Research-Academic Urology Unit

The Unit has a strong track record in each of our identified priority areas of work (evidence synthesis, guideline development, large multi-centre clinical trials and observational studies of surgical interventions, patient-oriented programmes of research including the health psychology of cancer survivorship and core outcome set development within urology).

Evidence synthesis and guideline development:
European Association of Urology (EAU) Collaboration (Dr Imran Omar):
The unit has an established track record in the design and delivery of systematic reviews of clinical effectiveness of interventions and diagnostic tests. These have been undertaken in conjunction with the EAU Guideline Office. The Guidelines Office has 20 Guideline Panels producing the most comprehensive set of clinical practice guidelines for urological care worldwide. A number of systematic reviews led by AUU have informed the development of EAU guidelines, which have informed and guided clinical practice in Europe and beyond. These reviews have also been published in high impact journals.

HSRU Collaboration (Health Technology Assessment and Single Technology Appraisal): Our unit has a successful history of collaboration with HSRU on several UK National Institute for Health Research (NIHR) HTA-commissioned systematic reviews including assessments of: 1) the clinical and cost effectiveness of surgical interventions for localised prostate cancer (review of ablative therapy for men with localised prostate cancer; review of robotic versus laparoscopic radical prostatectomy for men with localised prostate cancer), 2) surgical interventions for men with benign prostatic hyperplasia (review of surgical treatment for BPH), and 3) diagnostic test accuracy (review of role of multiparametric MRI in localising abnormalities within the prostate in men requiring repeat prostate biopsies; review of photodynamic diagnosis and urinary biomarkers for diagnosing bladder cancer).

The majority of these reviews have been incorporated by UK NICE in their clinical practice guidelines, and adopted by the Scottish Government in making policy decisions (e.g. regarding the provision of the first Scottish robotic surgery centre in Aberdeen).

Clinical trials and observational studies of surgical interventions:
CHART Collaboration: Our goal is to continue to build and strengthen our strong working partnership with CHART, HSRU on the design and delivery of clinical trials and observational studies of surgical interventions in urology.

Ongoing trials:
TISU, which is a multicentre randomised controlled trial comparing extracorporeal shock-wave lithotripsy versus ureteroscopy and intracorporeal lithotripsy in patients with symptomatic ureteric stones (recruitment ongoing);
PURE, which is a multi-centre randomised controlled trial of percutaneous nephrolithotomy (PNL), flexible ureterorenoscopy (FURS) and extracorporeal shockwave lithotripsy (ESWL) for lower pole calyceal kidney stones (recruitment to commence in March 2016).

Completed trials and observational studies:
SUSPEND, which is a multicentre placebo controlled randomised trial on the use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults (a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin)); published in the Lancet;

CATHETER, which is a multicentre randomised controlled trial of types of urethral catheter for reducing symptomatic urinary tract infections hospitalised adults requiring short-term catheterisation (antibiotic and antiseptic impregnated urethral catheters), recruited over 7000 participants; published in the Lancet;

MAPS, was a national multicentre trial of pelvic floor muscle training for incontinence after prostate surgery (benign and cancer – 2 parallel trials) recruiting from 30 UK centres, published in the Lancet;

OTIS, was an international, multicentre prospective comparative observational study to determine the oncological, functional, quality of life, adverse event and health economic outcomes following surgery using transposed intestinal segments to augment (cystoplasy), replace (bladder substitution) or divert (continent and incontinent diversion) the bladder, publication in preparation

In collaboration with Newcastle, AUU is co-applicant and recruiter to two other ongoing NIHR funded multicentre RCTs
OPEN Trial comparing optical urethrotomy versus buccal graft urethroplasty for management of urethral stricture disease
AnTic Trial comparing antibiotic prophylaxis use in patients using clean intermittent self catheterisation and suffering from recurrent UTIs

Patient-oriented Programmes of Research:
Our goal is to continue to build and strengthen our research on the health psychology of cancer survivorship and care after treatment (including palliative care) in urology and on the development of core outcome sets in urology. .

The Health Psychology of Cancer Survivorship (Dr Sara Jane MacLennan):
Cancer survivorship is the area focused on enabling individuals to make as full a return to normal life as possible from point of diagnosis onwards until end of life. This includes issues related to diagnosis, treatment, the promotion and maintenance of recovery, side effects and late effects of treatment, quality of life and psychosocial wellbeing, engagement in work, dealing with advanced disease and secondary cancers and information and support needs. Understanding the person within the social and cultural context in which they operate is important and survivorship includes significant others, friends, family etc.

Ongoing projects include:
Building the METIS Collaboration: This is an international collaboration focussed on psychosocial, organisational and economic factors in relation to serious long-term conditions, survivorship and working life ~ particular interest in cancers. Themes include the impact of Long Term Conditions (LTCs) on working life and their management, the promotion of cancer survivorship and work engagement, the cognitive, emotional and behavioural issues involved in coping with LTCs and resilience. Current partners include the Centre for Sustainable Working Life, Birkbeck University of London, the Institute of Society and Health, Newcastle University and the Management School, Lancaster University.
ESRC Seminar programme: This is a newly awarded ESRC Seminar Series grant to discuss “Social Science Perspectives on the Employment of Those with Cancer: Psychosocial, Organizational and Economic Issues”. Groups from three universities were involved in the application for this grant. They were: the Academic Urology Unit (Institute of Applied Health Research, University of Aberdeen: Sara MacLennan), the Centre for Sustainable Working Life (School of Business, Economics and Informatics, Birkbeck University of London: Tom Cox and the Institute of Society and Health (University of Newcastle: Heather Brown and Linda Sharp).

