Publications by authors named "John Withington"

16 Publications

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Growth and renal function dynamics of renal oncocytomas on active surveillance.

BJU Int 2021 May 28. Epub 2021 May 28.

Division of Surgery and Interventional Science, University College London.

Objectives: To study the natural history of renal oncocytomas and address indications for intervention by determining how growth associates with renal function over time, the reasons for surgery and ablation, and disease-specific survival.

Patients And Methods: Retrospective cohort of consecutive patients with renal oncocytoma on active surveillance reviewed at the Specialist Centre for Kidney Cancer at Royal Free London NHS Foundation Trust (2012 to 2019). Comparison between groups was tested using the Mann-Whitney U and the Chi-square tests. A mixed-effects model with a random intercept for patient was used to study the longitudinal association between tumour size and estimated glomerular filtration rate (eGFR).

Results: Longitudinal data from 98 patients with 101 lesions was analysed. Most patients were male (68.3%), median age was 69 years (IQR 13). The median follow-up was 29 months (IQR 26). Most lesions were small renal masses, 24% measured over 4 cm. Over half (64.4%) grew at a median rate of 2 mm per year (IQR 4). No association was observed between tumour size and eGFR over time (p=0.871). Nine lesions (8.9%) were subsequently treated. Two deaths were reported, neither were related to the diagnosis of renal oncocytoma.

Conclusion: Natural history data from the largest active surveillance cohort of renal oncocytomas to date show that renal function does not seem to be negatively impacted by growing oncocytomas, and confirms clinical outcomes are excellent after a median follow up of over 2 years. Active surveillance should be considered the gold standard management of renal oncocytomas up to 7cm.
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http://dx.doi.org/10.1111/bju.15499DOI Listing
May 2021

The opportunities at play, both home and away.

Authors:
John Withington

BJU Int 2020 09;126(3):403-405

Harkness Fellow in Healthcare Practice and Policy and ST7 Urology Registrar, London, UK.

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http://dx.doi.org/10.1111/bju.15212DOI Listing
September 2020

Testicular cancer outcome inequality: a curable disease?

Authors:
John Withington

BJU Int 2019 09;124(3):359-360

Urology, London Deanery and National Medical Director's Clinical Fellow, NHS England and NHS Improvement, London, UK.

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http://dx.doi.org/10.1111/bju.14860DOI Listing
September 2019

Comparison of testis cancer-specific survival: an analysis of national cancer registry data from the USA, UK and Germany.

BJU Int 2019 03 9;123(3):385-387. Epub 2018 Dec 9.

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1111/bju.14616DOI Listing
March 2019

Mental health nurses' views and experiences of working with undergraduate nursing students: A descriptive exploratory study.

Nurse Educ Today 2018 May;64:161-165

Canterbury District Health Board (CDHB), Christchurch, New Zealand.

Background: The core of pre-registration nursing education is the learning that takes place during the clinical placement. However, despite the fact that registered nurse preceptors are key players in supporting students during their placements there is a lack of literature examining the views of preceptors working with nursing students in mental health settings.

Objectives: To explore mental health nurses' views and experiences of working with undergraduate nursing students and determine what factors influence this experience.

Design: A descriptive exploratory study approach using an on-line questionnaire was adopted for this study.

Settings: A specialist mental health service (SMHS) within one District Health Board in New Zealand.

Participants: 89 registered nurses who had been involved in working with nursing students participated in this study.

Methods: Data was collected using an online questionnaire.

Results: The majority of the respondents in this study reported that they felt confident and well supported in the work they did with nursing students and had a positive perception of this role. However, one significant negative factor identified was the extra stress and workload pressure they reported when working with students, when no allowance was made for this. Another key finding was that engaging in some form of education related to the preceptorship role was positively correlated with nurses knowing what was required of them, feeling confident, the extent to which they planned clinical education, and feeling that they were sufficiently appreciated.

Conclusions: Ensuring nurses have access to education related to clinical teaching and learning increases their confidence in the work they do with nursing students and has also been shown to have a positive impact on how they view this role.
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http://dx.doi.org/10.1016/j.nedt.2018.02.021DOI Listing
May 2018

Contemporary surgical management of renal oncocytoma: a nation's outcome.

BJU Int 2018 06 2;121(6):893-899. Epub 2018 Mar 2.

Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.

Objective: To report on the contemporary UK experience of surgical management of renal oncocytomas.

Patients And Methods: Descriptive analysis of practice and postoperative outcomes of patients with a final histological diagnosis of oncocytoma included in The British Association of Urological Surgeons (BAUS) nephrectomy registry from 01/01/2013 to 31/12/2016. Short-term outcomes were assessed over a follow-up of 60 days.

