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Showing results for tags 'Surgery - Urology'.
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News Article
Urology inquiry: Waiting lists greatest source of harm
Patient Safety Learning posted a news article in News
A former consultant at the Southern Health Trust has told an inquiry into urology services that waiting lists are the "greatest source of patient harm". The inquiry was established in 2021 and is examining the trust's handling of urology services prior to May 2020. Aidan O'Brien became a consultant urologist in Craigavon Area Hospital in July 1992. His work is at the centre of the inquiry. Giving evidence on Monday, he said waiting list figures highlighted what "myself and my colleagues [have said] for decades" and described it as a "grossly inadequate service". "If you look at four-and-a-half years for urgent surgery, it is appalling," he told the inquiry. "I don't have a magic solution to the current situation, which is dire." Read full story Source: BBC News, 8 April 2024 -
Event
Future surgery 2022
Patient Safety Learning posted an event in Community Calendar
Future Surgery, brings together surgeons, anaesthetists and the whole perioperative team. Designed specifically to meet the training needs, promote networking and develop a stronger voice for all surgical professionals and their multidisciplinary teams in perioperative care. Our CPD accredited speaker programme explores disruptive technology, connectivity, human factors, training and research to support the transformation of the profession and the improved care and safety of patients. Future Surgery is the biggest gathering of surgical and operating theatre teams with over 110 expert speakers – in keynote sessions, panel discussions and workshop sessions, covering all that is new in the field of surgery. Register -
Content ArticleThere is concern among patients, surgeons and health authorities regarding reported adverse patient outcomes following use of mesh in certain urogynaecological surgical procedures. The European Society of Coloproctology (ESCP) has conducted an extensive review of the surgical literature on the outcome of use of mesh in the pelvis of patients who have undergone bowel surgery and will shortly publish its recommendations. ESCP would like to hear from patients who have had both good and not so good experiences with colorectal surgery using mesh such as operations for rectal prolapse (rectopexy), or operations for advanced rectal cancer/inflammatory bowel disease who had mesh inserted to assist in skin closure of the back passage area. The survey is designed to capture the experience of patients who have had an operation that involved using mesh in the pelvis as a part of a colorectal (bowel) surgical operation. The survey is NOT designed to cover outcomes following urogynaecological operations for prolapse or urinary incontinence. The use of mesh as part of abdominal wall hernia repair is also not included.
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Content ArticleSince 2015 Quomodus has developed the digital course 'Diathermy – a practical guide to electrosurgery' for surgeons and other professional users of electrosurgery. The 30-minute course covers the history of electrosurgery, indication and proper use, adverse effects and complications associated with the use of diathermy. The course has been tested and quality assured by health professionals in Scandinavia. The course is flexible, user friendly and applies to all models of diathermy equipment currently on the market.
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Content ArticleWhile COVID-19 has worsened patient waiting times across the NHS, patients with pelvic disorders have long been an under-served population experiencing unacceptable delays in care. Pelvic floor disorders are varied and can be complex, but treatment is available. However, patients, particularly those requiring surgery, can wait years from presentation before receiving the treatment they need. The report from the Pelvic Floor Society proposes changes in six key areas: Empowering and educating patients and beyond. Making use of technology. Integrating expertise. Looking again at surgical procedures. Making the most of our teams. Considering collaborations. Each area is addressed with its own chapter in the report.
