Since its introduction in 1974, the artificial urinary sphincter (AUS) has been considered the gold standard for treatment of moderate to severe male stress urinary incontinence. This article provides an overview of perioperative management and long-term outcomes, offering an evidence-based foundation for clinical practice. Current evidence on patient selection, preoperative diagnostics, surgical techniques, long-term outcomes, and management of complications was reviewed, based on recent studies, multicenter cohorts, and registry data. The implantation of an AUS generally results in high continence rates and substantial improvement in quality of life. Perioperative risk factors, including prior radiotherapy, diabetes mellitus, or previous urethral procedures, increase the likelihood of postoperative complications such as infections, urethral erosions, or mechanical failure. Specialized centers with extensive experience achieve better functional outcomes and lower revision rates. Despite potential complications, most patients report sustained satisfaction and an improved quality of life following AUS implantation. The AUS is an effective treatment option for moderate to severe stress urinary incontinence. Perioperative risk assessment, specialized implantation techniques, and treatment in experienced centers are crucial for therapeutic success. Prospective registry and multicenter data provide valuable guidance for evidence-based patient selection, complication management, and of long-term outcome optimization. HINTERGRUND: Seit der Einführung 1974 gilt der artifizielle Harnröhrensphinkter („artificial urinary sphincter“, AUS) als Goldstandard zur Behandlung von moderater bis schwerer Belastungsinkontinenz des Mannes. Dieser Artikel gibt einen Überblick über perioperatives Management und Langzeitergebnisse des AUS und bietet eine evidenzbasierte Grundlage für die klinische Praxis. Die aktuelle Evidenz zur Patientenselektion, präoperative Diagnostik, operative Techniken, Langzeitergebnisse und das Management von Komplikationen basierend auf aktuellen Studien, multizentrischen Kohorten und Registerdaten werden erläutert. Die Implantation eines AUS führt zu hohen Kontinenzraten und einer deutlichen Verbesserung der Lebensqualität. Perioperative Faktoren wie Strahlentherapie, Diabetes mellitus oder vorherige Harnröhreneingriffe erhöhen das Risiko für Komplikationen wie Infektionen, Harnröhrenerosion oder mechanisches Versagen des Sphinkters. Spezialisierte Zentren mit umfassender Erfahrung erzielen bessere funktionelle Ergebnisse mit geringeren Revisionsraten. Trotz möglicher Komplikationen berichten die meisten Patienten über eine nachhaltige Zufriedenheit und einen deutlichen Zugewinn an Lebensqualität. Der AUS ist eine effektive Therapieoption für eine moderate bis schwere Belastungsinkontinenz. Präoperative Risikobewertung, spezialisierte Implantationstechniken und die Behandlung in spezialisierten Zentren sind entscheidend für den Therapieerfolg. Prospektive Register- und Multicenterdaten liefern wertvolle Hinweise für evidenzbasierte Patientenselektion, Komplikationsmanagement und Optimierung der funktionellen Ergebnisse.
Ileal conduit diversion is currently the most commonly used urinary diversion method for patients undergoing radical cystectomy. Because intestinal reconstruction is involved, perioperative enteral nutrition intake is limited, placing patients at risk of malnutrition and affecting postoperative recovery and quality of life. Whole-process perioperative nutritional management is of great significance for promoting rapid postoperative recovery in such patients. This study aims to explore the effects of whole-process nutritional management intervention based on the information-knowledge-attitude-practice (IKAP) theory on nutritional status and quality of life in patients undergoing radical cystectomy for bladder cancer. A total of 69 patients who underwent radical cystectomy with ileal conduit diversion for bladder cancer in the Department of Urology, Third Xiangya Hospital of Central South University, between January 2022 and December 2024 were included. Patients were grouped according to admission time. Patients admitted between January 2022 and October 2023 were assigned to the control group (n=34) and received routine perioperative nutritional support for radical cystectomy with ileal conduit diversion. Patients admitted between November 2023 and December 2024 were assigned to the intervention group (n=35) and received whole-process nutritional management based on IKAP theory. Nutritional Risk Screening 2002 (NRS2002) score, Onodera's prognostic nutritional index (OPNI), and the third edition Chinese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTCQLQ-C30) were compared between the 2 groups at 3 time points: day 1 after admission, 1 day before discharge, and 1 month after discharge. The incidence of postoperative