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Introduction:To date, there is no specific recommendation or evaluation of the morbidity of prostate surgery in patients with haemophilia (PWH) although this surgery is common and at high risk of bleeding. Aim:To assess the post-operative morbidity of benign prostate hyperplasia (BPH) surgeries and of oncological prostate interventions in patients with mild haemophilia A or B. Methods:We performed a monocentre, epidemiological, in real life study. Data were collected between 1 January, 1997 and 1 September, 2020 and focused on prostate biopsy, radical prostatectomy, prostate radiotherapy, simple prostatectomy, transurethral resection of prostate (TURP) and laser-vaporisation in patients with mild haemophilia A or B.

INTRODUCTION AND OBJECTIVES: Ureteral Access Sheaths (UAS) represent a major advance in ureteroscopy (URS), but their use is not without risk, cost, and operating room time. UAS have been shown to be safe and beneficial in URS though indications on optimal patient selection may vary. We investigated practice patterns and outcomes for UAS usage within the state of Michigan utilizing data from the Michigan Urological Surgery Improvement Collaborative (MUSIC).METHODS: The MUSIC Reducing Operative Complications from Kidney Stones (ROCKS) initiative focuses on improving patient care by decreasing modifiable emergency department (ED) visits following URS. The ROCKS registry uses trained abstractors who record prospective standardized data for urinary stone patients undergoing URS. We analyzed all patients who underwent a primary URS between June 2016 and July 2018, examining data related to UAS use, complications, readmission rates, and ED visits. Multiple variables were reviewed and subjected to bivariate analysis. Outcomes were analyzed, adjusting for risk factors.RESULTS: The analysis included 5316 URS cases with UAS use in 1969 cases (37.7%). Of that, 47.3% of UAS were used for renal stones and 39.6% for ureteral stones. Frequency of UAS use varied greatly across practices (Figure 1). There were no significant differences in intraoperative complications with UAS usage versus no UAS (1.78% vs 1.51% p[0.447). After adjusting for risk factors, there was no difference in hospitalization rates (OR 1.41, 95% CI 0.94-2.10, p[0.09) or Stone Free Rates (SFR) (OR 0.79, 95% CI 0.61-1.04, p[0.089) between UAS and non UAS groups. There were a higher number of ED visits with UAS use (10.16% vs 7.98%, p[0.007) even after adjusting for risk factors (OR 1.37, 95% CI 1.05-1.79, p[0.020).CONCLUSIONS: Though a difference in intraoperative complications was not found, higher rates of ED visits were noted in patients undergoing URS with a UAS. Our findings demonstrate the use of UAS in URS is not without risk and should be used judiciously. Optimal patient selection parameters have not yet been determined, but this data helps to craft guidance on UAS use.

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