Results: Over 4 years, 32 130 renal surgical cases were recorded in the UK, of which 1202 were oncocytomas (3.7%). Most patients were male (756; 62.9%), the median (interquartile range [IQR]) age was 66.8 (13) years. The median (IQR; range) lesion size was 4.1 (3; 1-25) cm, 43.5% were ≤4 cm and 30.3% were 4-7 cm lesions. In all, 35 patients (2.9%) had preoperative renal tumour biopsy. Most patients had minimally invasive surgery, either radical nephrectomy (683 patients; 56.8%), partial nephrectomy (483; 40.2%) or other procedures (36; 3%). One in five patients (243 patients; 20.2%) had in-hospital complications: 48 were Clavien-Dindo classification grade ≥III (4% of the total cohort), including three deaths. Two additional deaths occurred within 60 days of surgery. The analysis is limited by the study's observational nature, not capturing lesions on surveillance or ablated after biopsy, possible underreporting, short follow-up, and lack of central histology review.

Conclusion: We report on the largest surgical series of renal oncocytomas. In the UK, the complication rate associated with surgical removal of a renal oncocytoma was not negligible. Centralisation of specialist services and increased utilisation of biopsy may inform management, reduce overtreatment, and change patient outcomes for this benign tumour.
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http://dx.doi.org/10.1111/bju.14159DOI Listing
June 2018

Attracting men to nursing: Is graduate entry an answer?

Nurse Educ Pract 2018 Jan 14;28:257-263. Epub 2017 Jul 14.

College of Education, Health and Human Development, University of Canterbury, Private Bag 4800, Christchurch 8140, New Zealand. Electronic address:

There is evidence which suggests that second degree graduate entry nursing programs may be a potential strategy to increase the number of men in nursing. This qualitative study used thematic analysis to describe the reasons underpinning men's enrolment in the first three intakes of the first such program in New Zealand. Interrogation of the data revealed two primary themes. First, in search of a satisfying career with the associated subthemes: was at a loss; fulfilment through working with and helping people; and a career with options. The second theme the time was right was underpinned by two subthemes: The right time of life; and, the right course. In contrast, to previous studies of men in nursing it was found that vertical career progression into management was not attractive, and that career satisfaction was seen as being able to help others. The findings may provide insight for developing strategies which encourage men's entry into nursing.
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http://dx.doi.org/10.1016/j.nepr.2017.07.003DOI Listing
January 2018

Surgical and Minimally Invasive Therapies for the Management of the Small Renal Mass.

Curr Urol Rep 2017 Aug;18(8):61

Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, UK.

Purpose Of Review: This article aims to summarise recent developments in surgical and minimally invasive therapies in the management of small renal masses (SRMs).

Recent Findings: The incidence of the small renal mass is increasing. Standard management of the SRM is partial nephrectomy. More recently, use of ablative techniques to manage the SRM has been increasing and an exciting array of technical advances is currently being made in the field. Nephron-sparing surgery looks set to become more financially viable with the advent of newer robotic platforms and, potentially, even less invasive with the evaluation of single-port access. Real-time imaging promises to improve tumour definition, nephron preservation and vascular management intraoperatively. Advances in surgical and minimally invasive therapies for the management of the SRM have the potential to improve cancer clearance and long-term renal function preservation. Patients will experience safer, more reliable and less invasive treatments for their small renal tumours. We describe the current advances underlying these changes.
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http://dx.doi.org/10.1007/s11934-017-0705-8DOI Listing
August 2017

Percutaneous nephrolithotomy access by urologist or interventional radiologist: practice and outcomes in the UK.

BJU Int 2017 06 21;119(6):913-918. Epub 2017 Mar 21.

Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Objective: To compare outcomes of urologist vs interventional radiologist (IR) access during percutaneous nephrolithotomy (PCNL) in the contemporary UK setting.

Patients And Methods: Data submitted to the British Association of Urological Surgeons PCNL data registry between 2009 and 2015 were analysed according to whether access was obtained by a urologist or an IR. We compared access success, number and type of tracts, and perceived and actual difficulty of access. Postoperative outcomes, including stone-free rates, lengths of hospital stay and complications, including transfusion rates, were also compared.

Results: Overall, percutaneous renal access was undertaken by an IR in 3453 of 5211 procedures (66.3%); this rate appeared stable over the entire study period for all categories of stone complexity and in cases where there was predicted or actual difficulty with access. Only 1% of procedures were abandoned because of failed access and this rate was identical in each group. IRs performed more multiple tract access procedures than urologists (6.8 vs 5.1%; P = 0.02), but had similar rates of supracostal punctures (8.2 vs 9.2%; P = 0.23). IRs used ultrasonograhpy more commonly than urologists to guide access (56.6% vs 21.7%, P < 0.001). There were no significant differences in complication rates, lengths of hospital stay or stone-free rates.

