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Technological advancements in the medical field are often slow and expensive, sometimes due to complexities associated with pre-clinical testing of medical devices and implants. There is therefore a growing need for new test beds that can mimic more closely the in vivo environment of physiological systems. In the present study, a novel bladder model was designed and fabricated with the aim of providing a pre-clinical testing platform for urological stents and catheters. The model is collapsible, has a Young’s modulus that is comparable to a biological bladder, and can be actuated on-demand to enable voiding. Moreover, the developed fabrication technique provides versatility to adjust the model’s shape, size, and thickness, through a rapid and relatively inexpensive process. When compared to a biological bladder, there is a significant difference in compliance; however, the model exhibits cystometry profiles during priming and voiding that are qualitatively comparable to a biological bladder. The developed bladder model has therefore potential for future usage in urological device testing; however, improvements are required to more closely replicate the architecture and relevant flow metrics of a physiological bladder.

Background: Isiris-α® is a single-use digital flexible cystoscope with an integrated grasper designed for double J (DJ) stent removal. Aim of this study was to conduct a multicentric evaluation of the costs and criticalities of stent removals performed with Isiris®-α in different hospitals and health systems, as compared to other DJ removal procedures.Methods: After gathering 10 institutions worldwide with experience on Isiris-α®, we performed an analysis of the reported costs of DJ removal with Isiris-α®, as compared to the traditional reusable equipment used in each institution. The cost evaluation included instrument purchase, Endoscopic Room (EnR)/ Operatory Room (OR) occupancy, medical staff, instrument disposal, maintenance, repairs, decontamination or sterilization of reusable devices.Results: The main factor affecting the costs of the procedure was OR/EnR occupancy. Decontamination and sterilization accounted for a less important part of total costs. Isiris-α® was more profitable in institutions where DJ removal is usually performed in the EnR/OR, allowing to transfer the procedure to outpatient clinic, with a significant cost saving and EnR/OR time saving to be allocated to other activities. In the only institution where DJ removal was already performed in outpatient clinics, there is a slight cost difference in favor of reusable instruments in high-volume institutions, given a sufficient number to guarantee the turnover.Conclusion: Isiris-α® leads to significant cost benefit in the institutions where DJ removal is routinely performed in EnR/OR, and brings significant improvement in organization, cost impact and turnover.

The objective of this narrative review was to search the existing literature for studies reporting measures to minimize radiation use during endoscopic management of stone disease and present ways of reducing the exposure of both patients and operating room staff.

Background and aims Our departmental planning for COVID-19 was actioned a week before the lockdown (13th March 2020). We look at a 7- week lockdown activity for all scheduled outpatient clinics and urgent procedures.Methods and results A total of 2361 outpatient clinic slots (52.6% oncology slots and 47.4% benign urology slots) were scheduled during this period. The oncology slots included 330 (26.5%) flexible cystoscopy, 555 (44.7%) prostate cancer and 357(28.8%) non-prostate cancer slots. The benign urology slots included 323 (28.8%) andrology, 193 (17.2%) stones and 603 (54%) lower urinary tract symptoms (LUTS) slots. Of the total oncology outpatient slots (n = 1242), 66.3% were virtual consultations, 20% were face-to-face and 13.6% were cancelled. Of the total benign outpatient slots (n = 1119), 81% were virtual consultations, 9.7% were face-to-face and 9.3% were cancelled. A total of 116 anaesthetic surgical procedures were carried out, of which 54 (46.5%) were oncological procedures, 18 (15.5%) were benign urological procedures, and 44 (38%) were diagnostic procedures.Conclusions Hospitals and urologists can benefit from the model used by our hospital to mitigate the impact and prioritise patients most in need of urgent care. Reorganisation and flexibility of healthcare delivery is paramount in these troubled times and will allow clinical activity without compromising patient safety.

Infection-related complications secondary to quinolone resistance have been on the rise following transrectal ultrasound-guided biopsy of the prostate (TRUSBP). The aim of this review was to compare the efficacy of fosfomycin with quinolone-based antibiotic prophylaxis for TRUSBP. A systematic review in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and Cochrane guidelines was conducted. All studies comparing fosfomycin vs. non-fosfomycin antimicrobial prophylaxis for TRUSBP were considered. The main outcomes were number of urinary tract infections (UTIs) (overall, afebrile, febrile, and urosepsis) and fluoroqinolone resistance. Secondary outcomes were positive urine and blood cultures, and adverse effects of drugs. Five studies comparing fosfomycin and non-fosfomycin antimicrobials were included in the review. In all, 1447 and 1665 patients were included in the fosfomycin and non-fosfomycin cohorts, respectively. The systematic review report significantly lower UTIs in the fosfomycin cohort (M-H, Fixed, 95% CI), 0.20 (0.13, 0.30), p< 0.00001. Urine cultures from patients given fosfomycin showed significantly lower resistance rates (M-H, Fixed, 95% CI) 0.27 (0.15, 0.50), p< 0.0001. The adverse effect profile between the two cohorts were similar (M-H, Fixed, 95% CI) 1.13 (0.51, 2.50), p= 0.33. On Grade Pro evaluation, overall UTI, afebrile UTI, febrile UTI, and urosepsis were rates as moderate, low, very low, and moderate quality evidence, respectively. Positive blood and urine culture were rated as moderate and very low-quality evidence, respectively. Fluoroquinolone resistance was rated as low-quality evidence. Adverse effects was rated as very low-quality evidence. This review suggests that fosfomycin has significantly lower septic complications with an equivalent side effect profile in comparison with quinolone-based prophylaxis regimen for TRUSBP. There is an urgent need for appropriate antibiotic stewardship and it is paramount that studies with robust methodology are developed to establish the role of fosfomycin over existing antibiotic regimens for TRUSBP.