Alexander Light

Imperial College London | Imperial · Department of Surgery and Cancer

OBJECTIVE: To analyse the current difference between dismembered robot-assisted pyeloplasty (RAP) and laparoscopic pyeloplasty (LP) in the treatment of pelvi-ureteric junction (PUJ) obstruction as of 26 June 2017, focusing on operating time, length of hospital stay, complication rate, and success rate. PATIENTS AND METHODS: We searched PubMed, Med...

Background Accurate prognostication is crucial in treatment decisions made for men diagnosed with non-metastatic prostate cancer. Current models rely on prespecified variables, which limits their performance. We aimed to investigate a novel machine learning approach to develop an improved prognostic model for predicting 10-year prostate cancer-spec...

Context Benign prostatic obstruction (BPO) is associated with sexual dysfunction. Furthermore, numerous BPO interventions may themselves impact sexual function. Objective To perform a systematic review with network meta-analysis to evaluate how BPO interventions affect erectile function. Evidence acquisition Three databases were searched for rand...

Objectives: To produce a best practice consensus guideline for the conduct of scrotal exploration for suspected testicular torsion using formal consensus methodology. Materials and methods: A panel of 16 expert urologists, representing adult, paediatric, general, and andrological urology used the RAND/UCLA Appropriateness Consensus Methodology t...

Prostate cancer recurrence is common after radical radiotherapy and the increasing use of novel, minimally invasive salvage treatments means that accurate detection and localization of radiorecurrent disease is vital in treatment planning and delivery. PET–CT is increasingly used to detect metastatic disease; however, data regarding its value for i...

BACKGROUND Non-muscle invasive bladder cancer (NMIBC) accounts for 75% of bladder cancers. It is common and costly. Cost and detriment to patient outcomes and quality of life are driven by high recurrence rates and the need for regular invasive surveillance with frequent repeat treatments. There is evidence that the quality of the initial surgical...

For men with newly diagnosed prostate cancer, we aimed to develop and validate a model to predict the risk of progression on active surveillance (AS), which could inform more personalised AS strategies. In total, 883 men from 3 European centres were used for model development and internal validation, and 151 men from a fourth European centre were u...

Robotic surgery training has lacked evidence-based standardisation. We aimed to determine the effectiveness of adjunctive interactive virtual classroom training (VCT) in concordance with the self-directed Fundamentals of Robotic Surgery (FRS) curriculum. The virtual classroom is comprised of a studio with multiple audio–visual inputs to which parti...

Abstract Introduction Radical cystectomy (RC) is historically considered the gold standard treatment for muscle invasive and high‐risk non‐muscle invasive bladder cancer. However, this technique leaves the majority of patients of both sexes with poor sexual and urinary function. Organ‐sparing cystectomy (OSC) techniques are emerging as an alternati...

Objectives: To determine if management of ureteric stones in the United Kingdom changed during the COVID-19 pandemic and whether this affected patient outcomes. Patients and methods: We conducted a multicentre retrospective study of adults with CT-proven ureteric stone disease at 39 UK hospitals during a pre-pandemic period (23/3/19 to 22/6/19)...

Aim Robotic surgical training has historically lacked evidence-based standardisation. The Fundamentals of Robotic Surgery (FRS) curriculum addresses this by incorporating proficiency-based modules which certify trainees’ skills. However, the curriculum is self-directed and non-interactive. We aim to determine the effectiveness of interactive virtua...

Active Surveillance (AS) for prostate cancer is a management option that continually monitors early disease and considers intervention if progression occurs. A robust method to incorporate “live” updates of progression risk during follow-up has hitherto been lacking. To address this, we developed a deep learning-based individualised longitudinal su...

Objectives To determine if management of ureteric stones in the United Kingdom changed during the COVID-19 pandemic and whether this affected patient outcomes. Patients and methods We conducted a multicentre retrospective study of adults with CT-proven ureteric stone disease at 39 UK hospitals during a pre-pandemic period (23/3/19 to 22/6/19) and...

Introduction Robotic surgery training has lacked evidence-based standardisation. We aimed to determine the effectiveness of adjunctive interactive virtual classroom training (VCT) in concordance with the self-directed Fundamentals of Robotic Surgery (FRS) curriculum. Methods The virtual classroom is comprised of a studio with multiple audio-visual...

