The COVID-19 pandemic has recently put a stop to elective surgical procedures across Canada, inherently compounding already lengthy waitlists that exist within most disciplines of surgery. These long waits for elective procedures within Canadian provinces have not been caused by the COVID-19 pandemic; it is an acute-on-chronic issue that has been ex­acerbated by the ongoing COVID-19 pandemic. As hospitals begin to reschedule elective surgeries, patients are likely to be prioritized by clinical urgency using both established and newly created surgical triage severity scales. The objective of this commentary is to discuss issues related to the rebooking of elderly surgical patients during the COVID-19 pandemic within the context of northern medicine. Northern and rural hospitals may already face a multitude of barriers related to the rebooking of surgical patients due to a paucity of available surgical resources, as well as difficulties related to access­ing care at the local level. While current surgical rebooking tools have been developed in response to the COVID-19 pandemic, they fail to explore certain risks related to the older adult population which may lead to increased mortality and morbidity. Review of the literature indicates that redistribu­tion of surgical resources for older adults in the COVID-19 era will require consideration of clinical medical ethics vs. population health ethics regarding who should be prioritized in re-bookings for elective surgical procedures. This should be done in conjunction with encompassing surgical triage severity scales specifically made for older adults in the time of COVID-19.

Background: The Bacillus Calmette-Guerin (BCG) vaccine has long been used for the prevention of tuberculosis (TB) around the world. BCG is also used as an immunotherapy agent for the treatment of non-muscle invasive urinary bladder cancer. This scoping literature review and preliminary data analysis aims to summarize the literature correlating infantile BCG vaccination with the incidence of future bladder cancer. Methods: Studies were identified by a formal literature search of MEDLINE and Cochrane Central Registrar of Controlled Trials following PRISMA guidelines. Preliminary data analysis was conducted on publicly accessible data summarizing the impact of gender, BCG vaccination, and socio-economic effects on crude and age-standardized rates of bladder cancer. Results: As part of our analysis, preliminary regression models demonstrated BCG vaccination status, gender, and socio-economic status to have statistically significant effects on crude and age-standardized rates of bladder cancer incidence. BCG vaccination was associated with a 35-37% lower age-standardized rate of bladder cancer incidence. Conclusions: There is very little literature examining the relationship between prior BCG vaccination and rates of bladder cancer incidence. Our limited data analysis indicates that a relationship does exist between infantile BCG vaccination and later bladder cancer development, although extensive future investigation is needed in this area.

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INTRODUCTION AND OBJECTIVE: To compare the effectiveness of Mini-PCNL and F-URS in treating 10-20 mm lower calyceal stones using a logistic regression model with propensity score matching (PSM) to create similar patient groups for accurate comparison METHODS: We carried out a retrospective analysis of adult patients that underwent Mini-PCNL or F-URS at our institution from September 2018 to December 2019 Patients were discharged on the same day of their procedure. A non-contrast helical CT was performed at 3 months postoperatively to detect residual stones accurately. Patients' clinical characteristics, stone demographics, and perioperative outcomes were collected and statistically analyzed RESULTS: After PSM, 60 patients from the F-URS cohort were matched to 60 similar patients from the Mini-PCNL group. The results of clinical characteristics and postoperative outcomes following PSM are listed in Table 1. The stone-free rate (SFR) after PSM was not significantly higher in the Mini-PCNL group than the F-URS group (91.7% vs. 81.7%, respectively p[0.1). The median operative time for the F-URS group was significantly shorter than the , respectively p[0.045 Table 1.CONCLUSIONS: Ambulatory Mini-PCNL and F-URS have a comparable hospital stay, SFR, and complication rates for treating lower calyceal stones 10-20mm. Both techniques may be considered acceptable treatment options, with a prolonged operative time in Mini-PCNL.

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