An aorto-gastric fistula is a catastrophic and rare cause of an upper gastrointestinal bleed. The diagnosis requires a high index of suspicion and expedient management as any delay in each of these component, will be to the detriment of the patient. We report a case of a patient with two episodes of this rare event, with haemodynamic compromise, 15 years after having had a trans-hiatal oesophagectomy for an adenocarcinoma of the oesophagus who presented on both occasions. He had thoracic endo-vascular aortic repair (TEVAR) on both presentations and survived. This case exemplifies the fact that while TEVAR is a good bridging therapy for the management of an aorto-enteric fistula. It however should not be considered as the definitive management for patients who are operable or patients who do not have prohibitive surgical risk.

Introduction Flexible nephroscopy is performed at the end of percutaneous nephrolithotomy (PCNL) to confirm stone clearance. Flexible cystoscopes are commonly used to perform nephroscopy through the PCNL tract, however reusable scopes can provide limited optics due to procedural factors such as renal bleeding and scope factors such as fibre-optic damage. The Ambu® aScope™ 4 Cysto (AmbuScope) is a single-use disposable, video flexible cystoscope which has been solely used in the outpatient setting for bladder visualisation. We describe the first experience of the single use scope in nephroscopy during PCNL. Method Retrospective data was collected and analysed in a 6-month period from 13 consecutive patients undergoing PCNL using the AmbuScope for flexible nephroscopy. Stone free rates on nephroscopy, post-op complications, surgeons’ useability scores and theatre staff opinions were collated. Results All procedures were completed without complication or scope malfunctions. One patient died 27 days post operatively from urosepsis and osteomyelitis: unrelated to the single use scope. All other cases had an uncomplicated recovery. Surgeon useability scores rated the scope as easy (40%) or very easy (60%) to access, very user friendly (100%) and had good (20%) and very good (80%) image quality. 60% of respondents preferred to use the Ambu® aScope™ over the reusable scope. The single scope was found to be more cost-effective at £135 compared to £166 for reusable scopes. Conclusions This study is the first to show that single use scopes are safe, user friendly and cost effectively used during percutaneous nephroscopy.

Introduction British Association of Urological Surgeons (BAUS) guidelines have provided comprehensive and standardized guidelines for urological procedures, including indications, benefits, risks involved, and alternatives. At our institution, currently, consent forms are handwritten resulting in generalized or incomplete information given to patients. Aim To improve patient understanding of the procedures they are undergoing by providing standardized consent form stickers for procedures as per BAUS guidelines. Method Single institution data were collected retrospectively for flexible cystoscopy, stent removal, transrectal ultrasonography (TRUS), and transurethral laser ablation (TULA). Consent forms compared to BAUS guidelines. A standardized consent form sticker for each procedure was developed in accordance with BAUS guidelines and reviewed via the trust's clinical governance process. Clinicians were educated in their use for future consenting. Results Consent forms of consecutive patients over a two-month period were analyzed. The initial audit showed that the proportion of patients who had all risks included was 0% for flexible cystoscopy, 0% for TRUS, and 100% for stent removal. Common and rare, but serious risks were not mentioned in all cases. 100% of patients had all risks mentioned for TULA. After education on the consent process and the introduction of consent form stickers, all risks (100%) were mentioned for all procedures. Conclusions It is imperative that patients are fully informed about the risks, indications, and alternatives of their treatment. Failure to provide this information in full may lead to unnecessary angst, morbidity, and litigation. Simple quality improvement projects can lead to measurable improvement in patient information.

dilation of the stent cell using a balloon catheter. After changing the guidewire to a thin, flexible guidewire, the delivery system passed successfully through the stent cell and exclusion of the aneurysm was achieved.