Journal of Clinical Urology

The National Health Service (NHS) accounts for 4%–5% of the UK’s greenhouse gas (GHG) emissions, approximately 20–25 million tonnes of carbon dioxide equivalent (CO2e) annually. Recognising the increasingly harmful effects of climate change on human health, the NHS aims to achieve net zero GHG emissions by 2045. The Environmental Lessons Learned and Applied (ELLA) methodology, developed and tested by the Getting It Right First Time (GIRFT) programme in the NHS in England, sets out a stepwise process for redesigning a clinical care pathway to reduce carbon emissions while maintaining or improving clinical standards.

We reviewed peer-reviewed and grey literature to identify clinical pathways within urology with probable large decarbonisation potential if the ELLA methodology was applied.

Opportunities lie in applying the ELLA methodology to uro-oncology, UTIS and outpatient care, catheter care and elective surgery. Suspected cancer pathways and outpatients are some of the highest volume pathways. The highest intensity modifiable hotspots at a per-patient level likely include surgery, particularly robot-assisted. The ELLA methodology guides identification of sustainable interventions through care pathway mapping, rather than focusing on individual procedures. This allows a wide range of potential sustainable improvements to be considered and prioritised. This approach can potentially drive greater reductions in the GHG emissions of urological care and avoid the pitfall of single-action bias.

We have applied the first steps of the ELLA framework to consider where future opportunities for decarbonisation of UK urology might lie. We have identified several pathways that have either very high levels of activity and/or very carbon-intensive processes. Full application of the ELLA framework to urological pathways can develop pragmatic strategies for decarbonising UK urology practice. We encourage multidisciplinary efforts to advance and build on the ideas raised and form action plans for the ongoing decarbonisation of urological care.

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British Association of Urological Surgeons (BAUS) is the subspecialty organization for urologists in the United Kingdom. BAUS implemented structured equality, diversity, and inclusion initiatives to improve representation at its annual scientific meetings (ASM). Scientific meetings play a critical role in academic visibility, leadership development, and professional networking. Historically, women, ethnic minority clinicians, and international medical graduates (IMGs) have been underrepresented in conference leadership roles. This study evaluated demographic representation among Chairs and Speakers (C&S) at BAUS ASMs from 2022 to 2025 and compared these data with membership demographics.

A retrospective observational analysis of publicly available BAUS ASM programs from 2022 to 2025 was conducted. Demographic variables including gender, ethnicity, and primary medical qualification (PMQ) region were extracted and compared with BAUS membership data. Descriptive statistics and trend analyses were performed.

A total of 682 C&S were identified. Women comprised 31.2% of participants and were significantly overrepresented relative to workforce proportions. Minority ethnicity representation increased significantly from 34.3% in 2022 to 48.7% in 2025 (p < 0.01). However, Caucasian clinicians and UK-trained doctors remained predominant overall. IMGs accounted for 25.1% of C&S and remained significantly underrepresented compared with workforce data, with only a modest upward trend.

Representation among BAUS ASM C&S has improved, particularly for ethnic minority clinicians and women. Nonetheless, disparities persist for IMGs and minority groups. Continued targeted strategies and longitudinal monitoring are required to achieve sustained equity in academic participation.

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Interest in targeted prostate cancer screening has increased following the UK National Screening Committee’s November 2025 draft recommendation and public consultation, which supported a risk-stratified approach rather than population-wide prostate-specific antigen (PSA) screening. This literature review summarises current evidence for screening in high-risk groups, including men of Black ethnicity, those with a family history of prostate cancer, and carriers of pathogenic BRCA1/2 variants.

A narrative review of landmark randomised screening trials, guideline documents, modelling studies, and prospective cohort data was performed, focusing on the effectiveness and limitations of targeted screening strategies in high-risk populations.

PSA-based screening reduces prostate cancer mortality in some settings but remains associated with substantial overdiagnosis. Contemporary pathways incorporating pre-biopsy magnetic resonance imaging (MRI) and active surveillance have improved the balance between benefit and harm. Recent UK modelling suggests that population screening is unlikely to be cost-effective, whereas targeted screening may offer greater value in selected high-risk groups, particularly BRCA2 carriers and potentially men of Black ethnicity.

Current evidence supports a move away from universal PSA screening towards structured, risk-stratified early detection. The strongest rationale exists for targeted screening in men with pathogenic BRCA2 variants, while evidence for other high-risk groups continues to evolve. Ongoing studies, including TRANSFORM, will be important in defining future UK screening policy.

Not applicable.

Prostate cancer screening remains limited by the biological heterogeneity of the disease and the inability of current approaches to reliably distinguish indolent from high-risk cancer. Population-based screening has demonstrated only modest reductions in prostate cancer-specific mortality, accompanied by substantial overdiagnosis and overtreatment, highlighting the need for more selective strategies. Risk-stratified screening has therefore emerged as a potential solution, aiming to enrich the detection of aggressive disease while minimising harm. This mini-review evaluates the evidence supporting targeted screening approaches, focusing on high-risk groups including men with a family history, inherited genetic susceptibility, Black ethnicity, and older age.

