Retrograde ureteroscopy in patients with ileal conduits can be technically challenging due to distorted anatomy. This procedure can be safely performed in experienced hands with standard endourological equipment. An antegrade approach can be carried out simultaneously, which may be required in a small number of patients.

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Introduction COVID-19 may negatively affect peri-operative outcomes, requiring strategies to allow operating whilst minimising risk. We present our endourology service provision throughout the “lockdown” period. Method Endourological operations 23rd March to 11th May 2020 were designated to the base hospital or independent “green” site by urgency and comorbidity status. Base hospital emergencies underwent surgery in main theatres, whilst elective patients had dedicated “COVID-free” theatres and wards. A portable Holmium laser enabled lasertripsy at the independent site. After 27th April, elective cases required a negative swab and 2-week self-isolation pre-operatively. Results 70 operations were performed: 42 ureteroscopies, 20 stent procedures, 8 PCNLs. Mean age was 57 and 58 at base and independent sites respectively, mean ASA 2.1 and 1.9. 37 operations (53%) occurred at the base hospital, including 14 emergencies (38%). 19 patients received post-operative COVID-19 swabs: 3 positives (8%), all emergencies. 2 patients (5%) died of COVID-19 pneumonia within 35 days; both had negative pre-operative swabs. Of 33 patients at the independent site, 3 (9%) received post-operative swabs, all negative. None had COVID-19 symptoms post-operatively. Conclusions “COVID-free” hospitals, wards and theatres enable elective operating whilst minimising peri-operative virus risk. Further utilisation of independent hospitals would more safely allow operating throughout the pandemic.

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Aim Intravesical Botulinum Toxin Type A (BoNT-A) is a common treatment for overactive bladder symptoms refractory to anticholinergic and beta-3 agonist medications. Urinary tract infection rates of < 10% are commonly reported for flexible cystoscopy. We aimed to establish whether local anaesthetic flexible cystoscopy BoNT-A treatment could be performed with an acceptable rate of infection and morbidity without prophylactic antibiotics. Method Prospective audit of patients treated with local anaesthetic intravesical BoNT-A over 8 weeks. A telephone questionnaire was administered at 10 to 17 days post-procedure assessing symptoms, infection and antibiotic use. Electronic records were used to review pre-procedure urine analysis and post-procedure urine culture. Antibiotic use and positive cultures within 10 days were considered significant. Results 51 (76%) of the 67 patients treated were contacted by telephone. These consisted of 41 female and 10 male patients with mean (range) age of 58 (25 to 86) years. 35 (69%) reported being asymptomatic or having symptoms as expected and 2 (4%) patients reported symptoms worse than expected following the procedure. 14 (27%) reported having a urinary tract infection with 9 (18%) provided with antibiotics. Positive urine cultures were present in 5 (10%) patients. Pre-procedure urine analysis, patient age, history of recurrent infection and catheter use did not predict post-procedure urinary tract infection. Conclusions Patients reported higher levels of infection and antibiotic use than expected. Patients should be well counselled about symptoms and complications to minimise antibiotic use. Further work is planned to establish whether prophylactic antibiotics will reduce symptomatic infections, antibiotic use and healthcare interactions post-procedure.