Bibliographic record
Abstract
Introduction: Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in men.Holmium laser enucleation of the prostate (HoLEP) has emerged as a superior option for patients with hemostatic concerns.Intraoperative hypotension (IOH) during general anesthesia is a phenomenon whereby general anesthetics reduce a patient's blood pressure (BP) and is commonly defined as a >20% reduction from baseline.Existing literature on the relationship between IOH and postoperative blood loss is sparse in urology but has been proposed in plastic surgery literature.This study aimed to address this critical knowledge gap by investigating the effect of IOH during HoLEP on postoperative hematuria.Methods: A retrospective analysis was conducted of all patients who underwent HoLEP by a single surgeon from January 1, 2024, to December 31, 2024.The primary comparison group was the incidence of clinically significant hematuria (CSH).Groups with and without CSH were matched by preoperative prostate volume as determined by preoperative imaging using coarsened exact matching.Mean baseline systolic BP (SBP) within one year before HoLEP, highest SBP during the first half of the procedure (the "enucleation phase"), and highest SBP during the second half (the "hemostasis and morcellation phase") were recorded.Patients were considered to have IOH if highest SBP was at least 20% below the mean baseline.Perioperative characteristics were compared using the Wilcoxon rank sum test for continuous variables and either the Chi-squared or Fisher's exact test for categorical variables.Results: Out of 182 HoLEPs in the study period, there were 26 included in each group after matching.Baseline characteristics were similar.The CSH cohort had a greater incidence of IOH during the hemostasis and morcellation phase (21 vs. 0%, p=0.022).The CSH cohort also demonstrated greater length of stay and incidence of ED visits and readmissions (Table 1).Conclusions: Patients with IOH throughout the hemostasis and morcellation phase of HoLEP appeared more likely to progress to CSH.Considering IOH role when identifying bleeding vessels and obtaining hemostasis is critical to improving patient safety.Thus, it may be prudent to optimize blood pressure during the hemostasis and morcellation phase of the procedure to minimize risk of CSH.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.000 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.377 | 0.125 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".