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News Article
Urologists support New Zealand MOH report recommendations on surgical mesh
Patient Safety Learning posted a news article in News
The Urological Society of Australia and New Zealand (USANZ) supports recommendations in the Hearing and Responding to Stories of Survivors of Surgical Mesh report released by the New Zealand Ministry of Health in response to complications resulting from the use of surgical mesh in a range of operations, including for stress incontinence and pelvic organ prolapse. The Ministry of Health commissioned the review, in which New Zealand urologists participated alongside a wide range of consumer and other health groups, to provide a plan “to minimize future risk to consumers and support those harmed by it”. “The Urological Society acknowledges that complications from the use of mesh for treating stress urinary incontinence and pelvic organ prolapse has caused considerable physical and psychological harm in some patients, which we feel is unacceptable, said USANZ President, Dr Stephen Mark. "We also acknowledge and accept findings that there were deficiencies in technical and communication skills of some surgeons. We recognise the distress caused to these patients and want to be part of the solution in helping these people, as well as ensuring no patients are harmed in future." “Further research is necessary to achieve best practice outcomes and help us understand why, when, and in which patient complications may occur. For this reason, USANZ supports participation with Australia in a mesh registry. By collaborating with Australian researchers, we can be part of a substantial database that would underpin ongoing research in the interests of patient safety." Read full story Source: New Zealand Doctor, 13 January 2020 -
News ArticleTwo years ago, it seemed that thousands of British women afflicted with crippling pain, ruined sex lives, shattered relationships and wrecked careers would finally get justice and practical redress. A government-commissioned report, following a campaign backed by Good Health, recognised that the plastic mesh tape surgeons had used to treat their incontinence and prolapse had caused some women catastrophic harm. How many women’s lives have been ruined by this mesh is unknown, but Baroness Cumberlege, who led the official review, estimated it to be ‘tens of thousands’. The use of the mesh for stress urinary incontinence was paused in July 2018 as recommended by the inquiry’s preliminary report — then the concluding report, in July 2020, said that this pause should continue until strict requirements on safety and recompense are met. These include the establishment of specialist centres to remove mesh from afflicted women, and financial compensation from government and mesh manufacturers for women affected, as well as the setting up of a database of victims to ascertain the numbers involved and their injuries. The final report also urged that the watchdog, the Medicines and Healthcare products Regulatory Agency (MHRA), which had approved the use of mesh tape in the 1990s, should be reformed to improve its vigilance on such problems. Matt Hancock, then Health Secretary, apologised for the women’s pain. ‘We are going to look carefully at the recommendations,’ he told reporters in July 2020. ‘We need to take action.’ But words can be cheap: a Good Health investigation has found none of the recommendations has been implemented properly and the use of mesh in women is continuing. Read full story Source: MailOnline, 6 June 2022
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Content ArticleOur understanding of race and human genetics has advanced considerably, yet these insights have not led to clear guidelines on the use of race in medicine. The result is ongoing conflict between the latest insights from population genetics and the clinical implementation of race. For example, despite mounting evidence that race is not a reliable proxy for genetic difference, the belief that it is has become embedded, sometimes insidiously, within medical practice. One subtle insertion of race into medicine involves diagnostic algorithms and practice guidelines that adjust or “correct” their outputs on the basis of a patient’s race or ethnicity. Physicians use these algorithms to individualise risk assessment and guide clinical decisions. By embedding race into the basic data and decisions of health care, these algorithms propagate race-based medicine. Many of these race-adjusted algorithms guide decisions in ways that may direct more attention or resources to white patients than to members of racial and ethnic minorities. To illustrate the potential dangers of such practices, Vyas et al. have compiled a partial list of race-adjusted algorithms.
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Content ArticleThe objective of this investigation was to explore the care of patients who have ureteric stents inserted following a diagnosis of a kidney or ureteric stone. A ureteric stent is a narrow tube that is inserted into the ureter (the tube that connects the kidney to the bladder) to help with urine drainage. The reference event investigated was a woman who suffered an episode of kidney stones which was treated successfully but required the insertion of a ureteric stent. The stent was left in situ (in position) for a longer period than intended and became encrusted – that is, minerals filtered from the bloodstream attached to and built up on the stent. This led to the patient needing a more extensive operation to remove the stent. The findings and conclusions aim to prevent the future occurrence of unplanned delayed removal of stents and improve care for patients across the NHS. Safety recommendations It is recommended that the British Association of Urological Surgeons, in collaboration with other relevant specialties (such as the Royal College of Radiologists and British Transplant Society), develops national standards which support electronic and paperbased systems for stent logging/ tracking. These standards should include guidance on monitoring and human oversight. It is recommended that the British Association of Urological Surgeons works with the Patient Information Forum to review its stent patient information leaflet. This should include accessibility and clinical considerations, especially with regards to side effects and complications, and advice on the action to take should concerns arise. It is recommended that the British Association of Urological Surgeons provides guidance for staff working within the stone care pathway to promote consistent advice to patients as part of discharge planning. It is recommended that the British Association of Urological Surgeons encourages members to include information in discharge letters and other communication sent to GPs and patients regarding patients’ stent status, potential complications and the possibility of a retained stent. Safety observations The NHS Summary Care Records (SCR) system is being developed to allow for specific patient groups to be flagged. It may be beneficial for the British Association of Urological Surgeons to liaise with NHSX should opportunities arise in the future to use SCR to flag patients with ureteric stents to aid communication with primary/urgent care services. The National Institute for Health and Care Excellence (NICE) guidance for the management of urinary tract infections does not include ureteric stents as a cause of urinary symptoms which could mimic a urinary tract infection. It may be beneficial for this potential complication to be considered in the next review of this and other clinical practice guidance.
