scholarly journals Analysis of risk factors of bladder neck contracture following transurethral surgery of prostate

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi-Zhong Chen ◽  
Wun-Rong Lin ◽  
Yung-Chiong Chow ◽  
Wei-Kung Tsai ◽  
Marcelo Chen ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Bladder Neck ◽  
Prostate Volume ◽  
Surgical Techniques ◽  
Group Versus ◽  
Bladder Neck Contracture ◽  
Matching Model ◽  
The Difference ◽  
Artery Disease

Abstract Backgrounds The aim of the present study was to investigate the perioperative parameters associated with bladder neck contracture (BNC) after transurethral surgery of the prostate and to compare the incidence of BNC after transurethral resection of the prostate (TURP) or Thulium vaporesection (resection group) versus Thulium vapoenucleation or enucleation of the prostate (enucleation group). Methods Between March 2008 and March 2020, 2363 patients received TURP and 1656 patients received transurethral surgery of the prostate with Thulium laser (ThuP) at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. A 1:1 propensity score matching model was used to evaluate the difference in incidence of BNC. Results Our study demonstrated that a greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs. 7/124, p = 0.009), coronary artery disease (14/48 vs. 16/108, p = 0.03), chronic kidney disease (14/62 vs. 11/124, p = 0.01), and two or more comorbidities (29/62 vs. 27/124, p = 0.001) compared with NBNC patients. Multivariate analysis showed that smaller prostate volume (OR 0.96 (0.94–0.99), p = 0.008) and recatherization (OR 5.6 (1.02–30.6), p = 0.047) were significantly associated with BNC. A ROC curve predicted that a prostate volume < 42.9 cm3 was associated with a notably higher rate of BNC. The propensity score matching model reported there was no difference in incidence between resection and enucleation groups. Conclusion This study demonstrated that incidence of BNC was the same in different surgical techniques and that low prostate volume, recatherization and ≥ 2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.

scholarly journals Analysis of Risk Factors of Bladder Neck Contracture Following Transurethral Surgery of Prostate

2021 ◽  
Author(s):  
Yi Zhong Chen ◽  
Wun-Rong Lin ◽  
Yung-Chiong Chow ◽  
Wei-Kung Tsai ◽  
Allen W. Chiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Chronic Kidney Disease ◽  
Multivariate Analysis ◽  
Bladder Neck ◽  
Prostate Volume ◽  
Bladder Neck Contracture ◽  
Cerebrovascular Accidents ◽  
History Of ◽  
Artery Disease

Abstract Backgrounds: The aim of the present study was to investigate the preoperative parameters associated with bladder neck contracture (BNC) after transurethral resection of the prostate (TURP) or Thulium vaporesection, vapoenucleation or enucleation of the prostate (ThuP) and to compare the incidence of BNC after TURP and ThuP. Methods: Between March 2008 and March 2020, 2,363 patients received TURP and 1,656 patients received ThuP at Mackay Memorial Hospital. A total of 62 patients developed BNC. These BNC patients were age-and operation-matched to 124 randomly sampled TURP/ThuP controls without BNC. Results: Multivariate analysis showed that when compared with patients without BNC, those with BNC had smaller prostates (43.0±18.95 ml vs 57.2±19.84 ml, p<0.001), lower resection weight (11.64±11.75 g vs 16.67±12.84 g, p=0.001), shorter operative times (43.0±30.9 min vs 57.2±34.5, p<0.001), and slower resection speed (0.124±0.081 g/min vs 0.151±0.952 g/min, p=0.041). A greater proportion of BNC patients had history of cerebrovascular accidents (11/62 vs 7/124, p=0.009), coronary artery disease(14/48 vs 16/108, p=0.03), chronic kidney disease (14/62 vs 11/124, p=0.01), and two or more comorbidities (29/62 vs 27/124, p=0.001). A ROC curve predicted that a prostate volume <42.9cm3 was associated with a notably higher rate of BNC. Conclusion: This study demonstrated that incidence of BNC was the same in TURP and ThuP and low prostate volume, low resection speed and ≥2 comorbidities were positively correlated with the development of BNC after TURP or ThuP.

scholarly journals Cost analysis of staged versus simultaneous bilateral total knee and hip arthroplasty using a propensity score matching