Previous projects:
SCOT-PAIS – the Better Ways Initiative: This is a three year action research and development programme to design, implement and evaluate a new patient advice and information system for those with urological cancers. It is focussed on their working lives and engagement with work across their journey from diagnosis to survival. It will be framed by a model of best practice for promoting individuals’ continuing and productive involvement with work and success in their working lives.
Informing the design and delivery of care: We have previously conducted research on a) understanding the information and support needs of patients and the family unit, b) defining patients and families’ experiences and concerns regarding the decision-making process related to their care, c) developing Plain English Guides for patients from systematic reviews of the relative clinical benefit and cost-effectiveness of surgical and medical interventions for urological disease.

Development of Core Outcome Sets (Dr Steven MacLennan):
Development of core outcome sets for effectiveness trials in localised prostate cancer (COMPACTERS study) is a prospective mixed methods study designed to identify a minimum set of the most important outcomes for use in interventional trials of localised prostate cancer; such a core outcome set would reflect the interests and priorities of both patients and clinicians.

Prostate cancer is a growing health problem worldwide. The management of localised prostate cancer is controversial. It is unclear which of several surgical, radiotherapeutic, ablative, and surveillance treatments is the most effective. Evidence from randomised controlled trials (RCTs) is not optimal because of uncertainty as to what constitutes important outcomes. Outcome definition, measurement, and reporting are also heterogeneous. This project aims to determine which outcomes are the most important to patients and healthcare professionals, and use these findings to recommend a standardised core outcome set for comparative effectiveness trials of treatments for localised prostate cancer, to optimise decision-making.

We are using a number of research methods to address the research questions. The range of potentially important outcomes and measures were identified through systematic reviews of the literature and semi-structured interviews with patients. A consultation exercise involving representatives from two key stakeholder groups (patients and healthcare professionals) was used to ratify the list of outcomes to be entered into a three round Delphi study. The Delphi process is underway (round 1 is closed and round 2 is under testing). The Delphi aim is to refine and prioritise the list of identified outcomes. A methodological substudy (nested RCT design) will also be undertaken. Participants will be randomised after round one of the Delphi study to one of three feedback groups, based on different feedback strategies, in order to explore the potential impact of feedback strategies on participant responses. This may assist the design of a future core outcome set and Delphi studies. Following the Delphi study, a final consensus meeting attended by representatives from both stakeholder groups will determine the final recommended core outcome set.

Implementation Science and Impact Assessment:

Global Health:
The vision is to develop a broad network of clinical teams and university based academic teams that will allow the Aberdeen Academic Urology Unit and other research groups in the University of Aberdeen to establish strong research collaborations to improve global health. Through the establishments of these global networks and the identification of key projects the aim will be to ensure that research carried out will be of international standard whilst at the same time benefiting the most vulnerable communities within society and specifically in low income countries such as The Gambia. One example of this is the Horizons project:

This is an ambitious new project linking Aberdeen with sub-Saharan Africa. The long term aim of Horizons is to improve healthcare systems in a low income setting (the Gambia) through the development of a high quality healthcare infrastructure.

Horizons has a two-fold vision for The Gambia.
1. To provide quality healthcare for those who desperately need it but who have no financial means (Horizons Charities). Horizons has already started doing charitable work in The Gambia focussing on improving healthcare for pregnant women and children less than two-years old by providing training to health professionals and thorough cleaning of childbirth facilities. In time, Horizons Trust Gambia will increase access to high quality care through community outreach centres.
2. To establish a high quality international standard medical facility in The Gambia (the Horizons Clinic). This is an unmet need in sub-saharan Africa (low income setting) and will be the first of its kind. Revenues from the Clinic will be used by Horizons Trust Gambia charity to provide high quality care to the poor: wealth redistribution through healthcare.
The Gambian Government has donated the land on which the Horizons Clinic will be built. The legal firm Pinsent Masons has provided its services on a pro bono basis to date to put in place the governance structure for Horizons and advise on legal matters.

Ultimately, the Horizons Clinic will be a one-stop hospital including a comprehensive diagnostic services (with a full radiological service including CT scanning and MRI), full Laboratory services, family practice/out-patient clinics, ambulatory and in-patient care (including general medicine, cardiology, general surgery, gastroenterology including endoscopy service, orthopaedic surgery, urological surgery, obstetrics, gynaecology, paediatric medicine and neonatology) and dental surgery. The clinic will also house a well-equipped intensive care unit, stabilisation unit and a neonatal intensive care section. Critically, the Horizons hospital complex will house a state-of-the-art Education and Training Institute offering a well equipped training hub for sub-saharan Africa. Partnerships are being negotiated with global health institutions such as Baylor College of Medicine (Texas Medical Centre) and MRC Unit in The Gambia.

The three Horizons charities in the UK, the US and the Gambia will continue to seek funding:
to pay for the care of at risk mothers/pregnant women and infants under the age of two years at the Horizons Clinic
to fund the development and implementation of outreach services and the Horizons training programme

In the past five years, Horizons has developed a broad network of clinical teams and university based academic teams internationally that will allow the Aberdeen Academic Urology Unit and other research groups in the University of Aberdeen to establish strong research collaborations globally. Horizons hopes to be a model which is scalable across other parts of sub-saharan Africa.