related complications between the two groups was also compared. In both groups, the NRS2002 score at 1 month after discharge was lower than that at 1 day before discharge, and the intervention group had lower scores than the control group, with statistically significant differences (all P<0.05). The OPNI at 1 month after discharge was significantly higher than that at 1 day before discharge in both groups, and the intervention group had higher values than the control group, with statistically significant differences (all P<0.05). There was no statistically significant difference in the incidence of postoperative related complications between the 2 groups (all P>0.05). The EORTCQLQ-C30 scores in the intervention group were higher than those in the control group at 1 day before discharge and 1 month after discharge, with statistical significant differences (both P<0.05). Whole-process nutritional management based on IKAP theory can improve the nutritional status and prognosis of patients undergoing radical cystectomy with ileal conduit diversion and improve their quality of life. 目的: 回肠通道术是目前临床最为常用的根治性膀胱全切患者的尿流改道方式，因涉及肠道重建，围术期肠内营养摄入受限，患者存在营养不良风险，影响术后患者的康复及生活质量。围术期全程营养管理对促进此类患者术后快速康复具有重要意义。本研究旨在探讨基于信息-知识-信念-行为(information- knowledge-attitude-practice，IKAP)理论的全程营养管理干预对膀胱癌根治术患者营养状况及生活质量的影响。方法: 纳入2022年1月至2024年12月中南大学湘雅三医院泌尿外科收治的69例因膀胱癌行根治性膀胱全切加回肠通道术的患者。根据入院的先后顺序对患者进行分组，2022年1月至2023年10月收治的患者为对照组(n=34)，给予常规的根治性膀胱全切加回肠通道术围手术期营养支持;2023年11月至2024年12月收治的患者为干预组(n=35)，给予基于IKAP理论的全程营养管理。比较2组患者在入院第1天、出院前1 d、出院后1个月3个时间点的营养风险筛查(Nutrition Risk Screening 2002，NRS2002)评分、小野寺预后营养指数(Onodera’s prognostic nutritional index，OPNI)及第3版中文版欧洲癌症研究与治疗组织生活质量量表(European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30，EORTCQLQ-C30)评分，并比较2组患者术后相关并发症的发生率。结果: 2组患者出院后1个月的NRS2002评分均低于出院前1 d，且干预组低于对照组，差异均有统计学意义(均P<0.05)。2组患者出院后1个月的OPNI均较出院前1 d明显升高，且干预组高于对照组，差异均有统计学意义(均P<0.05)。2组患者术后相关并发症发生率的差异均无统计学意义(均P>0.05)。干预组患者在出院前1 d、出院后1个月的EORTCQLQ-C30评分均高于对照组，差异均有统计学意义(均P<0.05)。结论: 基于IKAP理论的全程营养管理能改善根治性膀胱切除加回肠通道术患者的营养状况及预后，提高其生活质量。.
To evaluate the effectiveness of perioperative non-drug interventions in reducing postoperative pulmonary complications (PPCs) in adults undergoing abdominal surgery. Systematic review and meta-analysis. Ovid MEDLINE, Embase, and Web of Science from database inception to January 2025 and updated in January 2026, with no language restrictions. Randomised controlled trials assessing the effectiveness of perioperative non-drug interventions for the prevention of PPCs in adults undergoing elective abdominal surgery under general anaesthesia, with clearly defined PPCs. The primary outcome was the proportion of patients developing PPCs. Secondary outcomes included the proportion of patients with PPC subtypes according to European Perioperative Clinical Outcome definitions (respiratory infection, respiratory failure, pleural effusion, atelectasis, or pneumothorax) and hospital length of stay. Two reviewers independently screened studies, extracted data, and assessed risk of bias with the Cochrane RoB 2.0 tool. Data were synthesised using meta-analyses and trial sequential analyses, with the evidence certainty assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 255 trials including 55 260 participants were included, evaluating 10 types of interventions with 39 subtypes for PPC prevention. PPCs occurred in 6467 (11.7%) participants across all included trials. High certainty evidence showed that low fraction of inspired oxygen (FiO2) significantly reduced PPCs (risk ratio 0.81, 95% confidence interval 0.71 to 0.92). Moderate certainty evidence showed benefit for four intervention types: lung protective ventilation (risk ratio 0.66, 0.57 to 0.76), physiotherapy (0.55, 0.46 to 0.65), analgesia (0.73, 0.64 to 0.84), and nutrition (0.74, 0.63 to 0.87), with individualised positive end expiratory pressure, composite lung protective ventilation, early mobilisation, and epidural analgesia also showing benefit at the subtype level. Trial sequential analysis confirmed sufficient cumulative evidence for all the above interventions except early mobilisation. By contrast, goal directed haemodynamic therapy, targeted blood pressure management, restrictive fluid therapy, and postoperative bi-level positive airway pressure showed no evidence of benefit, with moderate certainty. This synthesis establishes an evidence hierarchy for PPC prevention in abdominal surgery. Low FiO2 is the only intervention supported by high certainty evidence and should be prioritised in clinical practice. Other beneficial strategies include lung protective ventilation, physiotherapy, analgesic techniques, and nutrition interventions. Conversely, the role of goal directed haemodynamic therapy-despite its widespread use-warrants reconsideration for PPC prevention. These findings facilitate prioritisation of effective interventions and development of evidence based guidelines. PROSPERO CRD42025637449.
