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Clement KD, Light A, Asif A, Chan VW, Khadhouri S, Shah TT, Banks F, Dorkin T, Driver CP, During V, Fraser N, Johnston MJ, Lucky M, Modgil V, Muneer A, Parnham A, Pearce I, Shabbir M, Shenoy M, Summerton DJ, Undre S, Williams A, MacLennan S, Kasivisvanathan V. A BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion: the Finding consensus for orchIdopeXy In Torsion (FIX-IT) study. BJU Int 2022; 130:662-670. [PMID: 35689399 PMCID: PMC9796508 DOI: 10.1111/bju.15818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology. MATERIALS AND METHODS A panel of 16 expert urologists, representing adult, paediatric, general, and andrological urology used the RAND/UCLA Appropriateness Consensus Methodology to score a 184 statement pre-meeting questionnaire on the conduct of scrotal exploration for suspected testicular torsion. The collated responses were presented at a face-to-face online meeting and each item was rescored anonymously after a group discussion, facilitated by an independent chair with expertise in consensus methodology. Items were scored for agreement and consensus and the items scored with consensus were used to derive a set of best practice guidelines. RESULTS Statements scored as with consensus increased from Round 1 (122/184, 66.3%) to Round 2 (149/200, 74.5%). Recommendations were generated in ten categories: consent, assessment under anaesthetic, initial incision, intraoperative decision making, fixation, medical photography, closure, operation note, logistics and follow-up after scrotal exploration. Our statements assume that the decision to operate has already been made. Key recommendations in the consent process included the discussion of the possibility of orchidectomy and the possibility of subsequent infection of the affected testis or wound requiring antibiotic therapy. If after the examination under anaesthesia, the index of suspicion of testicular torsion is lower than previously thought, then the surgeon should still proceed to scrotal exploration as planned. A flow chart guiding decision making dependent on intraoperative findings has been designed. If no torsion is present on exploration and the bell clapper deformity is absent, the testis should not be fixed. When fixing a testis using sutures, 3 or 4-point is acceptable and non-absorbable sutures are preferred. CONCLUSIONS We have produced consensus recommendations to inform best practice in the conduct of scrotal exploration for suspected testicular torsion.
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Affiliation(s)
- Keiran D. Clement
- British Urology Researchers in Surgical Training (BURST) CollaborativeGlasgowUK
- NHS Greater Glasgow and ClydeGlasgowUK
| | - Alexander Light
- British Urology Researchers in Surgical Training (BURST) CollaborativeGlasgowUK
- Charing Cross HospitalImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Aqua Asif
- British Urology Researchers in Surgical Training (BURST) CollaborativeGlasgowUK
- Leicester Medical SchoolUniversity of LeicesterLeicesterUK
| | - Vinson Wai‐Shun Chan
- British Urology Researchers in Surgical Training (BURST) CollaborativeGlasgowUK
- Faculty of Medicine and Health, School of MedicineUniversity of LeedsLeedsUK
| | - Sinan Khadhouri
- British Urology Researchers in Surgical Training (BURST) CollaborativeGlasgowUK
- Academic Urology Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
- Aberdeen Royal InfirmaryAberdeenUK
| | - Taimur T. Shah
- British Urology Researchers in Surgical Training (BURST) CollaborativeGlasgowUK
- Charing Cross HospitalImperial College Healthcare NHS TrustLondonUK
- Department of Surgery and CancerImperial College LondonLondonUK
| | - Frederick Banks
- Watford General HospitalWest Hertfordshire Hospitals NHS TrustWatfordUK
| | - Trevor Dorkin
- Freeman HospitalNewcastle NHS Foundation TrustNewcastle upon TyneUK
| | | | - Vinnie During
- New Cross HospitalThe Royal Wolverhampton NHS TrustWolverhamptonUK
| | - Nia Fraser
- Nottingham Children's Hospital, Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK
| | - Maximilian J. Johnston
- Department of Surgery and CancerImperial College LondonLondonUK
- Salisbury NHS Foundation TrustSalisburyUK
| | - Marc Lucky
- Aintree University Hospital, Aintree University Hospitals NHS Foundation TrustLiverpoolUK
| | - Vaibhav Modgil
- Manchester Royal InfirmaryManchester University NHS Foundation TrustManchesterUK
| | - Asif Muneer
- University College Hospital, University College London Hospitals NHS Foundation TrustLondonUK
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
- NIHR Biomedical Research CentreUniversity College London HospitalLondonUK
| | - Arie Parnham
- The Christie HospitalThe Christie NHS Foundation TrustManchesterUK
- Wirral University Teaching Hospital NHS Foundation TrustWirralUK
| | - Ian Pearce
- Manchester Royal InfirmaryManchester University NHS Foundation TrustManchesterUK
| | - Majed Shabbir
- Guy's HospitalGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Manoj Shenoy
- Nottingham Children's Hospital, Queen's Medical CentreNottingham University Hospitals NHS TrustNottinghamUK
| | - Duncan J. Summerton
- Leicester General HospitalUniversity Hospitals Leicester NHS TrustLeicesterUK
| | - Shabnam Undre
- Lister HospitalEast and North Hertfordshire NHS TrustStevenageUK
| | - Alun Williams
- New Cross HospitalThe Royal Wolverhampton NHS TrustWolverhamptonUK