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041147
Author(s):  
Ji-Fei Hou ◽  
Chuan Hu ◽  
Yun Zhang ◽  
Li-Qi Tian ◽  
Yan-Zheng Liu ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Nursing Care ◽  
Hip Arthroplasty ◽  
Medical Costs ◽  
Complication Rates ◽  
Propensity Score Matching Analysis ◽  
Total Knee ◽  
The Difference

BackgroundTotal joint arthroplasty (TJA), including total knee arthroplasty (TKA) and total hip arthroplasty (THA), is required for many patients. This study aimed to evaluate the medical costs, length of stay (LOS), blood transfusion and in-hospital complications in patients undergoing simultaneous and staged TJA.MethodsAll patients who underwent primary bilateral TJA from 2013 to 2018 in our institute were included. The propensity score matching analysis was performed between simultaneous and staged TJA patients. The difference in medical costs, LOS, blood transfusion and in-hospital complications was compared between simultaneous and staged groups.ResultsExcept for materials fees and general therapy fees, medical costs (bed fees, general therapy fees, nursing care fees, check-up and laboratory test fees, surgical fees and drug fees) were significantly lower in the simultaneous TKA, THA and TJA group. The total average medical costs in simultaneous and staged TKA groups were $15 385 and $16 729 (p<0.001), respectively; THA groups were $14 503 and $16 142 (p=0.016), respectively; TJA groups were $15 389 and $16 830 (p<0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for five common comorbidities and postoperative complications between the two subgroups. The simultaneous groups had a shorter LOS and the differences from the staged group for TKA, THA and the TJA group were 8, 6 and 8 days, respectively. The incidence of blood transfusion is higher for simultaneous groups and the difference from the staged group for TKA, THA and TJA is 32.69%, 18% and 29.3%, respectively.ConclusionsOur results indicate that simultaneous TKA and THA with a shorter LOS would cost fewer (costs incurred during hospitalisation) than staged TKA and THA. Complication rates were not affected by the choice for staged or simultaneous arthroplasty, but the incidence of blood transfusion was higher in the simultaneous groups.

scholarly journals Image guidance and improved accuracy of external ventricular drain tip position particularly in patients with small ventricles

2019 ◽  
Vol 130 (4) ◽  
pp. 1268-1273 ◽  
Author(s):  
Anan Shtaya ◽  
Joy Roach ◽  
Ahmed-Ramadan Sadek ◽  
Benjamin Gaastra ◽  
Jonathan Hempenstall ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Image Guidance ◽  
External Ventricular Drain ◽  
Group Versus ◽  
Neurosurgical Procedures ◽  
Emergency Setting ◽  
Optimal Position ◽  
Frontal Horn ◽  
Evans Index

OBJECTIVEExternal ventricular drain (EVD) insertion is one of the most common emergency neurosurgical procedures. EVDs are traditionally inserted freehand (FH) in an emergency setting, but often result in suboptimal positioning. Image-guided surgery (IGS) is selectively used to assist placement. However, the accuracy and practicality of IGS use is yet to be reported. In this study, the authors set out to assess if IGS is practical and improves the accuracy of EVD placement.METHODSCase notes and images obtained in patients who underwent frontal EVD placement were retrospectively reviewed. Ventriculomegaly was determined by the measurement of the Evans index. EVD location was classified as optimal (ipsilateral frontal horn) or suboptimal (any other location). Propensity score matching of the two groups (IGS vs FH) for the Evans index was performed. Data were analyzed for patient age, diagnosis, number of EVDs, and complications. Those without postoperative CT scans were excluded.RESULTSA total of 607 patients with 760 EVDs placed were identified; 331 met inclusion criteria. Of these, 287 were inserted FH, and 44 were placed with IGS; 60.6% of all unmatched FH EVDs were optimal compared with 75% of the IGS group (p = 0.067). The IGS group had a significantly smaller Evans index (p < 0.0001). Propensity score matching demonstrated improved optimal position in the IGS group when compared with the matched FH group (75% vs 43.2%, OR 4.6 [1.5–14.6]; p = 0.002). Patients with an Evans index of ≥ 0.36 derived less benefit (75% in IGS vs 66% in FH, p = 0.5), and those with an Evans index < 0.36 derived more benefit (75% in IGS vs 53% in FH, p = 0.024). The overall EVD complication rate was 36% in the FH group versus 18% in the IGS group (p = 0.056). Revision rates were higher in the FH group (p = 0.035), and the operative times were similar (p = 0.69). Long intracranial EVD catheters were associated with tip malposition irrespective of the group.CONCLUSIONSImage guidance is practical and improves the accuracy of EVD placement in patients with small ventricles; thus, it should be considered for these patients.