Enhanced recovery after surgery protocols, first proposed in the late 1990s, represent a multimodal and interdisciplinary framework for surgical management and perioperative care, with nursing involvement as a pivotal component. The application of enhanced recovery after surgery in cranial and spinal neurosurgery has advanced rapidly, with 89.01% of relevant publications emerging in the past 5 years. However, research on its implementation in this subfield remains immature. This narrative review focuses on the development of fast-track surgery, refinement of enhanced recovery after surgery protocols in spinal surgery, and the roles of nursing within enhanced recovery after surgery. Key perioperative interventions include preoperative personalized education, smoking cessation (≥4 weeks), nutritional support, prehabilitation, and preemptive analgesia; intraoperative tranexamic acid use, rational antibiotic administration, standardized or minimally invasive surgery, and goal-directed fluid therapy; and postoperative multimodal analgesia and early mobilization. Clinical evidence confirms that these interventions collectively reduce postoperative complication rates, shorten hospital stay, alleviate pain, and improve prognosis, with nurses playing a central role in enhanced recovery after surgery implementation across all phases. In conclusion, successful enhanced recovery after surgery adoption in spinal surgery relies on multidisciplinary collaboration, and evidence-based individualized care is critical for optimizing recovery. Future studies should focus on refining guidelines to promote enhanced recovery after surgery standardization and broader application.
Sedation and pain management are core strategies used to manage discomfort, anxiety, and pain in intensive care; however, strategies to improve this practice are inconsistently implemented with differential effect. We describe the development and psychometric testing of the Optimizing ContExt in Assessing sedatioN in ICU (OCEAN-ICU) instrument intended for use in intensive care to guide development of change strategies to optimize sedation. We also provide descriptive results. A prospective instrument development study was undertaken in the United Kingdom. Clinical staff who self-identified as responsible for prescribing, administering, and/or advising on sedation to invasively mechanically ventilated intensive care patients participated. Developed from previous interviews and refined during pilot testing, the draft instrument incorporated 68 statements aligned with the theoretical domains framework. Interested clinicians completed an online survey. Item responses were summed descriptively. Congruence between rankings of agreement and importance were assessed descriptively. Construct validity was assessed using confirmatory factor analysis. 252 usable responses were received from U.K.-based critical care clinicians (53 medical doctors, 149 nurses, 25 pharmacists, 16 physiotherapists, and nine other healthcare professionals). After refining, 39 items were retained with an overall internal consistency of 0.81 and construct validity of χ2/degrees of freedom = 1.86, comparative fit index = 0.73, and root mean square error of approximation = 0.058. Areas of practice with high levels of agreement and perceived importance focused on the value of light sedation and the lack of progress in sedation minimization. Conflict between importance and agreement was reported in the effective assessment and management of pain, delirium, and agitation. The OCEAN-ICU instrument has been developed to determine barriers and facilitators to improving sedation practice in local intensive care contexts. Further validation is required before testing whether the development of change strategies based on identified barriers and facilitators are effective in optimizing sedation practice.