INTRODUCTION AND OBJECTIVE: Robotic surgery is an established yet evolving surgical technique that requires specialist training. To date, training has lacked evidence-based standardisation. To address this, the Fundamentals of Robotic Surgery (FRS) curriculum has been established, to incorporate proficiency-based modules to certify the skills of no...

Objectives: To summarise the causes of ureteric damage and the current standard of care, discussing the risks and benefits of available therapeutic options. We then focus on the current and future solutions that can be provided by ureteric bioengineering and provide a description of the ideal characteristics of a bioengineered product. Methods:...

Objective: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures,...

Background: Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice...

Introduction Modern image-guided biopsy pathways at diagnostic centres have greatly refined the investigations of men referred with suspected prostate cancer. However, the referral criteria from primary care are still based on historical prostate-specific antigen (PSA) cut-offs and age-referenced thresholds. Here, we tested whether better contempor...

Introduction Urology is a common rotation for UK Foundation Year (FY) doctors, and accounts for >25% of acute surgical referrals. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology to be covered during medical school. However, its national upt...

Background Augmented reality (AR) in surgery can offer an enhanced view of reality through the superimposition of computer-generated digital images on the real environment. It allows surgeons to integrate image visualisation, improving operative efficiency, surgical outcomes, surgical training and patient education. This review aims to evaluate the...

The British Association of Urological Surgeons (BAUS) consensus statement(1) provides the latest update to guidance on management of bladder injury (BI). Clinical guidelines are a particularly helpful tool for such cases, which are uncommon, but require timely diagnosis and management to optimise outcome.

INTRODUCTION AND OBJECTIVE: The percentage of medical schools mandating urology rotations in the USA has decreased from 99% in 1956 to 17% in 2009, whereas 65% of medical school directors stated in 2008 that it was possible for their students to have graduated without a clinical rotation in urology. METHODS: LEARN is a national cross-sectional s...

Introduction: Urology is a common rotation for Foundation Year (FY) doctors, and accounts for 15% of general practitioner appointments and >25% of acute surgical referrals. The LEARN study aims to evaluate the current status of UK undergraduate urology teaching. Method: LEARN is a national multicentre cross-sectional study of undergraduate urology...

The ideal prostate cancer diagnostic pathway would maximise detection of clinically-significant prostate cancer (csPCa) while avoiding unnecessary biopsies and other investigations. The introduction of pre-biopsy MRI has done much to aid this goal. However, referrals into the image-based diagnostic pathway still depends on prostate-specific antigen...

Introduction Non-muscle invasive bladder cancer (NMIBC) can be curatively treated with ‘good quality’ transurethral resection of the bladder tumour (TURBT). However, despite evidence-based international guidelines, there is anecdotal evidence that practice varies widely, and this may affect oncological outcomes. Launching in 2020, RESECT aims to me...

Introduction Non-muscle invasive bladder cancer (NMIBC) is one of the most expensive cancers to treat, driven by high recurrence rates and disease progression. Mortality rates in the UK for all bladder cancers have remained relatively stable over the past decade. NMIBC can be curatively treated with transurethral resection of the bladder tumour (TU...

Introduction Urological conditions account for approximately 25% of acute surgical referrals and 10-15% of general practitioner appointments. In 2012, the British Association of Urological Surgeons (BAUS) produced ‘An Undergraduate Syllabus for Urology’, advising on common clinical areas of urology that must be covered during undergraduate medical...

Introduction Emergency scrotal exploration for suspected testicular torsion is a common procedure, performed by Paediatric surgeons, Urologists and General Surgeons. It is expected that there is variation in practice in the way that testes are fixed after torsion and other pathologies, both within departments and across specialties. We aim to surve...

Introduction: DECAF is a scoring tool that can predict severity in patients with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Previous research has shown AECOPD patients with DECAF scores of 0-1 are candidates for early discharge. Methods: Plan, do, study, act (PDSA) methodology was used. Patients with AECOPD and a DE...

Purpose of the study This study aimed to investigate whether, in the UK, medical school attended influences the propensity to apply to and be successful in obtaining an offer from the Academic Foundation Programme (AFP), thus taking the first step to embarking on a clinical-academic career. Study design A retrospective observational study was perf...