scholarly journals Impact of Dexmedetomidine On Secondary Hyperparathyroidism Recurrence In Uremic Patients Who Received Parathyroidectomy With Auto-Transplantation: A Retrospective Propensity-Matched Study

2021 ◽  
Author(s):  
Yun Wu ◽  
Wei Han ◽  
Peikun Li ◽  
Xianwen Hu ◽  
Ye Zhang
Keyword(s):  
Quality Of Life ◽  
Propensity Score ◽  
Secondary Hyperparathyroidism ◽  
Propensity Score Matching ◽  
Mechanism Of Action ◽  
Control Group ◽  
Total Parathyroidectomy ◽  
Uremic Patients ◽  
The Difference

Abstract Background: Recurrence of secondary hyperparathyroidism (SHPT) remains a big challenge in uremic patients who underwent total parathyroidectomy with auto-transplantation (tPTX-AT). However, the relationship between perioperative intervention and recurrence of SHPT remains unclear. Dexmedetomidine has been used safely and effectively in uremic patients’ anesthesia. The aim of the study was to explore the effect of dexmedetomidine on the recurrence of SHPT and speculate the possible mechanism of action.Methods: Records of patients who underwent tPTX-AT between 2017 and 2018 were retrospectively analyzed. The study consisted of patients who received dexmedetomidine intra-operatively and the controls were patients who did not receive dexmedetomidine. The primary endpoint was the difference in the recurrence of SHPT one year after surgery between the two groups. The secondary endpoint was health-related quality of life scores. Analysis included propensity score matching and multivariable logistic regression. Results: Of 354 patients, 133 patients received dexmedetomidine intraoperatively, and the total recurrence rate of SHPT was 10.2%. After propensity score matching, patients who received dexmedetomidine had a 3.80-fold decreased risk of SHPT recurrence (odds ratio, 0.263; 95% confidence interval, 0.081 to 0.854; P=0.026) and exhibited a better quality of life in terms of physical functioning and general health, and less emotional role limitations compared with those in control group.Conclusion: In uremic patients who received tPTX-AT, there was an association between dexmedetomidine use and decreased risk of SHPT recurrence. Further studies are needed to accurately assess the effects and mechanism of action of dexmedetomidine on the prognosis of this population.

Impact of Pre-Existing Depression in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention; A Nationwide Cohort Study

2020 ◽  
Author(s):  
Jangho Park ◽  
Sangwoo Park ◽  
Yong-Giun Kim ◽  
Soe Hee Ann ◽  
Hyun Woo Park ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Artery Disease ◽  
The Impact

Abstract The impact of pre-existing depression on mortality in individuals with established coronary artery disease (CAD) remains unclear. We evaluate the clinical implications of pre-existing depression in patients who underwent percutaneous coronary intervention (PCI). Based on National Health Insurance claims data in Korea, patients without a known history of CAD who underwent PCI between 2013 and 2017 were enrolled. The study population was divided into patients with angina (n=50,256) or acute myocardial infarction (AMI; n=40,049). The primary endpoint, defined as all-cause death, was compared between the non-depression and depression groups using propensity score matching analysis. After propensity score matching, there were 4,262 and 2,346 matched pairs of patients with angina and AMI, respectively. During the follow-up period, there was no significant difference in the incidence of all-cause death in the angina (hazard ratio [HR] of depression, 1.013; 95% confidence interval [CI]: 0.893-1.151) and AMI (HR, 0.991; 95% CI: 0.865-1.136) groups. However, angina patients less than 65 years of age with depression had higher all-cause mortality (HR, 1.769; 95% CI: 1.240-2.525). In Korean patients undergoing PCI, pre-existing depression is not associated with poorer clinical outcomes. However, in younger patients with angina, depression is associated with higher all-cause mortality.