In September 2025, the Royal College of Anaesthetists announced their intention to conduct the first National Clinical Audit of Perioperative Care. An audit project of this size and scope will impact practice for the anyone working in the perioperative environment. National level audit projects have a long history although most have limited themselves to single patient groups or care pathways. The National Hip Fracture Database is one of the longest running of these national audit projects and can offer an insight into the potential impacts of the National Clinical Audit of Perioperative Care.
Assessment of long-term patient-reported outcome allows identification of vulnerable populations undergoing cardiac surgery. Incorporation of findings into clinical practice may enhance risk-stratification, prevent perioperative complications, and improve outcome. Frailty is prevalent in up to a third of cardiac patients and peri-procedural programs addressing frailty and delirium may be relevant to long-term quality-of-life. This prospective study aims to identify predictors of health-related quality-of-life (HR-QoL) one year after cardiac surgery and assess outcome in patients enrolled in an extensive frailty- and delirium-pathway. Patients undergoing cardiac surgery at a high-volume German heart center were enrolled in an anesthesiology quality registry and health-related quality of life was assessed using the Short Form-12 (SF-12) questionnaire at 1-year-follow-up. Corresponding factors were analyzed for their association with individual outcome. The cohort comprised 812 patients. A subgroup of 190 patients participated in a frailty and delirium management program, providing extended preoperative screening and postoperative supervision. Female sex [B -2.59, 95% CI (-4.39 - -0.78), p = 0.005], increase in age [B -3.1, 95% CI (-5.34 - -0.86), p = 0.007] and weight [B -3.97, 95% CI (-6.03 - -1.91), p < 0.001], preoperative anemia [B -3.21, 95% CI (-5.64 - -0.77), p = 0.01], history of smoking [B -3.0, 95% CI (-5.39 - -0.6), p = 0.014], failure to extubate after 8 hours of postoperative ventilation [B -1.82, 95% CI (-3.36 - -0.28), p = 0.021], postoperative acute kidney injury [B -2.18 (95% CI -4.22 - -0.14), p = 0.037] and physical frailty [B -9.88, 95% CI (-18.28 - -1.49), p = 0.021] were independently associated with lower physical outcome scores. Cognitive scores were higher in older patients [B 4.08, 95% CI (1.57-6.59), p = 0.001] and lower in smokers [B -2.43, 95% CI (-4.34 - -0.51), p = 0.013]. Independent predictors of impaired HR-QoL at 1-year follow-up could be identified, suggesting a phenotype at risk. Physical frailty independently predicted poorer physical outcome, emphasizing potential for prehabilitation and frailty-management. Findings should be interpreted considering selection- and response-bias and absence of baseline HR-QoL-assessment. This observational study complied with the Declaration of Helsinki and was approved by the Ethics Committee of the Medical Faculty of the Ruhr-University Bochum on 17th November 2022 (Registration-Number: 2022 - 947). Minor additions to the questionnaire were approved on 19th August 2024 (Registration-Number: 2022 - 947_1).
With multiple treatment options available for hemorrhoidal disease (HD), identifying factors that influence surgical and perioperative management decisions is essential, particularly in advanced cases. This study aimed to determine the patient and disease-related determinants affecting the choice of surgical technique and perioperative management in patients with Grade III and IV HD, thereby addressing inter-institutional variations in treatment approaches. A secondary analysis was performed on data from a nationwide, multicenter prospective cohort study. The study included 315 patients diagnosed with Grade III (72%) and Grade IV (28%) HD, with a mean age of 43.7 ± 11.4 years and a male predominance (76.7%). Preoperative data, including patient demographics, comorbidities (ASA scores), symptom severity, and clinical findings, were collected at participating governmental and private hospitals. Surgical techniques were classified as excisional or non-excisional, while anesthesia type, use of perianal or pudendal analgesia, and hospitalization duration were determined by the surgical teams. Hospital type was also recorded. Multivariable analyses were conducted to identify factors influencing the choice of surgical techniques, anesthesia, analgesia application, and the decision for outpatient procedures. Multivariate analysis revealed that the presence of thrombosis significantly influenced the choice of surgical technique (OR: 7.2, CI: 2.8-12.7, p = 0.001), while hospital category also played an important role (OR: 5.1, CI: 2.7-9.7, p = 0.001). For anesthesia type, factors such as disease grade (OR: 3.3, CI: 1.6-6.7, p = 0.001), hospital category (OR: 9, CI: 4.1-19.9, p < 0.001), and surgical technique (OR: 6.8, CI: 3-15.3, p < 0.001) were significant determinants. The decision to use perianal or pudendal analgesia was influenced by hospital category (OR: 27.1, CI: 11.7-62.6, p < 0.001) and the presence of incontinence (OR: 0.2, CI: 0.04-0.93, p = 0.04). Outpatient management was associated with disease grade (OR: 2.3, CI: 1.1-4.8, p = 0.023), hospital category (OR: 2, CI: 1.2-3.2, p = 0.011), higher comorbidity (ASA ≥ 3, OR: 3.3, CI: 1.8-3.2, p = 0.007), and the selected surgical technique (OR: 3.1, CI: 1.6-5.8, p = 0.001). Significant inter-institutional variations exist in the management of advanced HD. Among various factors, the presence of thrombosis emerges as the predominant determinant in surgical decision-making, providing valuable insights for standardizing treatment protocols and reducing practice variability.