Conclusions: Our findings suggest that favourable PCNL outcomes may be expected where access is obtained by either a urologist or an IR, assuming that they have received the appropriate training and that they are skilled and proficient in the procedure.
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http://dx.doi.org/10.1111/bju.13817DOI Listing
June 2017

Assessment of Stone Complexity for PCNL: A Systematic Review of the Literature, How Best Can We Record Stone Complexity in PCNL?

J Endourol 2016 Jan 1;30(1):13-23. Epub 2015 Dec 1.

3 Department of Urology, Norfolk and Norwich Hospital , Norwich, United Kingdom .

Introduction: This study aims to systematically review the literature reporting tools for scoring stone complexity and the stratification of outcomes by stone complexity. In doing so, we aim to determine whether the evidence favors uniform adoption of any one scoring system.

Methods: PubMed and Embase databases were systematically searched for relevant studies from 2004 to 2014. Reports selected according to predetermined inclusion and exclusion criteria were appraised in terms of methodologic quality and their findings summarized in structured tables.

Results: After review, 15 studies were considered suitable for inclusion. Four distinct scoring systems were identified and a further five studies that aimed to validate aspects of those scoring systems. Six studies reported the stratification of outcomes by stone complexity, without specifically defining a scoring system. All studies reported some correlation between stone complexity and stone clearance. Correlation with complications was less clearly established, where investigated.

Conclusions: This review does not allow us to firmly recommend one scoring system over the other. However, the quality of evidence supporting validation of the Guy's Stone Score is marginally superior, according to the criteria applied in this study. Further evaluation of the interobserver reliability of this scoring system is required.
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http://dx.doi.org/10.1089/end.2015.0278DOI Listing
January 2016

Hospital Volume Does Not Influence the Safety of Percutaneous Nephrolithotomy in England: A Population-Based Cohort Study.

J Endourol 2015 Aug 4;29(8):899-906. Epub 2015 May 4.

4 Department of Urology, Norfolk and Norwich University Hospital NHS Foundation Trust , Norwich, United Kingdom .

Purpose: This study aims to investigate the relationship between hospital case volume and safety-related outcomes after percutaneous nephrolithotomy (PCNL) within the English National Health Service (NHS).

Patients And Methods: The study used the Hospital Episode Statistics (HES) database, a routine administrative database, recording information on operations, comorbidity, and outcomes for all NHS hospital admissions in England. Records for all patients undergoing an initial PCNL between April 1, 2006 and March 31, 2012 were extracted. NHS trusts were divided into low-, medium-, and high-volume groups, according to the average annual number of PCNLs performed. We used multiple regression analyses to examine the associations between hospital volume and outcomes incorporating risk adjustment for sex, age, comorbidity, and hospital teaching status. Postoperative outcomes included: Emergency readmission, infection, and hemorrhage. Mean length of stay was also measured.

Results: There were 7661 index elective PCNL procedures performed in 163 hospital trusts, between April 2006 and March 2012. There were 2459 patients who underwent PCNL in the 116 units performing fewer than 10 PCNL procedures per year; 2643 patients in the 37 units performing 10 to 19 procedures per year; and 2459 patients in the 9 hospitals performing more than 20 procedures per year. For low-, medium-, and high-volume trusts, there was little variation in the rates of emergency readmission (L 9.7%, M 9.3%, H 8.4%), infection (3.0%, 4.2%, 3.8%), or hemorrhage (1.3%, 1.5%, 1.5%), and there was no statistical evidence that volume was associated with adjusted outcomes. Mean length of stay was slightly shorter in the medium- (5.0 days) and high-volume (5.0) groups compared with the low-volume group (5.3). The effect remained statistically significant after adjusted for confounding.

Conclusion: Hospital volume was not associated with emergency readmission, infection, or hemorrhage. Length of stay appears to be shorter in higher volume units.
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http://dx.doi.org/10.1089/end.2015.0007DOI Listing
August 2015

'Measurement for improvement not judgement' -- the case of percutaneous nephrolithotomy.

BJU Int 2015 Feb 16;115(2):181-3. Epub 2014 Apr 16.

Department of Urology, Guy's and St Thomas' NHS Hospitals Trust, London, Norfolk, UK.

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http://dx.doi.org/10.1111/bju.12660DOI Listing
February 2015

Cystinuria-a urologist's perspective.

Nat Rev Urol 2014 May 25;11(5):270-7. Epub 2014 Mar 25.

The Urology Centre, Guy's and St Thomas' NHS Foundation Trust London, Guy's Hospital, Great Maze Pond, London SE1 9RT, UK.

