Flu vaccination rate of patients with severe immune-related adverse events.

e18234 Background: Infection with influenza in adults with cancer carries an increased risk of morbidity and mortality. Vaccination against seasonal influenza (Flu-V) can decrease the incidence of influenza, shorten its course, and reduce influenza-associated morbidity. Recent data has suggested that the administration of the Flu-V to patients on an ICI leads to an exaggerated inflammatory response and an increased risk of irAE. However, this trend was demonstrated in a small cohort of patients with lung cancer. Current recommendation for annual Flu-V in patients treated with ICI is unclear and literature about safety is limited. We compared rates of Flu-V for patients on ICI admitted with severe toxicity vs those patients on ICI who were admitted for reasons other than toxicity. We also evaluated rate of Flu-V among oncology patients who had received non-immunotherapy modalities. Methods: We retrospectively evaluated patients treated with ICI who were admitted to Massachusetts General Hospital from February 5, 2011- June 12, 2017. Patients received ipilimumab, pembrolizumab, nivolumab, atezolizumab, durvalumab, avelumab, or a combination in treatment of an advanced solid tumor malignancies including melanoma, NSCLC, SCCHN. Admissions due to irAE were confirmed by review of clinical, radiologic, and pathologic features. Flu-V status was determined by rigorous chart review. Nearest neighbor matching was used to create a control group of cancer patients treated with non-ICI modalities. Descriptive statistics compared rates and timing of Flu-V relative to admission. Statistical significance was determined using Fischer’s Exact Test, p < 0.05. Results: Of 540 patients on ICI, 28% were admitted for irAE, 72% had a non-irAE reason for admission. The rate of Flu-V in the flu season prior to admission for irAE group was lower than for non-irAE (18.5% vs 29.6%; p value = 0.01). There were no differences in vaccination rates within ≤30 days (2.7% vs 3.6%, p = 0.80), ≤90 days (4.0% vs 9.3%, p = 0.05), or ≤180 days of admission (11.9% vs 18.5%, p = 0.07). Flu-V rate overall in patients on ICI was 26.5%. In comparison, Flu-V rate in the nearest neighbor non-immunotherapy oncology patients was 67% (n = 101). Conclusions: Flu-V rates were much lower in patients treated with ICI compared to patients treated with non-ICI modalities. We did not see a higher rate of Flu-V in patients admitted with irAE compared to non-irAE which suggests that Flu-V and severe irAE may not be linked in clinical practice. Additional studies are needed, but Flu-V in patients on ICI holds potential to improve care.

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Neurodevelopment in Children Exposed to Zika Virus: What Are the Consequences for Children Who Do Not Present with Microcephaly at Birth?

Viruses ◽

10.3390/v13081427 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1427

Author(s):

Paula Sobral da Silva ◽

Sophie Eickmann ◽

Ricardo Ximenes ◽

Celina Martelli ◽

Elizabeth Brickley ◽

...

Keyword(s):

Neurological Examination ◽

Zika Virus ◽

Control Group ◽

P Value ◽

Zikv Infection ◽

Clinical Neurological Examination ◽

Cognitive Delay ◽

Increased Risk ◽

Neurodevelopmental Impairment ◽

The Impact

The relation of Zika virus (ZIKV) with microcephaly is well established. However, knowledge is lacking on later developmental outcomes in children with evidence of maternal ZIKV infection during pregnancy born without microcephaly. The objective of this analysis is to investigate the impact of prenatal exposure to ZIKV on neuropsychomotor development in children without microcephaly. We evaluated 274 children including 235 ZIKV exposed and 39 controls using the Bayley-III Scales of Infant and Toddler Development (BSIDIII) and neurological examination. We observed a difference in cognition with a borderline p-value (p = 0.052): 9.4% of exposed children and none of the unexposed control group had mild to moderate delays. The prevalence of delays in the language and motor domains did not differ significantly between ZIKV-exposed and unexposed children (language: 12.3% versus 12.8%; motor: 4.7% versus 2.6%). Notably, neurological examination results were predictive of neurodevelopmental delays in the BSIDIII assessments for exposed children: 46.7% of children with abnormalities on clinical neurological examination presented with delay in contrast to 17.8% among exposed children without apparent neurological abnormalities (p = 0.001). Overall, our findings suggest that relative to their unexposed peers, ZIKV-exposed children without microcephaly are not at considerably increased risk of neurodevelopmental impairment in the first 42 months of life, although a small group of children demonstrated higher frequencies of cognitive delay. It is important to highlight that in the group of exposed children, an abnormal neuroclinical examination may be a predictor of developmental delay. The article contributes to practical guidance and advances our knowledge about congenital Zika.