This study evaluated the impact of a dedicated perioperative nursing team on operating theatre efficiency in robotic-assisted spinal surgery. A structured training programme was developed for a team of four perioperative nurses to achieve competence and autonomy in robotic system management across all phases of care. Operative data were retrospectively collected and compared between a pre-implementation phase and a post-implementation phase. A total of 130 robotic-assisted spinal procedures were analysed, including 47 performed before and 83 after team implementation. Following introduction of the specialised nursing team, mean time to surgical start decreased from 67.5 to 61.1 min, and overall operative duration was significantly reduced from 253.9 to 195.0 min. Implant execution time remained stable (30.0 min) despite a significant increase in the mean number of pedicle screws implanted per procedure from 4.9 to 6.4. Efficiency per screw improved markedly, with time per screw decreasing from 7.0 to 4.8 min. Three robotic procedures were abandoned in the pre-implementation period due to workflow-related issues, whereas no procedures were abandoned after introduction of the dedicated team. These findings demonstrate that the implementation of a specialised perioperative nursing team is associated with substantial improvements in workflow efficiency in robotic-assisted spinal surgery.
BackgroundMultidisciplinary perioperative pathways are associated with improved outcomes in colorectal surgery, but evidence on real-world implementation is still scarce, especially in limited-resource settings. An audit was conducted targeting first-year outcomes after implementation of the Optimised Recovery Programme in Colorectal Surgery at a tertiary public hospital since February 2024. Results were compared with a historical pre-implementation cohort treated in 2022. Outcomes and quality indicators were analysed using descriptive statistics. Despite a higher proportion of patients with severe systemic disease in the optimised recovery cohort, mean hospital length of stay decreased substantially, as well as readmission rates, with no increase in 30-day mortality. Real-world implementation of a multidisciplinary perioperative pathway was feasible and safe, even in a high comorbidity population and limited-resource setting. These findings support the value of structured perioperative systems of care and multidisciplinary coordination in routine clinical practice.
Implementing early mobilization protocols can improve patient outcomes and accelerate postoperative recovery. This pre-test and posttest randomized controlled experimental study aims to evaluate the effects of early mobilization training on mobility, pain, comfort, and sleep quality in patients undergoing laparoscopic abdominal surgery. The study was conducted at a state hospital in Northern Cyprus between June and October 2022, and participant recruitment and follow-up were reported using the CONSORT 2010 flow diagram. The sample of the study comprised 78 abdominal surgery patients who were equally assigned to the intervention (n = 39) and control groups (n = 39). Perioperative information form and patient mobility scale were used for data collection. The mean ages of the intervention and control groups were 44.82 ± 12.37 and 44.41 ± 10.80 years, respectively. The total duration of mobilization in the intervention group (58.33 ± 11.20 min) was significantly higher than that of the control group (24.92 ± 5.64 min). Postoperative pain scores of the intervention group were significantly lower than those of the control group. Comfort and sleep quality scores of the intervention group were significantly higher than those of the control group. Finally, the length of hospital stay in the intervention group was significantly lower than that of the control group. The findings of this study imply that early mobilization training had a positive impact on reducing postoperative pain and increasing the duration of mobilization, comfort while turning in bed, and lying and the quality of sleep on the first postoperative day. This study provides practical insights for enhancing comfort, mobility, pain management, and sleep quality, while addressing a key gap in the literature and contributing to evidence-based clinical practice.
