EP.FRI.574 Screening tool to improve patient referral to acute surgical care from Emergency Department

Introduction The study aimed to audit the appropriateness of surgical referrals to general surgery; and, secondly, to devise a screening tool for use in the emergency department to screen patients that are safe to be discharged and to be seen in surgical ambulatory clinics. Methods The first phase of the study was an audit to check appropriateness of the surgical referrals (1st-18th February 2020). In the second part, a screening tool questionnaire was prospectively tested (1st February-24th March 2020) on the surgical referrals. The accuracy of the screening tool outcome was compared to actual patient consultation outcomes. The sensitivity and specificity of the questionnaire was assessed using an ROC curve. Results In the first audit, 68.9% patients were discharged on the same day with or without follow up in the ambulatory surgical clinic. In the prospective questionnaire phase of the study, there were 98 patients and the most common presentation was abdominal pain (n = 60) followed by urological symptoms (n = 11), symptoms of hernia complication (n = 10), abscess (n = 7) and testicular pain (n = 2). The sensitivity and specificity of the screening tool was 60.7% and 100%, respectively with overall accuracy being 88.82%. The area under the ROC curve was 0.80. Conclusion A large proportion of the patients referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool has the potential to screen patients who can be seen in the ambulatory clinic and safe to identify patients who require urgent surgical admission.

Comparing levonorgestrel intrauterine system versus hysteroscopic resection in patients with postmenstrual spotting related to a niche in the caesarean scar (MIHYS NICHE trial): protocol of a randomised controlled trial

IntroductionRecently, the rate of caesarean sections (CS) worldwide has risen and CS-associated complications such as niche have increased substantially. Until now, evidence-based clinical guidelines for the treatment of niche-related symptoms remain absent. In patients with postmenstrual spotting, it has not been studied if the effect of levonorgestrel 52 mg intrauterine system (LNG-IUS 52 mg) is superior to that of hysteroscopy. This study will answer the question of whether LNG-IUS 52 mg is more effective in improving postmenstrual spotting than hysteroscopic niche resection in women with niche-related spotting at 6 months after randomisation.Methods and analysisThis is a randomised controlled trial. A total of 208 women with postmenstrual spotting related to niche in the caesarean uterine scar of at least 2 mm and residual myometrium of at least 2.2 mm evaluated by MRI will be included. Women desiring to conceive within 1 year, with contraindications for LNG-IUS 52 mg or hysteroscopic surgery will be excluded. After informed consent is obtained, eligible women will be randomly allocated to LNG-IUS 52 mg or hysteroscopic niche resection at 1:1. The primary outcome is the efficacy in reducing postmenstrual spotting at 6 months after randomisation. The secondary outcomes include menstrual pattern, total days of blood loss per month, rate of amenorrhoea, side effects and complications.We will use a Visual Analogue Scale for chronic pelvic pain, urological symptoms and women’s satisfaction (five-point Likert scale).Ethics and disseminationThe study was approved by the local medical ethics committee and by the Institutional Review Board of the International Peace Maternity and Child Health Hospital, Shanghai, China (No. GKLW 2019-08). Participants will sign a written informed consent before participation. The results of this study will be submitted to a peer-reviewed journal for publication.Trial registration numberChiCTR1900025677.

Clinical characteristics and surgical treatment of ureteral endometriosis: our experience with 40 cases

Background To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. Methods To present the experience with the surgical management of ureteral endometriosis (UE) in our single center. A retrospective analysis of 40 patients with UE who presented with intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE was performed. Results Forty patients (median age, 42.5 years) with histological evidence of UE were included. Six (15%) patients had a history of endometriosis. Twenty-one (52%) patients had urological symptoms, and 19 (48%) patients were asymptomatic. All patients had hydronephrosis. The mean glomerular filtration rate (GFR) of the ipsilateral kidney was significantly worse than that of the contralateral kidney (23.4 vs 54.9 ml/min; P < 0.001). Twelve (30%) patients were treated with ureteroureterostomy (11 open approaches and 1 robotic approach). Twenty-two (55%) patients underwent ureteroneocystostomy (17 open approaches, 4 laparoscopic approaches and 1 robotic approach). Five patients underwent nephroureterectomy. One patient refused aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) patients required gynecological operations. Three (8%) patients in the open group suffered from major surgical complications. Nine (24%) patients received postoperative endocrine therapy. Twenty-eight (70%) patients were followed up (median follow-up time, 71 months). Twenty-four patients received kidney-sparing surgeries. The success rate for these 24 patients was 21/24 (87.5%). The success rates of ureteroneocystostomy and ureteroureterostomy were 15/16 (93.8%) and 5/7 (71.4%), respectively. Conclusions Although UE is rare, we should remain vigilant for the disease among female patients with silent hydronephrosis. Typically, a multidisciplinary surgical team is necessary. For patients with severe UE, segmental ureteral resection with ureteroureterostomy (UU) or ureteroneocystostomy may be a preferred choice.