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Content Article
Urology Services Inquiry
Patient Safety Learning posted an article in Other reports and inquiries
A decision was taken by the Minister for Health, Robin Swann MLA, to establish a statutory public inquiry following the lookback review of urology patients (January 2019 until May 2020) initiated by the Southern Health and Social Care Trust. These concerns were related to Mr Aidan O’Brien, Consultant Urologist employed within the Southern Trust. Terms of Reference Key documents, the hearings and latest news on the Inquiry can be found on the Urology Services Inquiry website. -
Content ArticleThis episode of the Business of Healthcare podcast delves into the complex and sensitive topic of the mesh scandal which has impacted countless women's lives. Host Tara Humphrey welcomes Consultant Gynecologist and Urogynecology subspecialist Dr Wael Agur to share his expert insights on the rise and fall of mesh devices in surgical procedures. Wael offers a candid look at the multifaceted issues surrounding patient consent, the role of manufacturers, aggressive marketing strategies, and the ethical dilemmas faced by medical professionals.
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Content ArticleSurgical mesh is a medical device that is used to provide additional support when repairing weakened or damaged tissue. The majority of surgical mesh devices currently available for use are made from man-made (synthetic) materials or animal tissue. This page on the US Food and Drug Administration (FDA) website outlines the types and uses of surgical mesh and the latest update on mesh manufacturers ordered to stop selling devices for transvaginal repair of pelvic organ prolapse.
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Content ArticleIn this blog, Luke Yamaguchi describes his experience of hernia mesh surgery and the impact the procedure had on his health. He tells his story of having laparoscopic hernia repair using polypropylene (PP) mesh, which left him with severe chronic pain. After nine years, he underwent mesh removal surgery. Alongside his story, he describes the risks associated with surgical mesh and the use of PP as a material, highlights the lack of research about its side-effects and draws attention to the role of industry in promoting the use of mesh.
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Content ArticleThis report by the US non-profit organisation the Emergency Care Research Institute (ECRI) was commissioned by the US Food and Drug Administration (FDA) to determine the safety profile of polypropylene (PP) mesh used in a variety of surgical procedures. ECRI performed a comprehensive literature search and systematic review to identify the current state of knowledge about how patients' bodies respond to PP mesh. Key findings Local host responses to polypropylene (PP) used in surgical mesh included pain, foreign body sensation, seroma and haematoma. When PP mesh was used in other surgeries (female stress urinary incontinence mesh or mini-sling, transvaginal or transabdominal prolapse mesh), the primary local responses were erosion/exposure followed by dyspareunia and pain. Studies reported these complications from immediately post surgery to five years post surgery. Evidence suggested that lightweight PP mesh was less likely than heavier weight PP mesh to cause pain or foreign body sensation. There were no studies elucidating patient– or material-related factors contributing to systemic responses. ECRI’s data pointed to infection in 40% of event reports associated with PP mesh. There were five deaths, and when patient harm was reported, 44% required intervention or hospitalisation. Evidence gaps The report identifies the following evidence gaps: Studies of local and systemic host response to PP as a material. Studies examining local or systemic host response to diaphragmatic hernia mesh. Better quality evidence regarding local responses such as inflammation, mesh migration, and pain and regarding systemic responses to mesh such as allergy, autoantibody development and systemic inflammation.
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News Article
Swab 'left inside patient for months after surgery'
Patient Safety Learning posted a news article in News
A consultant urologist left a 6.5cm swab in a patient after surgery and failed to identify it in a scan three months later, an inquiry has heard. The public inquiry concerns the work of Aidan O'Brien at the Southern Trust between January 2019 and June 2020. It heard Mr O'Brien endangered or potentially endangered lives by failing to review medical scans. He previously claimed the trust provided an "unsafe" service and was trying to shift blame on to its medics. On Tuesday, the inquiry into Mr O'Brien's clinical practice heard almost 600 patients received "suboptimal care". Counsel for the inquiry Martin Wolfe KC said the 6.5cm swab was left inside a patient by Mr O'Brien during a bladder tumour operation in July 2009. The error was described as a "never event'. At a CT scan appointment three months later in October 2009, a mass inside the patient's body was discovered by the reporting consultant radiologist. While he did not say it was a swab, he did "highlight the abnormality", said Mr Wolfe. A report was sent to Mr O'Brien but, the Inquiry heard, he did not read it and no one took steps to check out the abnormality. Read full story Source: BBC News, 9 November 2022 -
News Article
50 new surgical hubs set to open across England
Patient Safety Learning posted a news article in News
