Urology - Current Research

Urology research taking place at North Bristol NHS Trust

Having delivered clinical excellence and research innovation working collaboratively with both drug and device companies, the North Bristol NHS Trust urology department now delivers the clinical service for the whole Bristol area increasing both our clinical and research potential. The department has an enviable position focussing world leading clinicians, dedicated research staff and a patient population invested in the development of future treatment options.

Current studies:

UPSTREAM Phase II Study

Between 2014 and 2018, 820 men enrolled in the UPSTREAM study (“Phase I”) because they had bothersome lower urinary tract symptoms (LUTS) and were seeking further treatment. When referred to hospital, men with bothersome LUTS are assessed with a set of standard assessments (tests). UPSTREAM set out to see whether including an extra assessment called “urodynamics” helps when considering treatment options.

Men were split into two groups to receive either standard assessments (routine care) or routine care plus urodynamics. All men then discussed the test results with their urologist and decided what treatment to have. 18-months after they enrolled, they completed a questionnaire booklet about their urinary symptoms, the effect on their everyday life, and their general state of health, and identified what treatment they had received.

During “UPSTREAM – Phase I”, however, we identified that there is significant variation in the assessment pathway in 26 hospitals across England, including duration, as well as in patient factors. Several patients had not fully completed their LUTS treatment at the 18-month follow up, or had completed it less than 6-months beforehand; clinically, a 12-month timeframe is appropriate to show the immediate impact of surgery.

Additional funding was therefore awarded to conduct a long term (5-year) follow up of UPSTREAM participants. In “UPSTREAM – Phase II” we want to find out the 5-year results of treatment for the men’s LUTS, and see how many men went on to receive surgery after the initial 18-months (i.e. after “UPSTREAM - Phase I”).

During “UPSTREAM – Phase II” (01 July 2019 to 30 June 2022), we will ask existing UPSTREAM participants to complete one questionnaire booklet about their urinary symptoms, the effect on their everyday life, and their general state of health. We will also securely collect relevant information from central NHS records.

Host Site: North Bristol NHS Trust

Chief Investigator: Prof Marcus Drake

End Date: 30/06/2022

PURSUIT

The Proper Understanding of Recurrent Stress Urinary Incontinence Treatment (PURSUIT) study is a trial of endoscopic versus surgical treatment for women. Primary Stress Urinary Incontinence (SUI) affects 16-35% of women. It can arise due to abnormal urethral mobility (“hypermobility”) after pregnancy. NICE recommends pelvic floor muscle training (PFMT) and, if this fails, surgery is an option. At least 6% of women have persisting or recurrent SUI (rSUI) after surgery [1], which may reflect persistent hypermobility or emergence of sphincter deficiency. rSUI affects quality of life (QoL), ability to work, and has substantial cost impact. Up to 17% of women undergo a second operation for SUI within 10 years. The James Lind Alliance, a group of healthcare professionals and patients, identified rSUI as a top 10 research priority in urinary incontinence [2]. Women with rSUI commonly express desire to return to normal life, but they also wish to minimise the severity of surgery or complications.
 

Host Site: North Bristol NHS Trust

Chief Investigator: Prof Marcus Drake

End Date:  31/03/2025

Prof Hashim Hashim talks about the results of the UNBLOCS trial.   The full results have been published in the Lancet. 

 

Video Transcript:

Hi I'm Professor Hashim, a Consultant Urological Surgeon at the Bristol Urological Institute in Southmead Hospital. I was the Chief Investigator for the UNBLOCS trial which was funded by the NIHR, which is the National Institute for Health and Research. The UNBLOCS trial was looking at men with lower urinary tract symptoms and retention due to obstruction from the prostate. We compared the standard transurethral resection of the prostate, TURP, to a laser procedure called ThuVARP which is thulium vapour resection of the prostate. Essentially, what we found was that men who had both procedures had a good improvement a statistically significant and clinically significant improvement in flow rate in both procedures. However the TURP group actually had a more a better improvement in their flow rate statistically speaking. Both were clinically significant and in terms of quality of life and symptom scores they both scored equally with very good improvement in both of them. And this was also similar in terms of the questionnaires that were used during the trial such as the quality of life on the lower urinary tract symptoms. So one of the reasons we actually did the trial was there was a suggestion that the laser procedure results in less time in hospital with less bleeding and we found that there was no difference between TURP and the thulium vapour resection procedure, in terms of hospital stay, bleeding and other complications. What does that mean?  It means that people who are really doing the TURP can continue doing that and people who are doing the laser procedure will also continue to do that, and there was no need to switch clinically from one procedure to the other going forward. This trial will form a framework for the NICE guidelines to be updated in terms of procedures for TURP. And in terms of cost effectiveness and health economics we found that the TURP was slightly more cost effective to do and the ThuVARP actually took slightly longer. Thank you very much.

Contact Research & Innovation

Research & Innovation
North Bristol NHS Trust
Floor 3, Learning & Research Centre
Southmead Hospital
Westbury-on-Trym
Bristol, BS10 5NB

Telephone: 0117 4149330
Email: research@nbt.nhs.uk