Enhanced Recovery After Surgery (ERAS) and immunonutrition (IMN) are established strategies for enhancing postoperative outcomes and modulating immune response. However, current research often overlooks the influence of patients' nutritional status and acceptability in the effectiveness of these combined therapies. The study was aimed at evaluating the effectiveness of perioperative IMN in gynaecological cancer (GC) patients. This was an open-label randomised controlled trial. The primary outcomes were postoperative hospitalisation, nutritional status, and functional status. A total of 110 participants were randomised into the perioperative IMN intervention (I-ERAS) or control (CO) group under an ERAS protocol. Mean age was 50.15 ± 13.07 years in I-ERAS and 49.27 ± 13.80 years in CO. Compared with CO, I-ERAS had a significantly shorter hospital stay (81.5 ± 40.9 h vs. 102.7 ± 58.7 h, p < 0.05) and faster gastrointestinal recovery, including earlier transition to a solid diet and return of bowel sounds. Importantly, none of the I-ERAS patients were readmitted within 30 days, compared with a 7.4% readmission rate in the CO group (p < 0.05). In addition, I-ERAS patients had improved wound healing (p < 0.05); better preservation of nutritional status (p < 0.05), a more favourable inflammatory profile (p < 0.01), and faster recovery of functional status (p < 0.05) and physical performance (p < 0.01). Perioperative IMN within an ERAS protocol for GC surgery is a valuable intervention that reduces hospitalisation, enhances wound healing, improves inflammatory profiles, and lowers readmissions, making it suitable for routine ERAS practice. NCT06039306, dated 14 September 2024 PROTOCOL VERSION: POIMNERAS2023, version 2, September 2023.
Enhanced Recovery After Surgery programmes combine efficient perioperative care pathways with evidence-based strategies to improve physiological readiness for surgery. In total, 220 patients undergoing laparoscopic sleeve gastrectomies in 2018 (pre-Enhanced Recovery After Surgery) were retrospectively compared with 143 patients undergoing laparoscopic sleeve gastrectomies in 2023-24 (Enhanced Recovery After Surgery) at our institution. Comparisons looked at postoperative length of stay, post-anaesthesia care unit length of stay, opioid usage, postoperative nausea and vomiting, visual analogue pain scores, 30-day readmissions, and mortality rates. The primary goal of this study was to evaluate the association between implementation of our Enhanced Recovery After Surgery protocol at year 5 with postoperative outcomes, with a focus on patient length of stay and opioid usage. Our protocol saw a significant decrease in all variables, with similar readmissions and mortality rates. The bariatric Enhanced Recovery After Surgery protocol implemented at our institution for laparoscopic sleeve gastrectomy improved perioperative outcomes with no increased patient risk.
Social drivers of health influence every stage of pediatric perioperative care, shaping access to surgery, anesthetic readiness, and recovery. Social conditions, reflecting the circumstances of a family's daily life, and structural conditions, encompassing the systems and policies that shape those circumstances, contribute to missed appointments, delayed optimization, intraoperative vulnerability, and postoperative complications-outcomes not accounted for by physiology alone. Using the Gelberg-Andersen Behavioral Model for Vulnerable Populations, this Special Article synthesizes current evidence, outlines biologic and systemic pathways through which social drivers of health affect perioperative outcomes, and proposes strategies for integrating these insights into clinical practice and research.
This study aims to assess the perception of urinary catheter use in older patients undergoing urologic and orthopaedic surgery and to explore the associated factors, specifically functional independence and knowledge. A cross-sectional research design. Patients were eligible if they were aged 65 and older, had received urological or orthopaedic surgery, were able to communicate independently, and had a urinary catheter. Data collection included demographics, voiding function history, health conditions, and the knowledge and perception of urinary catheter use. Multiple regression analysis was employed to investigate the variables associated with the perception of urinary catheter use. A total of 204 older patients were enrolled. The mean score of perception was 41.8 ± 2.7 (range 13-65). Lower perception scores (indicating a preference for catheterization) were observed for items related to mobility difficulties and incontinence. Multiple regression analysis revealed that older patients with greater independence in activities of daily living (ADLs) and better knowledge were significantly more likely to have a positive perception (i.e., recognizing the benefits of catheter removal and its risks). Older surgical patients' perceptions of urinary catheter use are significantly shaped by their ADL status and knowledge levels. Although catheters are often viewed as a convenience for mobility and incontinence, such perceptions frequently misalign with evidence-based safety standards. To optimize perioperative care, it is imperative to implement structured preoperative education and shared decision-making frameworks that prioritize function-based urinary management. This study incorporates older patients' perspectives by assessing their perceptions and knowledge of catheterization. The findings advocate for a transition toward function-based management, where catheter alternatives are tailored to individual ADL status. By aligning clinical practice with patients' functional needs and informed preferences, healthcare providers can empower patients and reduce the risk of iatrogenic harm.