scholarly journals Treatment of intracranial meningioma with single-session and fractionated radiosurgery: a propensity score matching study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Sheng-Han Huang ◽  
Chun-Chieh Wang ◽  
Kuo-Chen Wei ◽  
Cheng-Nen Chang ◽  
Chi-Cheng Chuang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Local Control ◽  
Local Control Rate ◽  
Intracranial Meningioma ◽  
Single Session ◽  
Benign Meningioma ◽  
Efficient Treatment ◽  
The Difference

Abstract Single-session stereotactic radiosurgery (SSRS) is recognized as a safe and efficient treatment for meningioma. We aim to compare the long-term efficacy and safety of fractionated stereotactic radiotherapy (FSRT) with SSRS in the treatment of grade I meningioma. A total of 228 patients with 245 tumors treated with radiosurgery between March 2006 and June 2017were retrospectively evaluated. Of these, 147 (64.5%) patients were treated with SSRS. The remaining 81 patients (35.5%) were treated with a fractionated technique. Protocols to treat meningioma were classified as 12–16 Gy per fraction for SSRS and 7 Gy/fraction/day for three consecutive days to reach a total dose of 21 Gy for FSRT. In univariate and multivariate analyses, tumor volume was found to be associated with local control rate (hazard ratio = 4.98, p = 0.025). The difference in actuarial local control rate (LCR) between the SSRS and FSRT groups after propensity score matching (PSM) was not statistically significant during the 2-year (96.86% versus 100.00%, respectively; p = 0.175), 5-year (94.76% versus 97.56%, respectively; p = 0.373), and 10-year (74.40% versus 91.46%, respectively; p = 0.204) follow-up period. FSRT and SSRS were equally well-tolerated and effective for the treatment of intracranial benign meningioma during the10-year follow-up period.

scholarly journals Economic burden of IADPSG gestational diabetes diagnostic criteria in China: propensity score matching analysis from a 7-year retrospective cohort

2020 ◽  
Vol 8 (1) ◽  
pp. e001538
Author(s):  
Zonglin He ◽  
Yuan Tang ◽  
Huatao Xie ◽  
Yuchen Lin ◽  
Shangqiang Liang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Gestational Diabetes ◽  
Glucose Tolerance ◽  
Pregnant Women ◽  
Propensity Score Matching ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Medical Expenditure ◽  
Iadpsg Criteria ◽  
The Difference

IntroductionThe International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) increased the morbidity significantly, but the cost and effectiveness of its application are still unclear. This study aimed to analyze the impact of the IADPSG criteria for diagnosing GDM in China on the perinatal outcomes, and medical expenditure of GDM women versus those with normal glucose tolerance (NGT).Research design and methodsWe conducted a retrospective cohort study involving 7794 women admitted at the First Affiliated Hospital of Jinan University (Guangzhou, China), from November 1, 2010 to October 31, 2017. The perinatal outcomes and medical expenditure were retrieved from the electronic medical records in the hospital. Propensity score matching (PSM, in a 1:1 ratio) algorithm was used to minimize confounding effects on the difference in the two cohorts.ResultsPSM minimized the difference of baseline characteristics between women with and without GDM. Of 7794 pregnant women, half (n=3897) were all of the pregnant women with GDM admitted to the hospital during the period, the other half women had NGT and were selected randomly to match with their counterparts. Adopting the IADPSG criteria was associated with reduced risk of emergency cesarean section, polyhydramnios, turbid amniotic fluid and perineal injury (p<0.01 for all) and having any one of the adverse fetal outcomes (p<0.01), including fetal distress, umbilical cord around the neck, neonatal encephalopathy, admission to neonatal intensive care unit, birth trauma, neonatal hypoglycemia and fetal death. After PSM, the median total medical expenditure by the GDM women was ¥912.9 (US$140.7 in 2015) more than that of the the NGT women (p=0.09).ConclusionsDespite the increasing medical expenditure, screening at 24–28 gestational weeks under the IADPSG guidelines with the 2-hour, 75 g oral glucose tolerance test can improve short-term maternal and neonatal outcomes.

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