Over 50 new surgical hubs will open across the country to help bust the Covid-19 backlogs and offer hundreds of thousands more patients quicker access to vital procedures, Steve Barclay, has announced. These hubs will provide at least 100 more operating theatres and over 1,000 beds so people get the surgery they need. And they will deliver almost two million extra routine operations to reduce waiting lists over the next three years, backed by £1.5billion in government funding. They will focus mainly on providing high-volume, low-complexity surgery, as previously recommended by the Royal College of Surgeons of England, with particular emphasis on ophthalmology, general surgery, trauma and orthopaedics, gynaecology, ear nose and throat, and urology. Located on existing hospital sites, the surgical hubs will bring together skills and expertise of staff under one roof – reducing waiting times for some of the most-common procedures such as cataract surgeries and hip replacements. Improving quality and efficiency will mean patients have shorter waits for surgery, will be more likely to go home on the same day, and will be less likely to need additional treatment. And, as the hubs are separated from emergency services, surgical beds are kept free for patients waiting for planned operations, reducing the risk of short-notice cancellations and improving infection control. Read full story Source: Building Better Healthcare, 5 September 2022 -
Content Article
HQCA: Patient Experience Awards 2019
Patient Safety Learning posted an article in Implementation of improvements
For the fourth year, the Health Quality Council of Alberta (HQCA), in partnership with the Patient and Family Advisory Committee (PFAC), held the Patient Experience Awards programme to recognise and help spread knowledge about initiatives that improve the patient experience in accessing and receiving healthcare services in Alberta, Canada. Applications spanned all corners of the province and came from a wide variety of care settings, and ranged from “elegantly simple” to complex in nature. The initiatives described reflected the diverse healthcare needs of Albertans and were equally diverse in their approach to healthcare improvement. However, they all had one thing in common: A desire to make change and deliver a better patient and family member experience. The following four initiatives were selected to receive the HQCA’s 2019 Patient Experience Awards: NowICU Project, Neonatal Intensive Care Unit (NICU), Misericordia Community Hospital Rapid Access, Patient Focused Biopsy Clinic; Head and Neck Surgery, Pathology; University of Alberta Hospital Edmonton Prostate Interdisciplinary Cancer Clinic (EPICC), Northern Alberta Urology Centre Transitional Pain Service, South Health Campus Take a look at their presentations and find out more about these great initiatives. -
Content ArticleKath Sansom’s surgery changed her life forever – and motived her to lobby for its halt. In 2015, Kath Sansom was the “ridiculously superfit mother of two adult daughters”. She had started to have a few “embarrassing leaks” while exercising, so Sansom did what many women do in her situation: she went to her GP, who referred her for transvaginal tape surgery, in which a small piece of mesh is fitted around the urethra to prevent incontinence. “I assumed it was a bit like a coil,” says Sansom, 54, a PR manager from Cambridgeshire, “and if I didn’t get on with it, I could have it taken out. I had no idea it was permanent.” When Sansom awoke from her surgery, she was in pain, but expected it to settle down. “But the pain got worse,” she recalls. “It frightened me. I have good pain tolerance but I’d never experienced pain like it. I felt so stupid that I’d gone in for surgery and not even Googled it before I did. I trusted my doctor." Sansom started researching and learned that the procedure had been suspended in Scotland since 2014, after concerns over side-effects. “I felt so stupid,” she says, “that I’d gone for surgery and not Googled it beforehand. I trusted my doctor.” She decided to raise awareness of the possible side-effects of the procedure and founded Sling the Mesh in June 2015. Within days she had 20 members; now there are 9,400. Everyone in the group has been devastated by mesh. “Seven out of 10 women have lost their sex lives,” says Sansom. “A quarter are suicidal. The devastation on the page is so awful.” Further blogs from Kath Sansom ‘Mesh removal surgery is a postcode lottery’ - patients harmed by surgical mesh need accessible, consistent treatment Ineffective medical device recalls are a patient safety scandal Regulatory flaws: Women were catastrophically failed in the mesh, Primodos and Sodium Valproate tragedies
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Content ArticleDo you suffer from bladder leakage on coughing or exercising? Are you considering surgery because pelvic floor exercises and other options did not work? Learn what happens during the four main surgical procedures, how surgery works and what are the main advantages and disadvantages? This video will help you choose the bladder surgery most suitable for you. For further information, visit https://www.yourpelvicfloor.org/leafllets of the International Urogynecology Association (IUGA).
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Content ArticleThis decision aid is for women who have complications caused by pelvic mesh that was used to treat their stress urinary incontinence. Pelvic mesh has also been called ‘tape’, ‘net’ or a ‘sling’. Stress urinary incontinence is when you leak urine accidentally, especially during exercise or when you cough, laugh or sneeze. This decision aid has been written for women who have been referred to a specialist centre to treat complications from mesh used for stress urinary incontinence.