Localised renal cell carcinoma is treated with radical nephrectomy (RN) or partial nephrectomy (PN). Nephron-sparing PN increases preservation of renal function, reducing incidence of end stage renal failure and associated cardiovascular events. In patients with exophytic T1a (≤ 4 cm) tumours and normal contralateral kidney, PN is standard of care. In patients with T1b (> 4-7 cm) or endophytic T1a tumours and normal contralateral kidney, the benefits of PN over RN are less clear as there are increased surgical complications and more tissue may be excised reducing the preservation of renal function. There are no high-quality studies to address if PN is superior to RN in these more complex cases. PARTIAL is a pragmatic randomised controlled parallel group unblinded superiority trial with embedded internal pilot and economic and process evaluation. A total of 420 participants will be recruited in UK NHS centres with expertise in minimally invasive nephrectomy techniques. Eligible consenting adults with a single T1 renal cell carcinoma, normal contralateral kidney and equipoise within the multidisciplinary team confirming suitability to receive both interventions by minimally invasive approaches are randomised 1:1 to PN or RN. Patients with metastatic disease, existing chronic kidney disease, solitary functioning kidney, congenital renal abnormality, inherited kidney cancer syndrome, who lack capacity to consent or are pregnant or breast feeding are excluded. Primary outcomes are gains in preservation of renal function at 2 years and surgical complications over the peri-operative period. Secondary outcomes are quality of life and recovery, cost and cost-effectiveness, rates of positive surgical margin, recurrence and cardiovascular events, overall survival, progression to chronic kidney disease and end stage renal failure, operative conversion and patient acceptability. Participants are followed up for 2 years with outcomes collected from medical records and participant questionnaires. PARTIAL will determine if gains from PN are superior to RN and offset the potential harms and costs in complex T1 renal tumours suitable for either approach. If PN is not found to provide clinically significant gains and excess complications are confirmed, then a practice-changing case for RN as standard of care could be made. ISRCTN 11293415. Registered prospectively on 19 January 2023.
Advances in neurosurgical techniques and perioperative management have improved survival and neurological outcomes in several neurosurgical diseases. Nonetheless, even when objective functional scales, such as the modified Rankin Scale or Karnofsky Performance Status, indicate favorable outcomes, patients may experience persistent impairments in quality of life (QOL) and higher brain function, affecting daily activities, social participation, and treatment satisfaction. Conventional neurological examinations and imaging often fail to capture subtle cognitive, emotional, and psychosocial difficulties. Moreover, patient-reported outcomes and health-related QOL assessments provide a complementary perspective that reflects patients'subjective experiences, including fatigue, attention deficits, anxiety, and depressive symptoms. This review outlines a practical framework for incorporating QOL and higher brain function assessments into routine neurosurgical practice. Appropriate timing for preoperative and postoperative evaluations, commonly used general and disease-specific QOL instruments, and brief cognitive screening tools applicable in busy clinical settings are discussed. Notably, emphasis is placed on stepwise assessment strategies and multidisciplinary collaboration due to limited manpower. Integrating objective functional measures with patient-centered QOL evaluations enables a more comprehensive understanding of treatment outcomes and supports individualized clinical decision-making aimed at optimizing long-term patient well-being.
This case report describes the perioperative management of a massive solitary fibrous tumour of the pleura in a 77-year-old woman undergoing thoracotomy. The tumour, occupying a substantial portion of the right hemithorax, posed significant challenges regarding airway management, haemodynamic stability, and postoperative recovery. A comprehensive anaesthetic strategy was employed, including advanced monitoring, lung isolation, multimodal analgesia, and preemptive planning for potential complications. Careful intraoperative coordination minimised blood loss and maintained haemodynamic stability, avoiding the need for transfusion. Postoperative analgesia was effectively managed with a thoracic epidural catheter, facilitating early mobilisation and respiratory recovery. The patient experienced a favourable postoperative course and was discharged home on the seventh day. This case underscores the importance of individualised anaesthetic planning and multidisciplinary collaboration when managing large intrathoracic tumours.