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Impaired atrial electromechanical coupling in lichen planus patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.109 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

I Jafaripour ◽

Z Aryanian ◽

S Hosseinzadeh ◽

R Pourkia ◽

MM Ansari Ramandi ◽

...

Keyword(s):

Lichen Planus ◽

Electromechanical Coupling ◽

Wave Dispersion ◽

Tissue Doppler ◽

P Wave ◽

Control Group ◽

P Value ◽

P Wave Dispersion ◽

Increased Risk ◽

Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Lichen planus (LP) which is a chronic inflammatory disease can cause impaired atrial electromechanical coupling, leading to increased risk of atrial fibrillation. Purpose The present study aimed to evaluate atrial electromechanical coupling in LP patients by using electrocardiography (ECG) and echocardiography. Methods Forty-six LP patients were investigated in this cross-sectional case-control study. The control group comprised healthy individuals selected in age and gender-matched manner. Echocardiography and ECG were done for all patients to show inter and intra-atrial electromechanical delays and P wave dispersion respectively. The electromechanical delays were calculated by using the difference between the delays from the onset of the P wave on ECG to the onset of A wave on tissue Doppler recordings of the different areas. Results The baseline characteristics of the case and control group were similar and did not differ significantly. The P wave dispersion was 45.63 ± 3.48 milliseconds in the LP group in comparison to 36.56 ± 2.87 milliseconds in the control group (p < 0.001). As shown in the table, the intra and inter-atrial electromechanical delays were also significantly prolonged in LP patients when compared to the control group (p < 0.001). There was no significant difference between the left and right ventricular systolic function and diastolic function of the two groups. Conclusion The results of the study indicate the presence of significant impaired atrial electromechanical coupling in patients with LP confirmed by both electrocardiographic and echocardiographic tools. Electromechanical delays Case N = 46 (mean ± SD) Control N = 46 (mean ± SD) P value Septal - PA (msec) 59.71 ± 13.24 44.39 ± 11.07 0.002 Lateral - PA (msec) 55.71 ± 13.26 48.89 ± 11.21 0.009 Tricuspid - PA (msec) 52.37 ± 13.12 43.28 ± 10.58 0.002 Inter-atrial delay (msec) (lateral PA−RV PA) 8.47 ± 1.62 6.37 ± 1.36 <0.001 Intra-atrial delay (msec) (LA) [lateral PA−septal PA] 4.80 ± 1.48 3.83 ± 0.82 <0.001 Intra-atrial delay (msec) (RA) [septal PA−RV PA] 3.91 ± 0.96 2.02 ± 0.71 <0.001 PA Delay from the onset of the P wave on ECG to the onset of A wave on tissue Doppler, N: number, SD: Standard Deviation, LA: Left Atrium, RA: Right Atrium, RV: Right Ventricle

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Association of single-nucleotide polymorphisms in the ESR2 and FSHR genes with poor ovarian response in infertile Jordanian women

Clinical and Experimental Reproductive Medicine ◽

10.5653/cerm.2020.03706 ◽

2021 ◽

Vol 48 (1) ◽

pp. 69-79

Author(s):

Amer Mahmoud Sindiani ◽

Osamah Batiha ◽

Esra’a Al-zoubi ◽

Sara Khadrawi ◽

Ghadeer Alsoukhni ◽

...

Keyword(s):

Single Nucleotide Polymorphisms ◽

Statistical Significance ◽

Ovarian Response ◽

Control Group ◽

P Value ◽

Case Group ◽

Nucleotide Polymorphisms ◽

Poor Ovarian Response ◽

Single Nucleotide ◽

Number Of Patients

Objective: Poor ovarian response (POR) refers to a subnormal follicular response that leads to a decrease in the quality and quantity of the eggs retrieved after ovarian stimulation during assisted reproductive treatment (ART). The present study investigated the associations of multiple variants of the estrogen receptor 2 (ESR2) and follicle-stimulating hormone receptor (FSHR) genes with POR in infertile Jordanian women undergoing ART.Methods: Four polymorphisms, namely ESR2 rs1256049, ESR2 rs4986938, FSHR rs6165, and FSHR rs6166, were investigated in 60 infertile Jordanian women undergoing ART (the case group) and 60 age-matched fertile women (the control group), with a mean age of 33.60±6.34 years. Single-nucleotide polymorphisms (SNPs) were detected by restriction fragment length polymorphism and then validated using Sanger sequencing.Results: The p-value of the difference between the case and control groups regarding FSHR rs6166 was very close to 0.05 (p=0.054). However, no significant differences were observed between the two groups in terms of the other three SNPs, namely ESR2 rs1256049, ESR2 rs4986938, and FSHR rs6165 (p=0.561, p=0.433, and p=0.696, respectively).Conclusion: The association between FSHR rs6166 and POR was not statistically meaningful in the present study, but the near-significant result of this experiment suggests that statistical significance might be found in a future study with a larger number of patients.

