Objective Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. Study design COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. Setting Stakeholders from the United Kingdom. Subjects and methods Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. Results Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was ‘diffuse inflammation of the ear canal skin of less than 6 weeks duration’. Conclusion The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life.

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Open Access Original Article

Objective: To assess the feasibility and efficiency of ureterorenoscopy as a day-care procedure for treatment of ureteric calculi in order to reduce their heavy workload and to spare resources for reducing long waiting list of elective advanced urological surgeries for patients admitted as an indoor category. Study design: Prospective descriptive study. Place and duration of study: The study was conducted in Urology department of PNS Shifa, Karachi from July 2017 to March 2018. Methodology: All patients who presented to our institute for ureteric calculi with normal creatinine and no urosepsis were included in the study. The ureterorenoscopy procedure was carried out either in spinal anesthesia or general anesthesia using laryngeal mask. Post-operative outcomes criteria for feasibility were assessed as ‘rate of complications that required admission in the hospital’. Results: A total of 164 patients underwent ureterorenoscopy. Out of these 151 successful ureterorenoscopy procedures for urolithiasis were performed with 98% stone clearance. Majority of patients went home the same day with no sequel, only twelve patients were kept for a day or two for minor complications. Nine of these had severe pain postoperatively requiring parenteral analgesia and were discharged on first postop day. Three had developed fever and were discharged on second postop day. No confounding factors were found to predict the readmission event. Conclusion: A day care ureterorenoscopy is a safe procedure in a full time day care setting, with a rapid turnover and clinically safe outcome with few and trivial complications requiring readmission

Objective: To identify any adversities in the intraoperative and early postoperative outcome of right live-related donor nephrectomy. Study Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Jan 2013 to Jul 2015. Methodology: A total of 143 successive patients underwent open live donor nephrectomies (right=41). Perioperative outcome for both sided procedures were analyzed to identify any difference as regard the intraoperative (warm ischemia time, total duration of surgery, peroperative complications) and early postoperative parameters (days of hospitalization, complications). Results: No statistically significant difference was found in studied parameters like total operative time, the warm ischemia time, duration of hospital stay and the intra- and early postoperative complications amongst both the groups. The mean warm ischemia time was 86 ± 12 seconds (Rt) versus 90 ± 12 seconds (Lt). The mean time for surgery was 110 ± 18.1 minutes (Rt) versus 121 ± 18.2 minutes (Lt). There were only five minor complications and one major complication. Conclusion: Right live-related donor nephrectomy is equally safe and feasible option with similar intra-and postoperative complications as for left side. Therefore, whenever required, it is safe to leave the donor with a better functioning kidney.