Post-thoracic surgery pain remains a major clinical challenge, with substantial impact on pulmonary function, postoperative recovery, and patient quality of life. Thoracic epidural analgesia is widely regarded as the standard of care; however, it is associated with potential complications, including hypotension, urinary retention, and inadequate analgesia in a subset of patients. Intercostal cryoanalgesia, a peripheral nerve block technique that induces temporary axonal degeneration through controlled freezing, has emerged as a potential alternative for prolonged postoperative pain control. The primary objective of this study is to compare postoperative hospital length of stay between intercostal cryoanalgesia and thoracic epidural analgesia. Secondary objectives include the evaluation of postoperative pain intensity, opioid consumption, adverse effects, postoperative complications, quality of life, quality of recovery, and patient satisfaction. This is a single-center, prospective, randomized, parallel-group clinical trial comparing intercostal cryoanalgesia with thoracic epidural analgesia for postoperative pain control in patients undergoing thoracic surgery. Fifty adult patients (≥18 y) are randomized 1:1 to either epidural or cryoanalgesia groups. All perioperative and postoperative care is provided by the attending clinical teams according to routine institutional practice, with no influence from the research team beyond randomized allocation. The primary endpoint is postoperative hospital length of stay. Secondary outcomes include pain intensity (visual analog scale), opioid consumption, incidence of adverse effects and complications, quality of life (WHOQOL-BREF), and quality of recovery (QoR-15). Data are collected up to 1 year postoperatively. Approval from the Human Research Ethics Committee was obtained in November 2024, and participant recruitment began in July 2025. Data collection commenced concurrently with participant recruitment and is expected to be completed by August 28, 2027. Data analysis will begin in September 2027, with results anticipated in the first quarter of 2028. This study protocol outlines a randomized clinical trial designed to assess clinical outcomes associated with intercostal cryoanalgesia compared with thoracic epidural analgesia following thoracic surgery. The findings are expected to contribute to the evidence base on postoperative pain management and inform the design of future comparative and implementation studies in this field.
<b>Introduction:</b> Robotic platforms are increasingly used in colorectal surgery. Versius<sup></sup> is a modular robotic system whose safety and feasibility are currently being evaluated in routine clinical practice.<b>Aim:</b> To assess the safety, feasibility, and short-term oncologic outcomes of Versius-assisted colorectal cancer surgery in a single center during a two-year implementation period.<b>Material and methods:</b> A retrospective observational study was conducted, including patients undergoing elective robotic colorectal cancer resection using the Versius system between December 5, 2022, and August 27, 2025. Demographic characteristics, operative parameters (skin-to-skin time, docking time, console time, blood loss, conversions), intra- and postoperative complications (Clavien-Dindo classification), reoperations, 30-day readmissions and mortality, length of stay, and oncologic outcomes (resection margins, lymph node yield, mesorectal quality) were analyzed.<b>Results:</b> A total of 191 patients were included (51.8% male, mean age 69.7 9.8 years). The most common procedures were anterior resection (41.4%) and right hemicolectomy (26.7%). The median skin-to-skin operative time was 225 minutes (IQR 185-269). Median length of stay was 6 days (IQR 5-7). Conversion to laparotomy occurred in 8 patients (4.2%). Postoperative complications occurred in 40 patients (20.9%), including minor complications (Clavien-Dindo I-II) in 26 (13.6%) and major complications (≥III) in 14 (7.3%). Reoperation was required in 13 patients (6.8%), and 30-day readmission occurred in 6 (3.1%). One perioperative death was recorded (0.5%). Median lymph node yield was 22 (IQR 14-25), and ≥12 nodes were retrieved in 87.9% of patients. Complete mesorectal excision was achieved in 75.3%, with a combined rate of complete and nearly complete excision of 95.7%.<b>Conclusions:</b> Versius-assisted colorectal cancer surgery is feasible and safe in a center with established laparoscopic expertise. Acceptable complication rates and adequate oncologic parameters support its implementation in routine colorectal practice.