Aims Surgical inpatients with diabetes mellitus are common. We aimed to assess the diabetes management of diabetic adult surgical inpatients. This includes reviewing appropriate medication adjustment with altered eating statuses; fluids prescribed alongside a variable rate intravenous insulin infusion (VRIII); numbers of hypo- and hyper-glycaemic e...

Aims DECAF is a scoring tool that can predict the severity of patients attending hospital with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Previous research has shown AECOPD patients with DECAF scores of 0 and 1 are candidates for early discharge. Using quality improvement methodology, we aimed to implement a DECAF prot...

Objective: The aim of this systematic review is to evaluate the data currently available regarding the repurposing of different drugs for Covid-19 treatment. Participants with suspected or diagnosed Covid-19 will be included. The interventions being considered are drugs being repurposed, and comparators will include standard of care treatment or p...

Exposure to urology is essential for medical undergraduates to prepare them with the competencies required to manage basic urological conditions and to generate interest in the specialty. However, despite the existence of national curricula, the lack of urological exposure and falling competition ratios indicate a need for an evaluation of urologic...

Following the outbreak of the novel SARS-CoV-2 (COVID-19), the World Health Organization made a number of recommendations regarding the utilisation of healthcare services. In general, there has been a reduction in elective healthcare services including outpatient clinics, diagnostic services and elective surgery. Inevitably these reductions for all...

Background: Childhood obesity is a growing global health concern, with far-reaching implications on health in childhood and in later life. Early intervention strategies are key to reducing childhood obesity. This study aims to evaluate the implementation of an Early Years Nutrition programme in the London Borough of Newham’s children’s centres. Met...

Aim: For bladder cancer patients, whether organ-sparing cystectomy (OSC) techniques compared to standard radical cystectomy (RC) produce superior sexual and urinary function without compromising oncological outcome is unclear. A systematic review with meta-analysis is vital to address this. Method: This PRISMA-compliant review was registered with...

Objective: The aim of this systematic review is to evaluate the data currently available regarding the repurposing of different drugs for Covid-19 treatment. Participants with suspected or diagnosed Covid-19 will be included. The interventions being considered are drugs being repurposed, and comparators will include standard of care treatment or pl...

Purpose The recent Ebola virus disease (EVD) epidemic was one of the most severe public health emergencies in modern times. The economic impact of epidemics has mostly been analysed at the macroeconomic level. Conversely, we aimed to estimate the economic costs of preventive measures of the epidemic to an extractive firm, ArcelorMittal (AM), using...

Objective: With the advent of high-throughput genome analysis, we are increasingly able to sequence and hence understand the pathogenic processes underlying individual cancers. Recently, consortiums such as The Cancer Genome Atlas (TCGA) have performed large-scale projects to this end, providing significant amounts of information regarding the gen...

Purpose: The Ebola Virus Disease (EVD) outbreak was the most severe public health emergency in modern times. The economic impact of outbreaks has mostly been analysed at the macroeconomic level. Conversely, we aimed to estimate the economic costs of preventive measures of the outbreak to an extractive firm, ArcelorMittal, using data in the outbreak...

Introduction: Radical cystectomy (RC) is the gold standard bladder cancer treatment, but often leaves patients of both sexes with poor sexual and urinary function. Organ-sparing cystectomy (OSC) techniques are emerging but it is unclear if they produce superior functional outcomes without compromising oncological success. A systematic review with m...

Abstract Background Trainee research collaboratives (TRCs) have pioneered high quality, prospective ‘snap-shot’ surgical cohort studies in the UK. Outcomes After Kidney injury in Surgery (OAKS) was the first TRC cohort study to attempt to collect one-year follow-up data. The aims of this study were to evaluate one-year follow-up and data completion...

Objective: Pelvic fracture can be complicated by posterior urethral injury (PUI) in up to 25% of cases. PUI can produce considerable morbidity, including urethral stricture, erectile dysfunction (ED), and urinary incontinence. Optimal management of PUI is unclear, however, the current gold standard is placement of a suprapubic cystostomy with dela...

Purpose: The Ebola Virus Disease (EVD) outbreak was the most severe public health emergency in modern times. The economic impact of outbreaks has mostly been analysed at the macroeconomic level. Conversely, we aimed to estimate the economic costs of preventive measures of the outbreak to an extractive firm, ArcelorMittal, using data in the outbreak...

