU (16%).74% of GP referrals were seen within two weeks. All patients underwent CT imaging. Endoscopic procedures were performed in 57% of patients. The average age of death is 75 (range 34 – 97) years old, most commonly from distant metastatic sigmoid cancer. The average time between diagnosis and death was 4.4 months.Treatment intent was palliative in 90% (BSC in 44% and oncology in 56%).59% who were referred to oncology received palliative treatment. Eight patients were treated with curative intent but died due to sepsis and multiorgan failure(2), died prior to commencing treatment (1), complications from treatment (3) or declined treatment (2). Conclusion(s): This snapshot audit demonstrates that patients in Shropshire County newly diagnosed with colorectal cancer were elderly, aged over 70 years old with significant cardiovascular co-morbidities and performance status of at least 1.

DOI: 10.1093/bjs/znaf128.248

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Evaluating the Referral Pathway for Colonoscopy in a District General Hospital (2025)

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Type of publication:

Conference abstract

Author(s):

*Lakshmipathy G.R.; *Zaman H.; *Ball W.; *Smith M.

Citation:

British Journal of Surgery. Conference: 49th ASiT Annual Surgical Conference. Belfast United Kingdom. 112(Supplement 10) (pp x109-x110), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Objectives: We aim to evaluate: Method, urgency and appropriateness of colonoscopy referrals. Colonoscopies repeated within two years. Reasoning behind procedure modification or cancellation on the day Method: Data was collected between 5/1/24 and 28/2/24 using questionnaires completed by endoscopists. 112 colonoscopies in 51% (57) males and 49% (55) females were included. Result(s): The most common to least common referral sources are: Colorectal CNS telephone clinic 29(26%), consultant surgeon face-to-face Clinic 28(25%), triage system 14(12.5%), consultant surgeon telephone clinic 13(11.6%), others 13(11.6%), gastroenterology consultant face-to-face clinic 11(9.8%) and gastroenterologist telephone clinic 1(0.8%). Majority of referrals were two-week wait or urgent 97 (86.5%). Endoscopists were 18-week team 70(62.5%) followed by trust-employed consultant surgeons 26(23%). Four patients had repeat colonoscopies in last two years. 9(8%) scopes were modified or cancelled. Conclusion(s): Except for one scope, repeat scopes within two years had valid indications. Majority of the modified or cancelled scopes originated from telephone consultation referrals. Reasons for cancellation on the day included lack of fitness for scopy, ineffective bowel preparation, patient factor like uncontrolled atrial fibrillation on the day and no indication for colonoscopy. Modifications included switching from requests for flexible sigmoidoscopy to colonoscopy; colonoscopy to CTVC and vice versa. In light of this study, we aim to provide face-to-face appointments for patients referred through the urgent suspected cancer pathway. We plan to expand this study to evaluate the popularity of CTVC use as an alternative modality when colonoscopy is not possible.

DOI: 10.1093/bjs/znaf128.znaf128.438

Complications After Hydrocele Repair: Solving a Persistent Challenge (2025)

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Type of publication:

Conference abstract

Author(s):

*Lu Y.; *Abdellatif M.; *Desai C.; *Ali-Naja N.; *Han L.A.; *Kells L.; *Kachrilas S.;

Citation:

British Journal of Surgery. Conference: 49th ASiT Annual Surgical Conference. Belfast United Kingdom. 112(Supplement 10) (pp x179-x180), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Aim: Surgical intervention remains the gold-standard treatment for large or symptomatic hydroceles. Although hydrocele repair is a relatively minor procedure, complications such as haematoma and infection can have significant consequences. This study aims to evaluate the rates and severity of complications and explore strategies to minimise them following hydrocele repair Method: Aretrospective analysis was conducted of all hydrocele surgery performed in January 2021 to December 2022. Complication outcomes were classified using Clavien-Dindo grading. Result(s): A total of 85 hydrocele operations were included in the study, with an average patient age of 54.5. Post-operative complications occurred in 22 (25.88%) patients, including infection, haematoma and recurrence. Amount these, 7 complications (8.24%) were classified as Clavien-Dindo grade II, and 13 (15.29%) as grade III. No grade IV or V were recorded. Of the 22 patients with complications, 11 (12.94%) of them experienced recurrent hydroceles. Conclusion(s): Complications following hydrocele repair are relatively common, warranting further investigation. Comprehensive pre-operative counselling is essential to set realistic expectations and address potential risks with patients. Our centre implemented prophylactic antibiotics in high-risk group and the use of intra-operative betadine wash as potential solutions.

DOI: 10.1093/bjs/znaf128.718

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Survey of the current experience of colonoscopy training for colorectal surgical trainees in the UK (2025)

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Type of publication:

Journal article

Author(s):

Siggens K.; Williams S.; Yiu A.; El Sayed C.; Fletcher J.; Mills S.; Yeadon K.; Reza L.; Rabie M.; Drami I.; Green S.; Tamanna R.; Couderq D.; Javanmard-Emamghissi H.; Argyriou O.; Okocha M.; Khasawneh F.; Kat-Zsummercorn A.; Shakir T.; Anya L.; Bramwell C.; Haji A.; Johnston R.; Joshi H.; Oliphant R.; Piramanayagam B.

Citation:

Frontline Gastroenterology. (no pagination), 2025. Date of Publication: 2025.[epub ahead of print]

Abstract:

Introduction: The primary aim was to understand the current experience of colonoscopy training among general surgical trainees with a subspeciality interest in colorectal surgery. Method(s): An electronic survey was developed and disseminated by members of the Dukes' Club (colorectal trainees network) and Association of Coloproctologists of Great Britain and Ireland colonoscopy subcommittee between February and April 2024 to assess key themes identified through formal and informal feedback from colorectal trainees of endoscopy training experience. Result(s): The survey was completed by 196 participants. This included 13.3% from core trainee (CT) 2-speciality trainee (ST) 4, 28.6% from ST5-ST6, 36.5% from ST7-ST8, 13.3% from post-certificate for completion of training fellows, senior clinical fellows and speciality and specialist (SAS) doctors and 8.7% from early years consultants. The median number of colonoscopies performed by respondents was 121.6 (range 0-8000). Only 33.7% (66/196) reported having one dedicated training list per week, and 56.6% (111/196) were not allocated to any regular training list. The barriers to training were service provision (71.9%), lack of dedicated training lists (69.9%) and access to training lists due to other trainees or healthcare professionals (42.3%). Only 25% of respondents had experience of immersion training, but they consistently reported high numbers of colonoscopy during these periods, with 40% achieving more than 30 colonoscopies. Conclusion(s): There is an urgent need to improve access to colonoscopy training. Regular endoscopy training lists and funding of academies and immersion training centrally are likely to greatly improve the experience of colonoscopy training. Senior colorectal trainees should be prioritised to avoid delay in the completion of training.

DOI: 10.1136/flgastro-2025-103106

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