| | - Steven MacLennan
- Academic Urology Unit, Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - Veeru Kasivisvanathan
- British Urology Researchers in Surgical Training (BURST) CollaborativeGlasgowUK
- University College Hospital, University College London Hospitals NHS Foundation TrustLondonUK
- Division of Surgery and Interventional ScienceUniversity College LondonLondonUK
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Geraghty R, Fowler W, Suntharasivam T, Thomas D, Rix D, Haslam P, Dorkin T, Williams R, Rogers A, Shaw M. Use of allium ureteral stents for managing iatrogenic ureteric injuries. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rogers A, Fowler W, Williams R, Haslam P, Rix D, Suntharisavam T, Thomas D, Dorkin T, Shaw M. The use of allium metal ureteric stents in the treatment of ureteric obstruction or injury. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01273-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Payne SR, Fowler S, Mundy AR, Alhasso A, Almallah Y, Anderson P, Andrich D, Baird A, Biers S, Browning A, Chapple C, Cherian J, Clarke L, Conn I, Dickerson D, Doble A, Dorkin T, Duggan B, Eardley I, Garaffa G, Greenwell T, Hadway P, Harding C, Hilmy M, Inman R, Kayes O, Kirchin V, Krishnan R, Kumar V, Lemberger J, Malone P, Moore J, Moore K, Mundy A, Noble J, Nurse D, Palmer M, Payne S, Pickard R, Rai J, Rees R, Roux J, Seipp C, Shabbir M, Saxby M, Sharma D, Sinclair A, Summerton D, Tatarov O, Thiruchelvam N, Venn S, Watkin N, Zacherakis E. The logistical management of tertiary urethral disease in the United Kingdom: Implications from an online audit of male reconstructive urethral surgery. Journal of Clinical Urology 2020. [DOI: 10.1177/2051415819894182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Objective: To determine those patient groupings, based on volume and risk, whose optimal urethral reconstructive management might be provided by a reorganisation of UK reconstructive surgeons. Methods: Between 2010 and 2017, ~689 men/year were enrolled onto an online audit platform collecting data about urethral reconstruction in the UK; this accrual was compared against hospital episode statistics (HES). The available workforce, and where this was based, was collected. Individual and institutional incumbent patient volumes, pathology, surgical complexity and outcomes from treatment were collated to stratify volume/risk groups. Results: More than 90% of all HES-recorded data were accrued, being provided by 50 surgeons at 39 operative sites. Most reconstructive surgery was provided at 10 centres performing >20 procedures/year. More than 50% of all interventions were of a high-volume low-risk type. Of activity, 32.3% was intermediate volume or moderate risk, and 12.5% of men presented for lower-volume or higher-risk procedures. Conclusion: Correlation of detailed volume/outcome data allows the definition of patient populations presenting for urethral reconstruction. Stratification of each group’s management, to optimise the surgical outcome, may be applied to a hierarchical service delivery model based on the complexity of the patient’s presenting urethral pathology. Level of evidence: Level IV
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Affiliation(s)
| | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | - Anthony R Mundy
- University College London Hospitals NHS Foundation Trust, London, UK
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Lucky M, Brown G, Dorkin T, Pearcy R, Shabbir M, Shukla CJ, Rees RW, Summerton DJ, Muneer A. British Association of Urological Surgeons (BAUS) consensus document for the management of male genital emergencies - testicular trauma. BJU Int 2018; 121:840-844. [DOI: 10.1111/bju.14163] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marc Lucky
- Department of Urology; Aintree University Hospitals NHS Foundation Trust; Liverpool UK
| | - Gareth Brown
- Department of Urology; Royal Glamorgan Hospital; Llantrisant UK
| | - Trevor Dorkin
- Department of Urology; Freeman Hospital; Newcastle NHS Foundation Trust; Newcastle upon Tyne UK
| | | | - Majid Shabbir
- Department of Urology; Guy's and Saint Thomas’ NHS Foundation; London UK
| | | | - Rowland W. Rees
- Department of Urology; University Hospital Southampton NHS Foundation; Southampton UK
| | | | - Asif Muneer
- Department of Urology and NIHR Biomedical Research Centre; University College London Hospital; London UK
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Muneer A, Brown G, Dorkin T, Lucky M, Pearcy R, Shabbir M, Shukla CJ, Rees RW, Summerton DJ. BAUS consensus document for the management of male genital emergencies: priapism. BJU Int 2018; 121:835-839. [PMID: 29357203 DOI: 10.1111/bju.14140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Male genital emergencies relating to the penis and scrotum are rare and require prompt investigation and surgical intervention. Clinicians are often unfamiliar with the management of these conditions and may not work in a specialist centre with on-site expertise in genitourethral surgery. A series of consensus statements have been developed by an expert consensus committee comprising members of the BAUS Section of Andrology and Genitourethral Surgery together with experts from urology units throughout the UK. Priapism requires prompt assessment and treatment and these consensus statements provide guidance for UK practice.
