No abstract

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.

Background and Aim The American Society of Gastrointestinal Endoscopy (ASGE) and the European Society of Gastrointestinal Endoscopy (ESGE) have published guidelines for choledocholithiasis. However, the guidelines were formulated using data from a large number of patients with no to low risk of common bile duct (CBD) stones. This study aimed to assess the guidelines' predictive performance in a population with a high frequency of stones. Methods Data for three choledocholithiasis standard reference tests were retrospectively reviewed from January 2019 to June 2021. Clinical parameters were used to categorize patients into risk groups according to the guidelines, and then the guidelines' predictive abilities were calculated. Results Among 1185 patients, 521 were included. The stone prevalence was 61.0% (n = 318). Twelve (2.3%), 146 (28.0%), and 363 (69.7%) patients were classified into low‐, intermediate‐, and high‐risk groups according to the ASGE guidelines, and 30 (5.8%), 149 (28.6%), and 342 (65.6%) according to the ESGE guidelines. Focusing on the high‐risk group, the ASGE guidelines had a positive predictive value of 73.6 and a positive likelihood ratio of 1.78. The ESGE guidelines had a positive predictive value of 73.7 and positive likelihood ratio of 1.79. Both guidelines had equivalent areas under the receiver operating characteristic curve of 0.69 (95% confidence interval [CI]: 0.65–0.73) and 0.68 (95% CI: 0.64–0.72), respectively. Conclusion In the high‐risk group, the guidelines increased the chance of detecting choledocholithiasis by approximately 10% (61.0% prevalence to 73.6 and 73.7% positive predictive value). However, statistically, the guidelines had marginal discriminative performance in a population with high stone prevalence.

Colonic actinomycosis is rare and can present as an ill-defined intra-abdominal mass that can be difficult to differentiate from colon cancer. This case report aims to share the details of this case and provide diagnostic clues. A 63-year-old female presented with a palpable right-sided abdominal mass. Computed tomography (CT) revealed irregular thickening of the colonic hepatic flexure, and colonoscopy detected no abnormalities. Five months later, the patient returned with an increase in the mass size. Repeat CT revealed lesion expansion, with suspected abdominal wall invasion. Extended right-hemicolectomy with abdominal wall wedge resection was performed, and the histological results were compatible with actinomycosis infection. Colonic actinomycosis is a rare chronic inflammatory disease. Normal colonic mucosa during colonoscopy, with clinical and imaging findings, may help physicians diagnose the condition preoperatively.

Background Current choledocholithiasis guidelines heavily focus on patients with low or no risk, they may be inappropriate for populations with high rates of choledocholithiasis. We aimed to develop a predictive scoring model for choledocholithiasis in patients with relevant clinical manifestations. Methods A multivariable predictive model development study based on a retrospective cohort of patients with clinical suspicion of choledocholithiasis was used in this study. The setting was a 700-bed public tertiary hospital. Participants were patients who had completed three reference tests (endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography, and intraoperative cholangiography) from January 2019 to June 2021. The model was developed using logistic regression analysis. Predictor selection was conducted using a backward stepwise approach. Three risk groups were considered. Model performance was evaluated by area under the receiver operating characteristic curve, calibration, classification measures, and decision curve analyses. Results Six hundred twenty-one patients were included; the choledocholithiasis prevalence was 59.9%. The predictors were age > 55 years, pancreatitis, cholangitis, cirrhosis, alkaline phosphatase level of 125 - 250 or > 250 U/L, total bilirubin level > 4 mg/dL, common bile duct size > 6 mm, and common bile duct stone detection. Pancreatitis and cirrhosis each had a negative score. The sum of scores was -4.5 to 28.5. Patients were categorized into three risk groups: low-intermediate (score ≤ 5), intermediate (score 5.5 - 14.5), and high (score ≥ 15). Positive likelihood ratios were 0.16 and 3.47 in the low-intermediate and high-risk groups, respectively. The model had an area under the receiver operating characteristic curve of 0.80 (95% confidence interval: 0.76, 0.83) and was well-calibrated; it exhibited better statistical suitability to the high-prevalence population, compared to current guidelines. Conclusions Our scoring model had good predictive ability for choledocholithiasis in patients with relevant clinical manifestations. Consideration of other factors is necessary for clinical application, particularly regarding the availability of expert physicians and specialized equipment.