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The Connection of the Level of Estradiol in Serum and Obesity with the Endometrial Bleeding in Postmenopausal Women

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.079 ◽

2019 ◽

Vol 7 (1) ◽

pp. 88-91 ◽

Cited By ~ 1

Author(s):

Valentina Tofiloska ◽

Maria Krstevska ◽

Ana Daneva-Markova ◽

Viktorija Jovanovska

Keyword(s):

Endometrial Cancer ◽

Statistical Significance ◽

Abnormal Uterine Bleeding ◽

Control Group ◽

Prospective Clinical Study ◽

Study Group ◽

Gynecology And Obstetrics ◽

Increased Risk ◽

Significant Difference ◽

Post Menopausal

BACKGROUND: Postmenopausis is a period that begins one year after the last menstrual period. Abnormal uterine bleeding could be of different origins. AIM: This study aimed to determine the association of serum estrogen hormone levels and obesity with the occurrence of endometrial bleeding in post-menopausal women. MATERIAL AND METHODS: Prospective clinical study involving 120 postmenopausal patients treated at the University Clinic for Gynecology and Obstetrics-Skopje, divided into two groups: control and study. The control group consisted of 40 postmenopausal patients without endometrial bleeding, hospitalised and operated due to urogenital pathology. The study group consisted of 80 patients with endometrial bleeding who were divided into three subgroups according to the thickness of the endometrium: from 5-8 mm, 8-11 mm and above 11 mm. In all subjects, estradiol and BMI was determined. RESULTS: Estradiol levels were statistically higher in the study group compared to control while statistically significant difference among the three subgroups according to the thickness of the endometrium about the levels of estradiol in blood is not found. About BMI, the results showed that there was no statistical significance between the two examined groups. CONCLUSION: Patients with endometrial bleeding have increased levels of estradiol and are at increased risk of endometrial cancer about controls, the likelihood of endometrial cancer significantly increases by 1,108 times.

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Ultrasonographic Evaluation of Bowel Wall Thickness and Intramural Blood Flow in Ulcerative Colitis

QJM ◽

10.1093/qjmed/hcab100.061 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Moataz Mohamed Sayed ◽

Kamal El-Deen Abdelrahman El-Atrebi ◽

Tari Magdy Aziz George ◽

Hazem Mohamed Abd Elazim Marey

Keyword(s):

Ulcerative Colitis ◽

Disease Activity ◽

Wall Thickness ◽

Bowel Wall ◽

Bowel Movement ◽

Control Group ◽

P Value ◽

Bowel Wall Thickness ◽

Pathologic Features ◽

Relapse Group

Abstract Background Ulcerative colitis, a type of inflammatory bowel disease that merely affects the mucosa and submucosa of colon in the form of inflammatory ulcers. Colonoscopy is the gold standard for its diagnosis. For optimal monitoring of disease activity in UC patients, colonoscopy should be performed on a regular basis. However, repeated colonoscopies represent a logistic and economic challenge, as well as significant burden for the patients. Objectives Our study aimed to provide an extensive overview of the main pathologic features of gut wall vessels and bowel wall thickness at US examination of UC. Patients and Methods This prospective case control study was done on 40 patients confirmed to have UC attending to Outpatient Clinics of Internal Medicine and Gastroenterology Department – Ain-Shams University from October 2018 to Augost 2019. They were divided into two groups: Relapse group: Include 20 patients with active UC disease. Remission group: Include 20 patients with inactive UC disease (in remission state). These two groups were matched with 20 healthy individuals, matched for age and gender and considered to be a control group. Disease activity was categorized according to the endoscopic Mayo score.Ultrasound and endoscopic findings were compared for each colon segment except for the rectum. Results The peak incidence of affected patients was 30–40 years of age. Female predominance compared to male with a ratio of 2.6:1. 20% of remission patients complaining from 1-2 bowel movement while 45% and 50% of relapsing patients suffer from 3-4 and 5 bowel movement respectively. 100%, 100%, 20% and 15% of relapsing patients suffer from bleeding per rectum, abdominal pain, tenesmus and urgency. Higher ESR and CRP and lower hemoglobin in relapsing compared to remission group. Furthermore, The last group has higher value of ESR and CRP and lower value of hemoglobin compared to control group. BWT was significantly thicker in relapse group (4.8±0.7 mm) than of remission (3.55±0.5 mm) compared to control group (1.6±0.5) (p value <0.001). BWT at a cut-offs > 4 mm discriminating between cases with relapse from those with remission and at a cut-offs >4 mm discriminating between mild endoscopic severity from moderate and severe UC. Furthermore, BWT at a cut-offs >4.6 mm discriminating between mild and moderate endoscopic severity from severe UC. Vascular signal number at a cut-offs >1 discriminating between cases with relapse from those with remission and at a cut-offs >2 discriminating between mild and moderate endoscopic severity of UC. Conclusion Abdominal ultrasound is a widely available non-invasive method for imaging of UC. It provides a high sensitivity, specificity and accuracy in diagnosis and monitoring of UC activity.