Screening aims to identify prostate cancer at an early stage where curative treatment can reduce mortality. Given high false positive and false negative rates, however, the use of prostate‐specific antigen (PSA) in screening has long been controversial. Recent systematic reviews comprising large randomised‐controlled trials (RCTs) with long‐term fo...

Background: The gold standard for research is publication within a peer-reviewed journal. There is a discrepancy between the number of abstracts presented at scientific meetings and the number published as full articles. We identified publication rates for the 2012 meetings of four British surgical societies. These were the Association of Surgeons...

Objectives: Cervical spine trauma is a major aspect of both trauma and emergency medicine, and therefore an important area of research. The number of citations a study receives can be used as a marker of academic influence. It also helps to identify both strong and weak areas of research within that field. We sought to identify the 50 most-cited st...

Objectives: Neck of femur fracture (NOFF) is a common condition and a major public health concern, especially with an increasingly ageing population. It has therefore become a particularly important area of research within trauma and orthopaedics. The number of citations a study receives can be used as a marker of academic influence. It also helps...

Objectives: There is a high risk of surgical site infection (SSI) following surgery for neck of femur fracture (NOFF). Previous meta-analyses have demonstrated that prophylactic antibiotic administration significantly reduces rates of both superficial and deep SSI compared to placebo. However, guidelines from both the National Institute for Health...

Objectives: Deep infection rates following open fractures (OF) have been reported in up to 50% of cases. Prompt administration of antibiotics is therefore crucial in the management of these patients before surgery. Both National Institute for Health and Care Excellence (NICE) and British Orthopaedic Association Standards for Trauma (BOAST) guidelin...

Objectives: Pelvic fracture can be complicated by posterior urethral injury (PUI) in up to 10% of cases. PUI can produce considerable morbidity, including urethral stricture, erectile dysfunction, and urinary incontinence. Optimal management of PUI is unclear, however the current gold standard is placement of a suprapubic cystostomy with delayed ur...

Background Childhood obesity is a rapidly-growing global concern, with huge impacts on health in childhood and later life. Within the London Borough of Newham, about 25% of children aged 4–5 years and 40% of those aged 10–11 years are overweight. Early intervention strategies are key to targeting childhood obesity. As part of their Childhood Obesit...

Background: The 2015 Montgomery vs Lanarkshire Supreme Court ruling necessitated that ‘material risks’ must be disclosed to patients during the consent process for a planned procedure. These are risks likely to be deemed significant by the patient. However, facilitating the consent process using a handwritten consent form is highly user-dependent a...

Background Critical limb ischaemia (CLI) is a limb and life-threatening condition. Current NHS guidelines suggest that suspected CLI patients should be assessed by a vascular nurse practitioner (VNP) within 7 days of GP-presentation. Any indicated procedure should then be performed within the following 6 weeks. Retrospective review of patient recor...

Background: Pre-designed procedure-specific consent forms (PCFs) have potential advantages over handwritten forms for improving the consent process and disclosing material risks, as necessitated by the 2015 'Montgomery' ruling. We aimed to assess the use and quality of English NHS Trust PCFs for total hip replacement (THR), total knee replacement...

OBJECTIVE: To analyse the current difference between dismembered robot-assisted pyeloplasty (RAP) and laparoscopic pyeloplasty (LP) in the treatment of pelvi-ureteric junction (PUJ) obstruction as of 26 June 2017, focusing on operating time, length of hospital stay, complication rate, and success rate. PATIENTS AND METHODS: We searched PubMed, Med...

Aim: Total hip replacement (THR) and total knee replacement (TKR) are two commonly performed operations. Informed consent is crucial, especially following the 2015 ‘Montgomery’ ruling that ‘material risks’ must be disclosed. These are risks likely to be deemed significant by a patient. Pre-designed procedure-specific consent forms (PCFs) pre-list r...

OBJECTIVE: To analyse the current difference between dismembered robot-assisted pyeloplasty (RAP) and laparoscopic pyeloplasty (LP) in the treatment of pelvi-ureteric junction (PUJ) obstruction as of 26 June 2017, focusing on operating time, length of hospital stay, complication rate, and success rate. PATIENTS AND METHODS: We searched PubMed, Med...