Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Invasion Mechanisms of Bladder Cancer: A Molecular Review

Bladder cancer (BC) is a very common cancer and it has high mortality rates, especially in late stages. BC is considered as a different disease in various stages and grades. Non-muscle-invasive BC and muscle-invasive BC have different properties. There are some prognostic factors for progression and recurrence rates of BC and we have some risk assessment methods. These factors are based on clinical findings and histopathological properties. We do not know which factors and molecular processes are effective in the invasion mechanism. In this review, we summarized possible invasion mechanisms of BC

Invasion Mechanisms of Bladder Cancer: A Molecular Review

Bladder cancer (BC) is a very common cancer and it has high mortality rates, especially in late stages. BC is considered as a different disease in various stages and grades. Non-muscle-invasive BC and muscle-invasive BC have different properties. There are some prognostic factors for progression and recurrence rates of BC and we have some risk assessment methods. These factors are based on clinical findings and histopathological properties. We do not know which factors and molecular processes are effective in the invasion mechanism. In this review, we summarized possible invasion mechanisms of BC

Cough-Induced Spontaneous Rupture of the Kidney Secondary to Anticoagulant Therapy: Wunderlich’s Syndrome

Spontaneous renal or other organ ruptures secondary to anticoagulants have rarely been reported. The clinical features of renal rupture include acute flank/abdominal pain, haematuria, hypotension and shock. It can occur due to increased intraabdominal pressure during coughing. Rupture is most commonly caused by renal tumors such as angiomyolipomas. In the literature, other known causes are long-term haemodialysis, arteriosclerosis or arteritis. Wunderlich’s syndrome is an extremely dangerous complication that may cause death if not treated intensively. If the haemorrhage is self-limiting and the patient is responsive to fluid replacement, the patient can be managed conservatively. Selective angiographic embolization and emergency nephrectomy (partial or total) are the treatment options. In the literature, we found only one case that was presented as spontaneous non-traumatic renal rupture associated with coughing. In our case, total nephrectomy had to be performed, but it was not adequate

Factors affecting the course of body and kidney growth in infants with urolithiasis: A critical long-term evaluation

Objective: To investigate the possible effects of dietary, patient and stone related factors on the clinical course of the stone disease as well as the body and renal growth status of the infants. Patients and Methods: A total of 50 children with an history of stone disease during infancy period were studied. Patient (anatomical abnormalities, urinary tract infection - UTI, associated morbidities), stone (obstruction, UTI and required interventions) and lastly dietary (duration of sole breast feeding, formula feeding) related factors which may affect the clinical course of the disease were all evaluated for their effects on the body and renal growth during long-term follow-up. Results: Mean age of the children was 2.40 ± 2.65 years. Our findings demonstrated that infants receiving longer period of breast feeding without formula addition seemed to have a higher rate of normal growth percentile values when compared with the other children. Again, higher frequency of UTI and stone attacks affected the growth status of the infants in a remarkable manner than the other cases. Our findings also demonstrated that thorough a close follow-up and appropriately taken measures; the possible growth retardation as well as renal growth problems could be avoided in children beginning to suffer from stone disease during infancy period. Conclusions: Duration of breast feeding, frequency of UTI, number of stone attacks and stone removal procedures are crucial factors for the clinical course of stone disease in infants that may affect the body as well as kidney growth during long-term follow-up

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey

Objective To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic

Nation-wide analysis of the impact of Covid-19 pandemic on daily urology practice in Turkey

Ozkent, Mehmet Serkan/0000-0002-6613-0671; Mercimek, Mehmet Necmettin/0000-0002-0680-4451; karabay, emre/0000-0003-1654-8524; Sen, Volkan/0000-0003-2832-0682; Ceyhan, Erman/0000-0001-8223-6399; Irer, Bora/0000-0002-7719-9033; deger, dogan/0000-0002-5095-7770WOS: 000584084200001PubMed: 32996259Objective To present a nation-wide analysis of the workload of urology departments in Turkey week-by-week during Covid-19 pandemic. Methodology the centres participating in the study were divided into three groups as tertiary referral centres, state hospitals and private practice hospitals. the number of outpatients, inpatients, daily interventions and urological surgeries were recorded prospectively between 9-March-2020 and 31-May-2020. All these variables were recorded for the same time interval of 2019 as well. the weekly change of the workload of urology during pandemic period was evaluated, also the workload of urology and the distributions of certain urological surgeries were compared between the pandemic period and the same time interval of the year 2019. Results A total of 51 centres participated in the study. the number of outpatients, inpatients, urological surgeries and daily interventions were found to be dramatically decreased by the 3rd week of pandemics in state hospitals and tertiary referral centres; however, the daily urological practice were similar in private practice hospitals throughout the pandemic period. When the workload of urology in pandemic period and the same time interval of the year 2019 were compared, a huge decrease was observed in all variables during pandemic period. However, temporary measures like ureteral stenting, nephrostomy placement and percutaneous cystostomy have been found to increase during Covid-19 pandemic compared with normal life. Conclusions Covid-19 pandemic significantly affected the routine daily urological practice likewise other subspecialties and priority was given to emergent and non-deferrable surgeries by urologists in concordance with published clinical guidelines