A narrative review of the literature covering targeted screening approaches, focusing on men with a family history of prostate cancer, inherited genetic susceptibility to cancer, Black ethnicity, and older age.

While family history, inherited genetic susceptibility, Black ethnicity, and older age are consistently associated with increased prostate cancer incidence, their utility in identifying men at risk of high risk of disease is variable. Germline BRCA2 mutation carriers represent the most clearly defined high-risk group, with evidence of earlier onset, higher incidence, and a greater proportion of aggressive disease, although their low population prevalence limits impact at scale. In contrast, family history and ethnicity are heterogeneous and context-dependent, while older age reflects a high burden of disease but uncertain screening benefit due to competing mortality and delayed treatment effects. Advances in imaging, biomarkers, and multivariable risk models have created the potential for layered screening pathways that combine low-cost triage tests with progressively more specific risk-enrichment tools.

Current evidence suggests that effective screening will require an integrated, risk-adapted approach delivered within organised programmes. Ongoing trials are expected to define optimal implementation strategies, including eligibility criteria, screening intervals, and diagnostic pathways.

Not applicable

To characterise contemporary United Kingdom (UK) practice for suspected testicular cancer referrals and benchmark performance against the NHS Faster Diagnosis Standard (FDS).

EMPAST (Evaluating the Management Pathway for Suspected Testicular Cancer) is a British Association of Urological Surgeons (BAUS)-affiliated national retrospective audit. It comprised a unit-level questionnaire and two anonymised cohorts: patients referred with suspected testicular cancer (June–July 2025) and confirmed cancer undergoing orchidectomy (April 2023–March 2024). Timeliness to consultation and outcome communication was assessed against 14-day and 28-day (FDS proxy) standards. Analyses used descriptive statistics and logistic regression.

Across 107 centres, 1818 submissions were analysed (773 diagnostic; 947 confirmed cancer). Median referral-to-consultation time was 7.5 days (IQR 5–14), with 79% seen within 14 days. Median referral-to-outcome communication was 14 days (IQR 8–25), and 81% achieved the FDS proxy. Pre-referral ultrasound (PRUS) occurred in 18.6% of cases and was associated with a higher proportion of cancer diagnoses in the referred cohort (60% vs 9.7%) and higher FDS proxy achievement (OR 1.10, 95% CI 1.06–1.84, p < 0.01). Median referral-to-orchidectomy time was 23 days (IQR 15–35).

UK suspected testicular cancer pathways demonstrate good diagnostic timeliness but variation in pathway configuration between units highlights opportunities for optimisation.

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Conventional flexible ureteroscopy (fURS) techniques are limited by residual fragments, infectious complications and stone size. Flexible and Navigable Suction Ureteral Access Sheaths (FANS) have been developed to address these limitations through controlled suction and pressure modulation within the pelvico-calyceal system (PCS).

This narrative review summarises the design principles of FANS, outlines practical considerations for their use, and synthesises evidence on their use.

FANS incorporate a flexible distal tip permitting advancement into the PCS. By bypassing the pelvico-ureteric-junction (PUJ), FANS establish a low-resistance outflow, lowering IRP and increasing effective irrigation flow. Higher flow rates and continuous evacuation of stone dust may improve endoscopic visibility and enhance heat dissipation. Clinical studies demonstrate higher stone-free rates and lower infectious complications compared with conventional fURS. Non-inferior stone-free rates have been reported compared with mini-percutaneous nephrolithotomy for high stone burdens, with lower major complications. Their optimal use requires understanding the interaction between sheath and scope size, irrigation and suction pressure to avoid PCS collapse or over-pressurisation.

FANS represent a potential paradigm shift in RIRS with improved SFRs and reduced infectious complications. Long-term data are required to quantify the risk of PUJ strictures and to quantify cost-effectiveness and clinical benefits, especially in larger stone burdens.

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Over the last decade, simulation-based education (SBE) has evolved from a supplementary training modality into an essential core component of early urology specialty training in the United Kingdom. Introduced in 2015, the ST3 urology simulation bootcamp was designed to address heterogeneity in trainee experience, constrained operative exposure and the heightened anxiety associated with transition into specialty training.

The main aim is to evaluate the evolution, structure, educational outcomes and explore the wider impact of 10 years of SBE on early urology careers in the United Kingdom.

This narrative review amalgamates published literature, programme evaluations and the longitudinal experience of the UK ST3 urology bootcamp. The development of the bootcamp model, its educational framework, simulation modalities, assessment rubrics and integration within the national training structures are described. Educational and professional outcomes over 10 years are evaluated.

The urology bootcamp has consistently demonstrated improvement in trainees’ knowledge, technical skills, confidence and preparedness at the point of specialty entry. Multimodal simulation addressing both technical and non-technical skills has supported smoother transitions into clinical practice, earlier engagement in operative opportunities and professional identity formation. Iterative refinement informed by trainee and faculty feedback has enhanced curricular relevance and alignment with real-world needs and demands. The bootcamp model has also been successfully adapted internationally, including in low-resource settings.

