Outcomes and complications in surgical and urological procedures

Background: Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in...

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Main Author: Lundström, Karl-Johan
Format: Doctoral Thesis
Language:English
Published: Umeå universitet, Institutionen för kirurgisk och perioperativ vetenskap 2017
Subjects:
Online Access:http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-135046
http://nbn-resolving.de/urn:isbn:978-91-7601-717-3
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spelling ndltd-UPSALLA1-oai-DiVA.org-umu-1350462017-05-25T05:37:43ZOutcomes and complications in surgical and urological proceduresengLundström, Karl-JohanUmeå universitet, Institutionen för kirurgisk och perioperativ vetenskapUmeå : Umeå universitet2017HydroceleSpermatoceleGroin herniaprostate biopsycomplicationinfectionchronic painUrology and NephrologyUrologi och njurmedicinBackground: Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective. Aim: To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events. Results: When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days. Conclusions: The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated. Doctoral thesis, comprehensive summaryinfo:eu-repo/semantics/doctoralThesistexthttp://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-135046urn:isbn:978-91-7601-717-3Umeå University medical dissertations, 0346-6612 ; 1899application/pdfinfo:eu-repo/semantics/openAccess
collection NDLTD
language English
format Doctoral Thesis
sources NDLTD
topic Hydrocele
Spermatocele
Groin hernia
prostate biopsy
complication
infection
chronic pain
Urology and Nephrology
Urologi och njurmedicin
spellingShingle Hydrocele
Spermatocele
Groin hernia
prostate biopsy
complication
infection
chronic pain
Urology and Nephrology
Urologi och njurmedicin
Lundström, Karl-Johan
Outcomes and complications in surgical and urological procedures
description Background: Minor procedures in surgery and urology such as groin hernia and hydrocele repair, as well as prostate biopsies are very frequently done in routine practice. Complications and insufficient outcomes thus affecting many patients and the cumulative effect of this are of major importance in a population perspective. Aim: To explore complications and outcomes of surgical or diagnostic procedures and possible risk factors or predictors for adverse effects. Methods: By using both national quality and administrative registers, and by complementing registers with patient reported outcome measures, examine outcomes such as complications, persistent pain and recurrences. Also, in the case of hydro and spermatoceles, report incidence numbers. Further, by using a randomized trial, explore minimally invasive procedure such as sclerotheraphy compared to conventional surgery in respect to cure and adverse events. Results: When comparing with the open anterior mesh repair, endoscopic technique is advantageous in respect to the patient reported outcome of persistent pain. The drawback was an increased risk of postoperative complications and reoperation for recurrence. Incidence numbers for hydro and spematocele were 100/100000 men. Aspiration (± sclerotherapy) had a significantly lower rate of complications as compared to conventional surgery. In the interim analysis of the randomized trial, comparing sclerotherapy to Lord´s procedure for hydroceles, the cure rate was similar between treatments. Definite conclusions cannot be made due to the risk of type 2 errors, and the study will thus continue. In the case of trans-rectal prostate biopsy, the rates increased every year during the study time frame, up to an approximate risk of two per cent in 2012 for hospital readmission within 30 days, without an increased mortality within 30 days. Conclusions: The open anterior mesh procedure is still the preferred method for groin hernia repair in routine surgical practice. Hydro and spermatocele surgery is associated with high rates of complications, and the indication for repair should be scrutinized. The rates of infection after prostate biopsy is increasing and methods to reduce unnecessary biopsies as well as improved prophylaxis should be investigated.
author Lundström, Karl-Johan
author_facet Lundström, Karl-Johan
author_sort Lundström, Karl-Johan
title Outcomes and complications in surgical and urological procedures
title_short Outcomes and complications in surgical and urological procedures
title_full Outcomes and complications in surgical and urological procedures
title_fullStr Outcomes and complications in surgical and urological procedures
title_full_unstemmed Outcomes and complications in surgical and urological procedures
title_sort outcomes and complications in surgical and urological procedures
publisher Umeå universitet, Institutionen för kirurgisk och perioperativ vetenskap
publishDate 2017
url http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-135046
http://nbn-resolving.de/urn:isbn:978-91-7601-717-3
work_keys_str_mv AT lundstromkarljohan outcomesandcomplicationsinsurgicalandurologicalprocedures
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