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The Relationship between the Type of Milk Consumed and the Risk of Kidney Stones in Children Under Two Years of Age

Journal of Iranian Medical Council ◽

10.18502/jimc.v3i4.5192 ◽

2021 ◽

Author(s):

Hamideh Shajari ◽

Ahmad Shajari ◽

Mohammad Golshan Tafti ◽

Reza Samaninejad

Keyword(s):

Kidney Stones ◽

Statistical Significance ◽

Cow Milk ◽

Control Group ◽

P Value ◽

Case Group ◽

Growth Disorders ◽

Formula Milk ◽

Significant Difference ◽

Duration Of Breastfeeding

Background: Kidney stones are one of several serious health problems in childhood that cause nutritional and growth disorders, and may finally lead to chronic kidney failure in this group. Methods: In this analytical study conducted through a case-control design, 30 children under the age of two with kidney stones, and 125 children of the same age and sex without stones were studied. Patient information including personal profile and the results of some necessary tests were extracted from patient records and listed in a checklist. The data was analyzed using SPSS (Version 17.0). Statistical significance was considered when p-value was <0.05. Results: In terms of duration of breastfeeding, a significant difference was observed between the patients with stones and patients without stones; the duration of breastfeeding was longer in the control group (p=0.003). In addition, the duration of feeding with formula milk and cow milk was longer in the case group (p=0.038 and p=0.012, respectively). Conclusion: Breastfeeding can serve as a nutritional factor that plays a preventive and protective role against the formation of kidney stones in infants.

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Performance and Return to Sport After Hip Arthroscopic Surgery in Major League Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119825835 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711982583 ◽

Cited By ~ 5

Author(s):

Robert A. Jack ◽

Kyle R. Sochacki ◽

Takashi Hirase ◽

Justin Vickery ◽

Patrick C. McCulloch ◽

...

Keyword(s):

Major League Baseball ◽

Statistical Significance ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Control Group ◽

P Value ◽

Postoperative Performance ◽

Significant Difference ◽

Major League ◽

And Performance

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain that may lead to decreased performance in Major League Baseball (MLB) players. Purpose: To determine the (1) return-to-sport (RTS) rate in MLB players after hip arthroscopic surgery for FAI; (2) postoperative career length, innings pitched (IP) (pitchers), and plate appearances (PA) (position players); (3) preoperative and postoperative performance; and (4) postoperative performance compared with control players matched by position, age, years of experience, and performance. Study Design: Cohort study; Level of evidence, 3. Methods: MLB athletes who underwent hip arthroscopic surgery for FAI and matched controls were identified. Demographic and performance data were collected. RTS was defined as playing in at least 1 MLB game after surgery. Continuous variables of each group were compared using a 2-tailed paired-samples Student t test for normally distributed data. The chi-square test was used to analyze categorical data. The Bonferroni correction was used to control for multiple comparisons, with statistical significance defined by a P value of ≤.007. Results: A total of 50 players (57 surgeries) were analyzed (mean age, 30.4 ± 3.9 years; mean MLB experience at the time of surgery, 7.0 ± 4.6 years). Pitchers (31 surgeries; 54.4%) represented the largest proportion of players analyzed. Of these players, 42 (47 surgeries; 82.5%) were able to RTS at a mean of 8.3 ± 4.1 months. The overall 1-year MLB career survival rate of players undergoing FAI surgery was 78.9%. Players in the control group were in MLB a similar number of years (4.0 ± 2.9 years) to players who underwent surgery (3.3 ± 2.4 years) ( P > .007). There was no significant decrease in IP or PA per season after surgery ( P > .007). There was no significant difference in performance for pitchers and nonpitchers compared with matched controls after surgery ( P > .007). Conclusion: The RTS rate for MLB athletes after hip arthroscopic surgery for FAI was high. There were similar IP, PA, and career lengths postoperatively compared with preoperatively and with matched controls. There was no significant difference in performance for pitchers and nonpitchers compared with matched controls after surgery.

