En bloc enucleation technique during holmium laser enucleation of the prostate: An analysis of its efficiency.

OBJECTIVE: Despite the acknowledgment that holmium laser enucleation of the prostate (HoLEP) is a safe, efficacious procedure with benefits over traditional treatments, it is not widely adopted. Its steep learning curve is considered responsible, and the new en bloc technique (EBT) aims to improve this. METHODS: A retrospective analysis of 268 consecutive patients (215 lobe technique [LT] and 53 EBT) who underwent HoLEP between May 2016 and April 2020 was performed. Data were collected on patient demographics, prostate volume, enucleation time, prostatic weight, and length of stay. RESULTS: There was no difference in mean prostate volume and enucleated prostatic weight between the LT and EBT (99.2 mL vs 98.5 mL, P = .95216, and 71.7 g vs 69.3 g, P = .92034, respectively). There was a reduction in mean enucleation time with the EBT to 37.7 minutes compared with 53.3 minutes (LT) (P < .00001). This translated to an improved operative efficiency of 1.84 g/min (EBT) compared to 1.33 g/min (LT) (P < .00001). The EBT demonstrated a continuous improvement in operative efficiency with increasing prostate size unlike the LT where efficiency plateaus. CONCLUSIONS: The EBT for HoLEP demonstrates a significant improvement in operative efficiency which has the potential to reduce the surgeons' learning curve and lead to more widespread adoption.

Safety of "hot" and "cold" site admissions within a high-volume urology department in the United Kingdom at the peak of the COVID-19 pandemic.

OBJECTIVES: To determine the safety of urological admissions and procedures during the height of the COVID-19 pandemic using "hot" and "cold" sites. The secondary objective is to determine risk factors of contracting COVID-19 within our cohort. PATIENTS AND METHODS: A retrospective cohort study of all consecutive patients admitted from March 1 to May 31, 2020 at a high-volume tertiary urology department in London, United Kingdom. Elective surgery was carried out at a "cold" site requiring a negative COVID-19 swab 72-hours prior to admission and patients were required to self-isolate for 14-days preoperatively, while all acute admissions were admitted to the "hot" site.Complications related to COVID-19 were presented as percentages. Risk factors for developing COVID-19 infection were determined using multivariate logistic regression analysis. RESULTS: A total of 611 patients, 451 (73.8%) male and 160 (26.2%) female, with a median age of 57 (interquartile range 44-70) were admitted under the urology team; 101 (16.5%) on the "cold" site and 510 (83.5%) on the "hot" site. Procedures were performed in 495 patients of which eight (1.6%) contracted COVID-19 postoperatively with one (0.2%) postoperative mortality due to COVID-19. Overall, COVID-19 was detected in 20 (3.3%) patients with two (0.3%) deaths. Length of stay was associated with contracting COVID-19 in our cohort (OR 1.25, 95% CI 1.13-1.39). CONCLUSIONS: Continuation of urological procedures using "hot" and "cold" sites throughout the COVID-19 pandemic was safe practice, although the risk of COVID-19 remained and is underlined by a postoperative mortality.

Two and five year survival for colorectal cancer after resection with curative intent: A retrospective cohort study.

INTRODUCTION: Colorectal cancer is a major cause of illness, disability and death in the United Kingdom. The stage of disease at diagnosis has a major impact on survival rates. The aim of this study is to assess whether the survival rates of patients receiving curative treatment in our centre are comparable with national results published by Cancer Research UK, National Bowel Cancer Audit Annual Report 2016, and NCIN Colorectal Cancer Survival by Stage Data Briefing. METHODS: The study involved a retrospective survival analysis of consecutive patients who underwent colorectal cancer resections with curative intent performed by two surgeons between January 2009 and March 2012. Patients were identified from a prospectively collected database. Data was collected via hospital computer systems including patient notes, laboratory, pathology, and radiology systems. Exclusion criteria included all patients with advanced disease who underwent surgery with palliative intent. RESULTS: A total of 281 patients were included. The median age at operation was 71. Overall 2-year survival was 82.6% and overall 5-year survival was 69%. 2-year and 5-year survival, respectively, for Dukes A was 93.7% and 92%, Dukes B was 85.6% and 76.7%, Dukes C1 was 81.1% and 57.8%, Dukes C2 was 56.3% and 25%, and Dukes D was 61.9% and 47.6%. CONCLUSION: Our data demonstrates that our survival rates compare favourably with current published national survival rates. Dukes C2 patients had the poorest five year survival, highlighting the significance of a positive apical node. Dukes D patients had a particularly good outcome which indicates good patient selection by the multi-disciplinary meeting (MDT) and high quality oncology and tertiary surgical support.