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Content ArticleWyndaele et al. evaluated the trends in female stress urinary incontinence (SUI) surgery in a UK tertiary referral centre during five years before the July 2018 tape suspension and to compare it with NHS England data. They found that when all invasive treatment options are transparently presented to female patients with SUI, they prefer other surgical treatments as an alternative to mid-urethral sling.
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Content ArticleStress urinary incontinence is when you leak urine accidentally, especially during exercise or when you cough, laugh or sneeze. The National Institute for Health and Care Excellence (NICE) has produced a diagram that shows what treatments NICE recommends as options for managing stress urinary incontinence. If you have tried to manage your condition without surgery, but this hasn’t worked, you might like to think about surgery. This decision aid can help you and your surgeon decide together which type of surgery is best for you. You might also decide that you don’t want to have any surgery. It is important to make the choice that you feel is right for you. This will depend on your individual circumstances and how you feel about each type of surgery. Every woman is different, so this decision aid is only a guide. Information about how this decision aid was produced and the evidence on which it is based is available on the NICE website.
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Content ArticleStress urinary incontinence (SUI) is the loss of urine when coughing, laughing, sneezing or exercising. It is a common and distressing condition, with negative impact on quality of life. If conservative treatment, e.g. pelvic floor muscle training, is not successful, the most successful surgical procedures are mid-urethral mesh tape, colposuspension, autologous fascial sling and urethral bulking agent injections. Between April 2008 to March 2017, procedure data from the UK NHS confirmed that 100,516 patients had a mid-urethral tape procedure, while only 1195 patients had a non-tape SUI procedure. Although the 2013 national guideline from The National Institute for Health and Care Excellence (NICE) recommended that tape and non-tape SUI procedures be offered equally, 84 mesh tape procedures were performed for every 1 non-tape procedure over the 10-year period. Hundreds of patients recently engaged in litigation on the basis of lack of informed consent, particularly in offering alternatives to the mesh tape option. Little is known, however, about how patients choose among different treatment options for SUI and there are no validated patient decision aids (PDAs) in this context. PDAs have been shown to increase patient knowledge, clarity about their own values and accuracy of risk perceptions regarding various management options. Women considering SUI surgery require up-to-date information on all common and available surgical procedures as well as support in their decision-making, tailored to their values and needs. Agur et al. on behalf of the NHS Ayrshire & Arran Continence Multidisciplinary Team designed and developed a novel SUI surgery patient decision aid (SUI-PDA) to help women in making a choice of treatment based on their own individual values. This study reports the development and validation of SUI-PDA as well as the initial evaluation of its usefulness in clinical practice for women considering SUI surgery.
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Content ArticleDifferent surgical treatments are available to treat pelvic organ prolapse (POP) and stress urinary incontinence (SUI). One of these treatments uses mesh which for some has led to complications requiring further corrective surgery. This research is being carried out to help develop a new patient-reported outcome questionnaire for women who have had surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI), and/or mesh complications. The new questionnaire will support women to report the effects of pelvic floor surgery on their quality of life, and will provide a way that surgery outcomes, risks and benefits can be measured and compared. The questions have been developed following interviews with women who have had surgery for POP, SUI and/or mesh complications, and now would like to test this questionnaire (v2) to see how well it works at measuring long-term outcomes of surgery.You can take part if (1) you have had surgery for either pelvic organ prolapse, stress urinary incontinence and/or mesh complications, (2) your last surgery was between 6 months and 14 years ago, and (3) you are aged 16 years or older.
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Content Article
In this podcast interview series, NHS whistleblower Peter Duffy and Patient Safety Learning’s Chief Executive Helen Hughes explore how the healthcare system responds when its staff raise concerns about patient safety. In each episode, Helen and Peter interview someone who has spoken up about patient safety issues in healthcare organisations, or who works to help staff raise concerns where they see unsafe care. In this episode, Helen and Peter speak to Michael Swinn, a consultant urological surgeon in Surrey. Mike talks about his time at Surrey and Sussex Healthcare NHS Trust, Redhill, and how he and his colleagues became concerned about patient care and the struggles they encountered trying to persuade hospital managers to listen. Mike reflects on why senior managers are more interested in limiting corporate reputational damage than protecting patients and the lack of support he received when the case eventually went to court. He describes the impact it has had on his mental health and on his family, but why he doesn't regret speaking up and would do so again. Subscribe to our YouTube podcast to keep up to date with the latest episodes. Transcript of the interview Read a blog from Peter and Helen about the interview series