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Performance and return to sport after hip arthroscopy for femoracetabular impingement syndrome in National Hockey League players

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz030 ◽

2019 ◽

Author(s):

Kyle R Sochacki ◽

Robert A Jack ◽

Takashi Hirase ◽

Justin Vickery ◽

Joshua D Harris

Keyword(s):

Hip Arthroscopy ◽

Statistical Significance ◽

Return To Sport ◽

Performance Data ◽

National Hockey League ◽

Control Group ◽

P Value ◽

Career Length ◽

Operative Performance ◽

And Performance

Abstract Femoroacetabular impingement (FAI) syndrome is a common cause of hip pain in National Hockey League (NHL) players that may lead to decreased performance. The purpose of this study was to determine the (i) return to sport (RTS) rate in NHL players following hip arthroscopy for FAI, (ii) post-operative career length and games per season, (iii) pre- and post-operative performance and (iv) post-operative performance compared with control players. NHL athletes who underwent hip arthroscopy for FAI and matched controls were identified based on position, age (±1 year), years of experience (±1 year) and performance data prior to the surgery date. Demographic and performance data were collected. RTS was defined as playing in at least one NHL game after surgery. A Bonferroni correction was used to control for multiple comparisons with statistical significance defined by a P-value ≤ 0.007. Seventy players (77 surgeries) were analysed (mean age 29.4 ± 4.5 years; mean 8.8 ± 4.7 years NHL experience at the time of surgery). Sixty-three players (70 surgeries, 90.9%) RTS at an average of 6.8 ± 4.1 months. The 1-year NHL career survival rate for players undergoing surgery was 84.4%. Players in the control group (4.4 ± 2.7 years) had longer careers (P = 0.00002) than players that underwent surgery (3.3 ± 2.5 years). There was no significant (P > 0.007) decrease in post-operative performance compared with pre-operatively and with matched controls. The RTS rate for NHL athletes after hip arthroscopy for FAI is above 90% at less than 1 year. Following surgery, if a player returns to the NHL, then their post-operative performance is similar to pre-operatively and controls, but their careers are approximately one season less than controls.

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Relationship of Migraine and Body Mass Index (BMI)

Journal of Enam Medical College ◽

10.3329/jemc.v6i2.27762 ◽

2016 ◽

Vol 6 (2) ◽

pp. 80-87

Author(s):

Mohammed Momenuzzaman Khan ◽

Md Nazmul Huda ◽

Manabendra Bhattacharjee ◽

Md Jalal Uddin ◽

Mustofa Kamal Uddin Khan

Keyword(s):