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Affiliation(s)
| | - Asif Muneer
- Department of Urology and NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Gareth Brown
- Department of Urology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Trevor Dorkin
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marc Lucky
- Department of Urology, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Majid Shabbir
- Department of Urology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | | | - Rowland W Rees
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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Rees RW, Brown G, Dorkin T, Lucky M, Pearcy R, Shabbir M, Shukla CJ, Summerton DJ, Muneer A. British Association of Urological Surgeons (BAUS) consensus document for the management of male genital emergencies - penile fracture. BJU Int 2018; 122:26-28. [PMID: 29438589 DOI: 10.1111/bju.14167] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Male genital emergencies relating to the penis and scrotum are rare and require prompt investigation and surgical intervention. Clinicians are often unfamiliar with the management of these conditions and may not work in a specialist centre with on-site expertise in genitourethral surgery. The aim of these consensus statements is to provide best practice guidance for urological surgeons based in the UK which are developed by an expert consensus. Penile fracture is a rare emergency and in most cases requires prompt exploration and repair to prevent erectile dysfunction and penile curvature.
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Affiliation(s)
- Rowland W Rees
- Department of Urology, University Hospital Southampton NHS Foundation, Southampton, UK
| | - Gareth Brown
- Department of Urology, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, UK
| | - Trevor Dorkin
- Department of Urology, Freeman Hospital, Newcastle NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Marc Lucky
- Department of Urology, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Majid Shabbir
- Department of Urology, Guy's and Saint Thomas' NHS Foundation, London, UK
| | | | | | - Asif Muneer
- Department of Urology and NIHR Biomedical Research Centre, University College London Hospital, London, UK
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Shukla CJ, Brown G, Dorkin T, Lucky M, Pearcy R, Rees RW, Shabbir M, Summerton DJ, Muneer A. British Association of Urological Surgeons (BAUS) consensus document for the management of male genital emergencies - penile amputation. BJU Int 2018; 121:699-702. [PMID: 29331084 DOI: 10.1111/bju.14135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Male genital emergencies relating to the penis and scrotum are rare and require prompt investigation and surgical intervention. Clinicians are often unfamiliar with the management of these conditions and may not work in a specialist centre with on-site expertise in genitourethral surgery. A series of consensus statements have been developed by an expert consensus committee comprising members of the British Association of Urological Surgeons (BAUS) Section of Andrology and Genitourethral Surgery together with experts from urology units throughout the UK. Penile amputation is a rare genital emergency, which requires prompt intervention and microsurgical reconstruction. The consensus statements will outline the management of these cases for non-specialist units, as well as recommendations for reconstruction for specialists.
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Affiliation(s)
| | - Gareth Brown
- Department of Urology, Royal Glamorgan Hospital, Llantrisant, Rhondda Cynon Taf, UK
| | - Trevor Dorkin
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Marc Lucky
- Department of Urology, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Rowland W Rees
- Department of Urology, University Hospital Southampton NHS Foundation, Southampton, UK
| | - Majid Shabbir
- Department of Urology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | | | - Asif Muneer
- Department of Urology and NIHR Biomedical Research Centre University College London Hospital, London, UK
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Shabbir M, Shukla C, Brown G, Dorkin T, Lucky M, Pearcy R, Rees R, Summerton D, Muneer A. Surgical management of azoospermia: can the NHS England Clinical Commissioning Policy reduce geographical inequality of services? BJU Int 2017; 121:172-175. [PMID: 29105258 DOI: 10.1111/bju.14068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Majid Shabbir
- Department of Urology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | | | | | | | - Marc Lucky
- Department of Urology, Alder Hey Children's Hospital NHS, Liverpool, UK
| | | | - Rowland Rees
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Jackson MJ, Veeratterapillay R, Harding C, Dorkin T. Intermittent self-dilatation for urethral stricture disease in men. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd010258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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