British Association of Urological Surgeons

BackgroundGeneral practices have been tasked with increasing detection of atrial fibrillation (AF) to reduce stroke. Paroxysmal AF is often missed through usual care but can be detected through screening with repeated ECGs over a period of time using hand-held ECG devices. As part of the drive to detect AF, screening with such devices is being encouraged by both policy makers and industry. It is unclear whether general practice should be leading this effort. Previously, we showed that there was no quantitative difference between a centralised administration and general practice-delivered AF screening programme in terms of the quality and numbers of ECGs generated. Here, we aimed to assess the strengths and weaknesses of each approach using qualitative methods.MethodsWe compared programme delivery by one UK general practice and by a non-clinical centralised administration for two UK general practices in a qualitative study to explore how to conduct screening for AF in a planned trial. From September to December 2020, we conducted semi-structured interviews with 19 staff members. We took field notes of implementation issues arising during observation of 4.5 h of training and collected 15 training evaluation forms. Data were analysed thematically sensitised by the Consolidated Framework for Implementation Research. Analysis focused on the strengths and weaknesses of the different approaches.ResultsWhile both general practice staff and centralised administrators showed motivation to deliver a screening programme, there were differences in skills and capacity. General practice staff provided continuity of care and offer other care in parallel. They could use relational and communication skills to potentially engage those from underserved communities, but were limited by resources. Centralised administrators, with a singular focus on screening, could deliver a consistently high performance and undertake more complicated administration. Their initial anxieties about communication skills reduce with training and experience.ConclusionsIn screening for AF, primary care and centralised administration demonstrate different strengths and weaknesses. A hybrid approach with centralised screening and primary care signposting, particularly for underserved communities, might be optimal. Awareness of this may help policy makers optimise the use of primary care in the drive to detect AF.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-026-03172-1.

Introduction: On-call work is an integral part of urological practice in the United Kingdom, yet its effects on urologists’ lifestyles, well-being and stress remain underexplored. Identifying factors that contribute to this stress may help prolong careers and improve professional quality of life. Materials and Methods: An anonymised online survey of BAUS members assessed the impact of out-of-hours duties on lifestyle, well-being and stress. Variables included age, gender, hospital type, clinical experience, rota design and call frequency between midnight and 8 a.m. Lifestyle and well-being were measured using linear evaluation scales, while stress was assessed with a validated perceived stress scoring system. Results: Complete responses were obtained from 132 mid-grade urologists and 289 consultants engaged in on-call rotas. Overall, out-of-hours work moderately impaired quality of life. Lifestyle disruption increased with consultant age, whereas younger and less experienced colleagues reported higher stress, particularly related to childcare responsibilities and sleep deprivation. Conclusion: Although the impact of on-call work on UK urologists appears less severe than for other medical specialties, significant challenges persist. Ageing, childcare demands and sleep deprivation remain key stressors associated with out-of-hours activity, underscoring the need for strategies to support well-being across career stages.

Objective: Recently, there has been increased competition for specialist urological training at National Selection. This paper aims to investigate potential factors that may contribute to individuals deciding to pursue a urological career. Materials and methods: Core trainee numbers and National Selection competition ratios for core training, general surgery, trauma and orthopedics, and urology were obtained from NHS England between 2016 and 2023. Trainees’ views about stress, burnout, teamworking, the training environment, and global satisfaction with training were extracted from General Medical Council survey data 2019–2024. NHSE data obtained 2010–2023 were analysed to assess urological consultant numbers and their work intensity. Results: Exposure to urology during core training increased by 165% between 2010 and 2023, accompanied by a 60% rise in applications for specialist training. Urology consistently demonstrated higher trainee satisfaction rates compared against general surgery and trauma and orthopedics. In addition, the evolution of consultant practice, a shift towards more outpatient-based activity, may further contribute to the specialty’s growing appeal to an increasingly female workforce. Conclusion: Multiple factors may contribute to the rising competition ratios observed in urological training. These include increased exposure to urology during core training, high levels of trainee satisfaction and the transition towards lower-intensity consultant practice. Level of evidence: Not applicable

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A switch to pre‐biopsy multiparametric MRI as the first investigation in patients with a clinical suspicion of prostate cancer has resulted in capacity issues that may mean not all men will be tested in a timely manner. Biparametric MRI might produce similar results using fewer resources and thus help tackle the capacity issues. A new trial is designed to test whether the strategy could work.