Social Life ◽

Overweight And Obesity ◽

Control Group ◽

P Value ◽

Case Group ◽

Increased Risk ◽

Significant Difference ◽

Associated Symptoms ◽

Migraine Group ◽

The Relationship

Background: Migraine is an important cause of headache and headache-related disabilities. It increases loss of working time, causes inability to carry out daily activities and disruption of family and social life. The pathophysiology of migraine is still poorly understood. On the other hand, the prevalence of obesity is constantly increasing worldwide. The consequence of overweight and obesity includes increased risk of diabetes mellitus, dyslipidemia, hypertension, cardiovascular disease and cancer.Objectives: This study was performed to assess the relationship between BMI and migraine by finding out the relationship between migraine frequency and duration in different BMI groups, comparing the socio-demographic variables in migraine and non-migraine patients and to find out the migraine related co-morbidities.Materials and Methods: This observational case-control study was conducted on 100 subjects aged 1250 years in the Neurology Outpatient Department, Mymensingh Medical College Hospital, Mymensingh in the period of January 2011 to December 2012. Out of total subjects fifty migraine patients were selected as cases and fifty nonmigraineurs as controls. Subjects were then categorized in three groups based on BMI: <23, 23 to 25 and >25. Collected data were compiled and appropriate analyses were done by using computer based software, Statistical Package for Social Sciences (SPSS) version 16.0. For statistical analysis one way ANOVA tests were done for comparing means of quantitative data and Chi-square tests were done for qualitative data. A p value <0.05 was considered statistically significant.Results: In this study, majority (>95%) of the study subjects were between 10 and 35 years of age. Mean age of case group was found 25.55 ± 5.87 and that of control was 25.53 ± 4.22 years. Case group contained 10 (20%) males and 40 (80%) females whereas control group had 14 (28%) males and 36 (72%) females. Number of female cases and controls were higher than that of male. In control group 30 (60%) were unmarried and 20 (40%) were married. There was no significant difference in the financial condition between case and control groups. Students and housewives occupied the largest number of study subjects who were unemployed. Regarding residence, rural and urban patients were equal in case group and in control group 29 (58%) were urban and 21 (42%) rural. Mean duration of headache was 8.9 ± 7.5, 5.8 ± 6.7, 9.6 ± 14.3 years in different BMI groups (<23, 2325, >25 respectively) in case group and 4.6 ± 5.3, 4.4 ± 3.4, 3.4 ± 1.4 years in control group respectively. There was significant difference in quality of headache. In migrainous group 58.6% in BMI <23, 30% in BMI 2325, 36.4% in BMI >25 noted their headache as throbbing, in contrast most of the nonmigrainous described them as dull in nature. Mean frequency of headache per month was significantly higher in migraine group compared to non-migraine group (p=0.02). Regarding associated symptoms, nausea, vomiting, photophobia and phonophobia were observed significantly higher in migraine patients in BMI <23 group. Odd ratios (ORs) for vomiting, photophobia and phonophobia with 95% confidence interval (CI) were 23.385 (2.75297.739), 16.500 (3.060 88.971) and 13.000 (2.92257.846) respectively. Smoking was found significantly higher in nonmigrainous group than migraine group in case of BMI <23.Conclusion: From the result of present study it can be concluded that there is statistically no significant relation of BMI with frequency of headache, but some relationship were observed for associated symptoms of migraine with low BMI.J Enam Med Col 2016; 6(2): 80-87

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Safety of a first-day catheter removal after transurethral resection of the prostate (TURP): a propensity score-matched historical control study

Insight Urology ◽

10.52786/isu.a.21 ◽

2021 ◽

Vol 42 (1) ◽

pp. 40-45

Author(s):

Songwut Prasopsuk ◽

◽

Suppadech Tunruttanakul ◽

Keyword(s):

Propensity Score ◽

Transurethral Resection ◽

Nearest Neighbor ◽

Intraoperative Complications ◽

Postoperative Bleeding ◽

Safety Data ◽

High Rate ◽

Catheter Removal ◽

Control Group ◽

P Value

Objective: Transurethral resection of the prostate (TURP) is the standard surgical management for patients with benign prostatic hyperplasia (BPH). Postoperative maintenance of bladder catheterization is a routine procedure. However, the timing of catheter removal varies. Our objective is to evaluate the safety of early catheter removal (less than 24 hours) whilst maintaining efficacy, especially in an overcrowded community-based hospital, which has a high rate of preoperative catheterization (47.7%). Materials and Methods: This was a prospective and retrospective observational cohort study of 399 TURP indicated patients from February 2014 to September 2019. Since October 2017, the urological unit protocol has changed the process of removal of the catheter to less than 24 hours after monitoring for safety. Data from 95 patients after October 2017 was prospectively collected as the less than 24 hours group. The information from 2014 to October 2017 was collected and used as the control group. Data was then studied retrospectively for three years. The primary outcome, morbidity, and postoperative stay were compared with a 1:1 nearest neighbor propensity score-matched analysis. Results: After the score was matched and balanced, there was no difference as regards complications between the two groups (Odd ratio (OR): 1, (95% Confidence interval (95% CI): 0.14-7.10, p-value: 1.00). Acute urinary retention and postoperative bleeding were also comparable (OR: 0.5, 95% CI: (0.05-5.51), p-value: 0.57, and p-value: 0.99). The postoperative hospital stay was significantly less in the < 24 hours group (38.1 less hours, 95% CI: (41.82- 34.31), p-value: < 0.01). Conclusion: After TURP early catheter removal was safe even in the hospital with a high preoperative catheterization rate. Experienced surgeons, well-educated and compliant patients without contraindications (neurogenic bladder, urethral stricture, stroke, and some intraoperative complications: urinary bladder perforation, urinary tract infection, prostatic capsule perforation, or intraoperative bleeding) are our recommendation for adopting this protocol.

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