Background
Last-minute cancellations in urological surgery are a global issue resulting in wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections (UTIs) are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective, urological surgery as part of our elective recovery plan following the COVID-19 pandemic.
Methods
A specialist urology nurse-led clinic was introduced to review urine culture results preoperatively. Specialist nurses contacted patients with positive urine cultures and their general practitioners by telephone and email to ensure a minimum of 2 days of “lead-in” antibiotics were given prior to surgery. Patients unfit for surgery were postponed and optimised, and vacant slots were backfilled. A new guideline was created to improve timing and structure of the generic preassessment.
Results
Between 01/01/21 and 30/06/21, a mean of 40 cases were booked each month, with average cancellations rates of 9.57/40 (23.92%). After implementing changes on 01/07/21, cancellations fell to 4/124 (3%) for the month. On reaudit there was a sustained and statistically significant reduction in cancellation rates: between 01/07/21 and 31/12/21 cancellations averaged 4.2/97.5 (4.3%, p<0.001). Between 2 and 9 (2-16%) patients each month were started on antibiotics, while another 0 to 2 (0-2%) were contacted for other reasons.
Conclusion
The implementation of a specialist urology nurse-led preassessment clinic resulted in a sustained reduction in cancellations of last-minute elective urological procedures.
We report on a 79-year-old male patient who presented with asymptomatic elevation of prostate-specific antigen and a concurrent papillary lesion, which raised the suspicion of synchronous bladder and prostatic malignancies. He underwent a trans-perineal prostate biopsy as well as transurethral resection of bladder tumour, which revealed a Gleason 9 adenocarcinoma of prostatic origin. While synchronous bladder and prostate cancer is a possibility, differential diagnosis in a patient presenting with lesions of the bladder neck should include advanced prostate cancer.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.