Prevalence and Determinants of Genitourinary Syndrome among Postmenopausal Women of Eastern UP: A Cross Sectional Study

Objective: This study was centered to explore the prevalence and determinants of genitourinary syndrome of menopause (GSM) in postmenopausal women of Eastern, Uttar Pradesh (UP). Methodology: A cross sectional study was performed, over a period of 6 months (September 2018 to February 2019), on 162 women, who had attained menopause one or more years back, visiting to Gynecology OPD of B.R.D. Medical College, Gorakhpur, Uttar Pradesh and had given consent for participation. Using a pre structured questionnaire, the participating women were questioned about genitourinary complains, and the relationship between these symptoms and other factors were determined. Results: The prevalence of genitourinary syndrome was found to be 38.6%. The most prevalent genital symptom was vaginal irritation/burning (69.35%), followed by vaginal dryness (61.29%). Increased frequency of micturition (54.83%) and dysuria (51.6%) were the most prevalent urological symptoms. However, dyspareunia, in sexually active females, was the most common (14.52%) symptom. Most prevalent signs were loss of vaginal rugae (88.71%) and vaginal pallor (69.35%). The prevalence of genitourinary symptoms was higher in women already having urogynecological pathologies, like stress incontinence (OR 3.6), vaginal prolapse (OR 4.43), urinary tract infections (OR 2.77). BMI >30 kg/m2 was found to be an important determinant for genitourinary syndrome. Conclusion: The prevalence of GSM is very high in Eastern UP. There is an urgent need that all Government and non-Government health sectors should have a menopausal clinic, with the aim of timely diagnosis and treatment and to improve the quality of life of menopausal women. Key words: genitourinary syndrome; menopause; dyspareunia; vaginal dryness.

Acute Urinary Retention Following Primary VaricellaZoster Virus Infection

Background Acute urinary retention following primary varicella-zoster virus infection (chickenpox) is very rare. Case Presentation We present a case of 34 years old male patient presented with acute urinary retention following primary varicella-zoster virus infection (chickenpox), there was no lesion detected neither by MRI brain nor whole spinal cord imaging. There was a typical blistering rash over the face, trunk, back and upper limbs but sparing the perennial and perianal area. Conclusion Once herpes zoster is found in lumbar lumbosacral region be alert there is possibility of voiding dysfunction like acute retention of urine. The effective treatment plan includes antiviral therapy and urethral catheterization. Most of urological symptoms due to herpes zoster subsides in the very short duration with active guideline treatment. Keywords: Varicella-zoster virus infection; Blister-like rash; Acute urinary retention.

Physiopathology of the diabetic bladder

Objective: To investigate the incidence of diabetic cystopathy in relation to age, gender, type of diabetes, duration of diabetic disease and clinical evidence of peripheral neuropathy and to analyze the physiopathology of the various forms of diabetic cystopathy due to sensory impairment, motor-sensory impairment, motor impairment and hyperreflexia. Materials and methods: In a retrospective multicenter cohort study the medical records of a cohort of 126 diabetic patients with (128 patients) or without (48 patients) urological symptoms were analyzed. Patients were observed at the Città di Alessandria Clinic of Policlinico di Monza and/or at the outpatient clinic of Alessandria Hospital from June 2018 to June 2020. The study excluded patients with central and/or peripheral neuropathy, spina bifida (mylomeningocele or meningocele) or spina bifida occulta; with persistent urinary infections; in anticholinergic treatment for enteric dysfunctions; in medical treatment for cervical-prostatic-urethral obstruction; with vaginal and/or rectal prolapse of II, III, IV degree; with previous spinal or pelvic surgery including radical prostatectomy, Wertheim hysterectomy or colorectal surgery. All the patients were studied with computed tomography (CT) scan of the urinary tract, voiding cystourethrography (VCUG), uroflowmetry, cystomanometry with intrinsic pressure assessment and compliance evaluation, electromyography (EMG) of the anal sphincter, pressure flow analysis, urethral pressure profile and, when advised, pharmacological tests.Results: Out of 126 diabetic patients, 48 did not show any signs or symptoms of urine voiding dysfunction; 30 were men and 18 women with an average age of 62.6 years; 20 had type I diabetes and were in treatment with insulin and 28 type II diabetes treated with oral hypoglycemic medication. The remaining 78 patients (48 men and 30 women), with an average age of 64.8 years, presented urological symptoms; 31 had type I diabetes and 47 had II type diabetes. Conclusions: Diagnosis of the various forms of diabetic cystopathy and early treatment decreases complications and consequently accesses to outpatient facilities and hospital admissions, resulting in an improved quality of life.

Retro-Aortic Left Renal Vein as an Uncommon Cause of Left Sided Varicocele and Haematuria.

Retro-aortic left renal vein [RLRV] is a congenital anomaly characterised by a left renal vein passing posterior to abdominal aorta. It has been suggested that RLRV may cause varicocele and haematuria. The urological symptoms are probably due to the increased pressure in the left renal vein secondary to posterior nutcracker phenomenon. The diagnosis of RLRV is usually radiological. We report a case of a 53-year old man who presented with left scrotal swelling which was then confirmed to be varicocele by Doppler ultrasound. Two months later, the patient had microscopic haematuria and computed tomography [CT] abdomen and pelvis scan was done. CT showed presence of RLRV. Keywords: Retro-aortic left renal vein; varicocele; haematuria; computed tomography [CT].