Over the decade, simulation-based urology bootcamp training has become a foundational element of early specialty education in the United Kingdom. By mitigating transitional uncertainties, addressing educational heterogeneity and supporting essential skills acquisition, the bootcamp model offers a scalable, reproducible, evidence-based framework with relevance across surgical specialties and training programmes.

To synthesize current evidence on generative artificial intelligence (AI) integration in urology and propose a structured, patient-centered framework for its responsible implementation in daily urological workflows.

A narrative review was conducted examining applications of large language models (LLMs), ambient documentation platforms, retrieval-augmented generation (RAG) systems, and multimodal clinical decision-support tools across the urology care continuum, including pre-visit triage, patient education, clinical decision support, surgical planning, and academic productivity.

A four-agent model was developed defining complementary roles for the digital AI agent, staff urologist, resident or fellow, and institutional AI champion. RAG systems reduced hallucinations by anchoring outputs to guideline-based sources. AI-assisted documentation decreased administrative burden and clinician burnout, while validated predictive models improved risk stratification and reduced unnecessary interventions. Safe deployment requires continuous human oversight, systematic bias auditing, transparent patient opt-out mechanisms, and ongoing guideline-aligned validation.

The proposed framework demonstrates that generative AI can enhance efficiency and clinical quality across urological care when governed responsibly. Generative AI should function as a supervised clinical co-pilot rather than an autonomous decision-maker. A governance-first, patient-centered approach is essential to preserve safety, equity, and scientific integrity in modern urology.

High-quality data has transformed surgical practice, with consultant appraisal, quality improvement, and governance now relying on validated benchmarking of clinical outcomes. The General Medical Council (GMC) requires consultants to review their performance against local, regional, or national data as part of appraisal and revalidation. The National Consultant Information Programme (NCIP) provides a practical, clinician-led solution to meet this requirement.

Developed in response to the Paterson Inquiry, NCIP is a national, free data platform using routinely collected Hospital Episode Statistics and Office for National Statistics mortality data to deliver consultant-level activity and outcomes dashboards across surgical specialities.

In urology, NCIP provides procedure-specific metrics including volume, length of stay, day-case rates, readmissions, and mortality, benchmarked against national distributions and presented alongside patient demographics and co morbidity profiles. NCIP supports multiple clinical and professional uses, including data for appraisal and revalidation, morbidity and mortality meetings, clinical audit, quality improvement, and Clinical Impact Award applications. Case study evidence demonstrates how triangulating NCIP data with other datasets can identify unwarranted variation, support service redesign, and improve patient outcomes.

Wider engagement with NCIP is essential to embed data-informed reflection and continuous improvement into routine urological practice.

Not applicable.

To establish current views of British Association of Urological Surgeons (BAUS) members and non-members on global urology and compare findings with its 2016 Urolink survey, to inform future strategic priorities.

A 2025 cross-sectional survey, adapted from one carried out in 2016, collected demographic data, global surgery experience, suggested Urolink priorities, and barriers to global health work on a 5-point Likert-type scale, with further suggestions as free text. Quantitative data were analysed descriptively, and subjective data responses, thematically.

One hundred urologists responded. 38% had previously undertaken urological work in low- and lower-middle-income countries (LMIC), consistent with the 2016 survey. Activity, mentoring, and in-country training were rated the most important Urolink functions at means of 4.5/5 and ~4.5/5, respectively. Advocacy, regional training hubs, equipment support, and reciprocal training opportunities scored means of ⩾ 4.0/5. Key barriers included lack of time, insufficient professional leave, family commitments, and financial constraints. 90% of respondents believed professional leave was important for humanitarian work. 89% of respondents viewed Urolink as important to BAUS’s international profile and 79% expressed interest in remote engagement.

UK urologists show sustained commitment to global health and have clear preferences for partnership-based, educational, and sustainable models. The findings support expanding long-term institutional links, structured remote training and mentorship, and advocating formal professional leave to facilitate global health activities. Respondents also endorsed reciprocal training opportunities for LMIC and UK trainees, providing a focused framework for Urolink’s future strategy.

On-call work is an integral part of urological practice in the United Kingdom, yet its effects on urologists’ lifestyles, well-being and stress remain underexplored. Identifying factors that contribute to this stress may help prolong careers and improve professional quality of life.

An anonymised online survey of BAUS members assessed the impact of out-of-hours duties on lifestyle, well-being and stress. Variables included age, gender, hospital type, clinical experience, rota design and call frequency between midnight and 8 a.m. Lifestyle and well-being were measured using linear evaluation scales, while stress was assessed with a validated perceived stress scoring system.

Complete responses were obtained from 132 mid-grade urologists and 289 consultants engaged in on-call rotas. Overall, out-of-hours work moderately impaired quality of life. Lifestyle disruption increased with consultant age, whereas younger and less experienced colleagues reported higher stress, particularly related to childcare responsibilities and sleep deprivation.

Although the impact of on-call work on UK urologists appears less severe than for other medical specialties, significant challenges persist. Ageing, childcare demands and sleep deprivation remain key stressors associated with out-of-hours activity, underscoring the need for strategies to support well-being across career stages.