Browsing by Author "Ulkuniemi, Uula"
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Ulkuniemi, Uula (2022)This thesis presents a complication risk comparison of the most used surgical interventions for benign prostatic hyperplasia (BPH). The investigated complications are the development of either a postsurgery BPH recurrence (reoperation), an urethral stricture or stress incontinence severe enough to require a surgical procedure for their treatment. The analysis is conducted with survival analysis methods on a data set of urological patients sourced from the Finnish Institute for Health and Welfare. The complication risk development is estimated with the AalenJohansen estimator and the effects of certain covariates on the complication risks is estimated with the Cox PH regression model. One of the regression covariates is the Charlson Comorbidity Index score, which attempts to quantify a disease load of a patient at a certain point in time as a single number. A novel Spark algorithm was designed to facilitate the eﬀicient calculation of the Charlson Comorbidity Index score on a data set of the same size as the one used in the analyses here. The algorithm achieved at least similar performance to the previously available ones and scaled better on larger data sets and with stricter computing resource constraints. Both the urethral stricture and urinary incontinence endpoints suffered from a lower number of samples, which made the associated results less accurate. The estimated complication probabilities in both endpoint types were also so low that the BPH procedures couldn’t be reliably differentiated. In contrast, BPH reoperation risk analyses yielded noticeable differences among the initial BPH procedures. Regression analysis results suggested that the Charlson Comoborbidity Index score isn’t a particularly good predictor in any of the endpoints. However, certain cancer types that are included in the Charlson Comorbidity Index score did predict the endpoints well when used as separate covariates. An increase in the patient’s age was associated with a higher complication risk, but less so than expected. In the urethral stricture and urinary incontinence endpoints the number of preceding BPH operations was usually associated with a notable complication risk increase.
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