Cystinuria is a genetic disease that leads to frequent formation of stones. In patients with recurrent stone formation, particularly patients <30 years old or those who have siblings with stone disease, urologists should maintain a high index of suspicion of the diagnosis of cystinuria. Patients with cystinuria require frequent follow-up and a multidisciplinary approach to diagnosis, prevention and management. Patients have reported success in preventing stone episodes by maintaining dietary changes using a tailored review from a specialist dietician. For patients who do not respond to conservative lifestyle measures, medical therapy to alkalinize urine and thiol-binding drugs can help. A pre-emptive approach to the surgical management of cystine stones is recommended by treating smaller stones with minimally invasive techniques before they enlarge to a size that makes management difficult. However, a multimodal approach can be required for larger complex stones. Current cystinuria research is focused on methods of monitoring disease activity, novel drug therapies and genotype-phenotype studies. The future of research is collaboration at a national and international level, facilitated by groups such as the Rare Kidney Stone Consortium and the UK Registry of Rare Kidney Diseases.
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http://dx.doi.org/10.1038/nrurol.2014.51DOI Listing
May 2014

The changing face of urinary continence surgery in England: a perspective from the Hospital Episode Statistics database.

BJU Int 2014 Aug 22;114(2):268-77. Epub 2014 May 22.

Guy's and St Thomas' NHS Hospitals' Trust, King's College London, London, UK.

Objective: To quantify changes in surgical practice in the treatment of stress urinary incontinence (SUI), urge urinary incontinence (UUI) and post-prostatectomy stress incontinence (PPI) in England, using the Hospital Episode Statistics (HES) database.

Patients And Methods: We used public domain information from the HES database, an administrative dataset recording all hospital admissions and procedures in England, to find evidence of change in the use of various surgical procedures for urinary incontinence from 2000 to 2012.

Results: For the treatment of SUI, a general increase in the use of synthetic mid-urethral tapes, such as tension-free vaginal tape (TVTO) and transobturator tape (TOT), was observed, while there was a significant decrease in colposuspension procedures over the same period. The number of procedures to remove TVT and TOT has also increased in recent years. In the treatment of overactive bladder and UUI, there has been a significant increase in the use of botulinum toxin A and neuromodulation in recent years. This coincided with a steady decline in the recorded use of clam ileocystoplasty. A steady increase was observed in the insertion of artificial urinary sphincter (AUS) devices in men, related to PPI.

Conclusions: Mid-urethral synthetic tapes now represent the mainstream treatment of SUI in women, but tape-related complications have led to an increase in procedures to remove these devices. The uptake of botulinum toxin A and sacral neuromodulation has led to fewer clam ileocystoplasty procedures being performed. The steady increase in insertions of AUSs in men is unsurprising and reflects the widespread uptake of radical prostatectomy in recent years. There are limitations to results sourced from the HES database, with potential inaccuracy of coding; however, these data support the trends observed by experts in this field.
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http://dx.doi.org/10.1111/bju.12650DOI Listing
August 2014

Percutaneous nephrolithotomy in England: practice and outcomes described in the Hospital Episode Statistics database.

BJU Int 2014 May 21;113(5):777-82. Epub 2013 Nov 21.

Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

Objective: To investigate the postoperative outcomes of percutaneous nephrolithotomy (PCNL) in English National Health Service (NHS) hospitals.

Patients And Methods: We extracted records from the Hospital Episode Statistics (HES) database for all patients undergoing PCNL between March 2006 and January 2011 in English NHS hospitals. Outcome measures were haemorrhage, infection within the index admission, and rates of emergency readmission and in-hospital mortality within 30 days of surgery.

Results: A total of 5750 index PCNL procedures were performed in 165 hospitals. During the index admission, haemorrhage was recorded in 81 patients (1.4%), 192 patients (3.8%) had a urinary tract infection (UTI), 95 patients (1.7%) had fever, and 41 patients (0.7%) had sepsis. There were 595 emergency readmissions in 518 patients (9.0%). Reasons for readmission were varied: 70 (1.2%) with UTI, 15 (0.3%) sepsis, 73 (1.3%) haematuria, 25 (0.4%) haemorrhage, and 25 (0.4%) acute urinary retention. There were 13 (0.2%) in-hospital deaths within 30 days of surgery.

Conclusions: Haemorrhage and infection represent relatively common and potentially severe complications of PCNL. Mortality is extremely rare after PCNL (about one in 400 procedures overall) but almost one in 10 patients have an unplanned hospital readmission within 30 days of surgery. Complications of PCNL may be under-reported in the HES database and need to be corroborated using other data sources.
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http://dx.doi.org/10.1111/bju.12373DOI Listing
May 2014

The forgotten ureteric stent: what next?

BJU Int 2014 Jun 16;113(6):850-1. Epub 2014 Apr 16.

Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.

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http://dx.doi.org/10.1111/bju.12357DOI Listing
June 2014