One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa (SSA) has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients that established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically or restricted by the abilities of the surgeons in SSA. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them, and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. However, they are largely dependent upon the supply of equipment from non-governmental organisations in high-income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.

BackgroundRenal stone disease is common and can cause emergency presentation with acute pain due to ureteric colic. International guidelines have stated the need for a multicentre randomised controlled trial (RCT) to determine whether a non-invasive outpatient (shockwave lithotripsy [SWL]) or surgical (ureteroscopy [URS]) intervention should be the first-line treatment for those needing active intervention. This has implications for shaping clinical pathways. ObjectiveTo report a pragmatic multicentre non-inferiority RCT comparing SWL with URS. Design, setting, and participantsThis trial tested for non-inferiority of up to two sessions of SWL compared with URS as initial treatment for ureteric stones requiring intervention. Outcome measurements and statistical analysisThe primary outcome was whether further intervention was required to clear the stone, and secondary outcomes included quality of life assessment, severity of pain, and serious complications; these were based on questionnaires at baseline, 8 wk, and 6 mo. We included patients over 16 yr with a single ureteric stone clinically deemed to require intervention. Intention-to-treat and per-protocol analyses were planned. Results and limitationsThe study recruited between July 1, 2013 and June 30, 2017. We recruited 613 participants from a total of 1291 eligible patients, randomising 306 to SWL and 307 to URS. Sixty-seven patients (22.1%) in the SWL arm needed further treatment compared with 31 patients (10.3%) in the URS arm. The absolute risk difference was 11.7% (95% confidence interval 5.6%, 17.8%) in favour of URS, which was inside the 20% threshold we set for demonstrating noninferiority of SWL. ConclusionsThis RCT was designed to test whether SWL is non-inferior to URS and confirmed this; although SWL is an outpatient noninvasive treatment with potential advantages both for patients and for reducing the use of inpatient health care resources, the trial showed a benefit in overall clinical outcomes with URS compared with SWL, reflecting contemporary practice. The Therapeutic Interventions for Stones of the Ureter (TISU) study provides new evidence to help guide the choice of modality for this common health condition. Patient summaryWe present the largest trial comparing ureteroscopy versus extracorporeal shockwave lithotripsy for ureteric stones. While ureteroscopy had marginally improved outcome in terms of stone clearance, as expected, shockwave lithotripsy had better results in terms of health care costs. These results should enable patients and health care providers to optimise treatment pathways for this common urological condition.

BackgroundThe COVID-19 pandemic has resulted in significant changes to healthcare systems which impact the delivery of surgical training. This study aimed to investigate the qualitative impact of COVID-19 on surgical training in the United Kingdom (UK) & Republic of Ireland (ROI)MethodsThis national, collaborative, cross-sectional study involving 13 surgical trainee associations distributed a pan-surgical specialty questionnaire on the impact of COVID-19 on surgical training over 4 weeks in May 2020. Various aspects of training were assessed.Results810 completed responses were analysed (males = 401, females = 390) from all deaneries and training grades. The perceived negative overall impact of the pandemic on surgical training experience was significant. (Weighted average = 8.66). 41% of respondents (n = 301) were redeployed with 74% redeployed for >4 weeks. Complete loss of training was reported in elective operating (69.5%), outpatient activity (67.3%) and endoscopy (69.5%). A reduction of >50% was reported in emergency operating (48%) and completion of work-based assessments (WBAs) (46%). 3.3% (n = 17) of respondents reported plans to leave medicine altogether. Cancellations in study leave and regional teaching programmes without rescheduling were reported in 72% and 60% of the cohort respectively. Elective operative exposure and WBAs completion were the primary reported factors affecting potential trainee progression. Only 9% of trainees reported that they would definitely meet all required competencies.ConclusionCOVID-19 has had a negative impact on surgical training across all grades and specialties, with implications for trainee progression, recruitment and retention of the surgical workforce. Further investigation of the long-term impact at a national level is required.