Clinical Characteristics and Surgical Treatment of Ureteral Endometriosis: Our Experience with 40 Cases

Background: To present the experience of surgical management of ureteral endometriosis (UE) in our single center.Methods: A retrospective analysis of 40 cases of UE who had intraoperative surgical findings of endometriosis involving the ureter and pathology-proven UE.Results: Forty patients (median age, 42.5 years) with histologic evidence of UE were included. Six (15%) patients had history of endometriosis. Twenty-one (52%) patients had urological symptoms and 19 (48%) patients were asymptomatic. All patients had hydronephrosis. The mean glomerular filtration rate of the affected-side kidney was significantly worse than the healthy-side one (23.4 vs 54.9 ml/min; P < 0.001). Twelve (30%) patients were treated with ureteroureterostomy (11 open approaches and 1 robotic approach). Twenty-two (55%) patients underwent ureteroneocystostomy (17 open approaches, 4 laparoscopic approaches and 1 robotic approach). Five patients underwent nephoureterectomy. One patient refused the aggressive surgery and received ureteroscopic biopsy and ureteral stent placement. Thirteen (33%) cases were required gynecological operations. Three (8%) patients in open group suffered from major surgical complications. Nine (24%) patients received postoperative endocrine therapy. Twenty-eight (70%) patients were followed up (median follow-up time, 71 months). The success rate was 25/28 (89%).Conclusions: Although UE is rare, early diagnosis and treatment of UE will help reduce the morbidity of this disease. Most of time, A multidisciplinary team is necessary. For the patients with severe UE, segmentally ureteral resection with UU or ureteroneocystostomy may be a good choice.

1681. Female Urinary Metagenomic Analysis and Natural Language Processing Enhances the Infectious Diagnostic Yield in Precision Medicine

Background In this study, we assessed the diagnostic yield of metagenomics urine sample testing in patients with urological symptoms. Methods We conducted metagenomic analysis on 69 consecutive unbiased female patients, by sequencing their DNA using the KAPA HyperPlus library construction with next-generation sequencing (Nextseq500, Illumina) and reads were analyzed using Xplore-Patho®, an analytical system that permits the detection of 37,000+ microorganisms, including over 12,000 known pathogens, and examined report summaries written by infectious disease experts to obtain a diagnostic yield. In addition, infectious disease expert analysis was contrasted with a natural language (NLP) pathogen detection system to investigate its accuracy. Results In the expert data summaries, a total of 95% of the patients tested had at least one pathogen identified by metagenomics as a potential explanation of their urological symptoms and these results were binned into four categories: 1) 51% of infection likely, 2) 4% of infection possible, 3) 26% of low-grade infection likely and 4) 14% of low-grade infection possible. Data from healthy controls was used in conjunction with an NLP pathogen detection pipeline and compared to infectious disease expert summaries. The NLP pathogen algorithm detected that at least 97% of samples had one pathogen which was more than 5 standard deviations from the abundance of that pathogen in healthy controls, and least 84% had 2 or more pathogens. These diagnostic percentages were consistent with the infectious disease expert summaries. The NLP algorithm had access to a large database derived from PubMed articles and it was found that several relevant uropathogens were not mentioned in report summaries. For example, one well-documented uropathogen was present in 13 samples, but was not mentioned in any report summaries. Conclusion In conclusion, this study demonstrated the high diagnostic yield in females with urological symptoms following metagenomic analysis and the ability of NLP to enhance the sensitivity of reportable pathogens. Disclosures All Authors: No reported disclosures

The ureaplasma biovars clinical significance in the practice of a urologist

Introduction. The presence of Ureaplasmas in the body of healthy men has been proved by many studies. The ability to assess their effect on the male body from a different perspective appeared with the advent of modern quantitative diagnostic methods.Purpose of the study. Определить распространённость уреаплазм у мужчин без репродуктивных нарушений, а также распространённость биоваров уреаплазм и их влияние на урологическую симптоматику.Materials and methods. There was analyzed 249 patient surveys in the clinic, divided into 2 groups: men who had various urological complaints and clinically healthy men.Results. We found Ureaplasmas in 76 (30.5%) men based on a survey of 249 men. In the group of clinically healthy men (n = 129), microorganisms were found in 24 (18.6%) cases, in the group of men with urological symptoms (n = 129) in 52 (43.3%) cases. U. Urealyticum was observed in 28 (36.8%) patients, U. parvum were in 45 (59.2%). The combination of both strains was detected in 3 (4%) cases.Conclusion. The total prevalence of Ureaplasmas in men without reproductive disorders was 30% of cases. The prevalence of Ureaplasmas in the group of men with urological symptoms was more than 2 times higher. U. parvum and U. urealyticum are usually found in isolation from each other. We found both taxa in 4% of cases only. The prevalence of ureaplasmas was 19% among clinically healthy men. Both strains can develop symptoms, but U. urealyticum does it to a greater extent if both are present at the same time.