ABSTRACT
INTRODUCTION AND OBJECTIVE: The SARS-CoV-2 (COVID) pandemic threatened access to healthcare, raising concerns that patients were going underdiagnosed and undertreated. The aim of our study was to understand the impact of the COVID pandemic on diagnosis and surgical management of common urological conditions. METHODS: Using a large multi-center electronic health record network (TRINETx) consisting of 46 healthcare organizations, we conducted an epidemiological study investigating the number of patients newly diagnosed with common urological conditions and those undergoing urologic surgeries at yearly intervals from March 1st, 2016 to March 1st, 2021. Relevant international classification of diseases (ICD) codes used to identify urologic conditions are elaborated on in Table 1. Current procedural terminology (CPT) codes used to identify surgeries are detailed in Figure 1. We then determined the percentage of newly diagnosed patients who underwent surgery for each specific year. RESULTS: We saw a decrease in number of all urologic surgeries being performed during the initial year of the pandemic (Figure 1). From March 2020-2021, there was a >20% decrease in surgical case load for benign prostatic hyperplasia procedures (-29.5%), prostate biopsies (-30.1%), incontinence procedures (-33.6%), and vasectomies (-22.8%), compared to the preceding year. Radical cystectomies and orchiectomies saw the lowest decrease, -5.9% and -8.6%, respectively. A similar trend was seen in the number of individuals newly diagnosed with urologic conditions and percentage of patients undergoing surgical intervention. The lowest drops were seen with ureteral stent placements (-5.0%) and prostate biopsies (-3.1%). CONCLUSIONS: The number of people receiving urologic diagnoses and surgical case load for urologic procedures significantly reduced during the first year of the COVID pandemic. Providers should be aware of this healthcare disparity, and greater efforts made to identify these missed patients moving forward.
ABSTRACT
INTRODUCTION AND OBJECTIVE: Vaccine hesitancy is a major public health obstacle to fighting the ongoing COVID-19 epidemic. Due to studies that show COVID-19 infection can affect sperm parameters and lead to orchitis, the public are concerned about how the COVID vaccines may impact male reproduction. In this study, we investigated the association between COVID-19 vaccination and risk of developing orchitis and/or epididymitis outcomes in a cohort of men using a large, US-based, electronic health record database (TriNetX). METHODS: We queried the database for male patients ages 12 years and older who received a single-dose COVID-19 vaccine or at least 1 dose of a 2-dose regimen using specific ICD-10 medication and procedure codes and compared them to a cohort of men who had no record of any COVID-19 vaccination in their health record. The outcome for analysis was diagnosis of orchitis and/or epididymitis (ICD-10-CM: N45-N45.4, N51) between 1-9 months after the index event of COVID-19 vaccination. The two cohorts were balanced for the following potentially confounding variables through propensity score matching: age at index event, race, urinary tract infection, and unspecified sexually transmitted disease. We determined the association between COVID-19 vaccination and orchitis and/or epididymitis using logistic regression analysis with statistical significance assessed at p<0.05. RESULTS: We identified 663,774 men in the database who had received at least one dose of a COVID-19 vaccine, and 9,985,154 who did not. Prior to propensity score matching, 0.051% of men in the vaccinated cohort and 0.083% in the unvaccinated cohort received a diagnosis of orchitis and/or epididymitis in the time window (OR =0.619;95% CI: 0.556 - 0.690;p<0.0001). After balancing for potentially confounding variables, the COVID-19 vaccine remained protective against development of orchitis and/or epididymitis (OR =0.568;95% CI: 0.497 - 0.649;p<0.0001). CONCLUSIONS: In this retrospective cohort study, we demonstrated that receiving a COVID-19 vaccine is associated with a decreased risk of developing orchitis and/or epididymitis. These findings have important implications in the counseling of patients that are hesitant to receive the COVID-19 vaccine and refute misinformed claims on social media regarding the effect of the vaccines on male fertility.
ABSTRACT
â¯: This article has been removed: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article has been retracted at the request of the authors. The abstract was presented as a poster in the IMED last year. Our study was about the association of Ivermectin with reduction in mortality in COVID, a retrospective study with many limitations (which is innate in these types of studies). As in any retrospective study, we could not control for all the confounding variables, mainly severity of disease in patients treated with either ivermectin or remdesivir. Another important caveat is that it was conducted in July 2021, eight months ago, when we did not have all the clinical evidence we have right now about ivermectin in COVID-19. We were very clear in the abstract conclusions that our results are only showing an "association", they are not definitive, and further randomized clinical trials must be done to prove the efficacy of Ivermectin. However, the study has been misinterpreted by a significant number of people in the scientific community and the general population, stating that based on our study, ivermectin is effective to reduce COVID-19 mortality. We are really concerned about this problem because the patients may start taking or demanding this medication from their physicians, which can potentially be harmful. We know that a retrospective study like ours cannot be used to change or guide clinical practice. Retrospective studies are only helpful to formulate hypothesis that can be utilized to design clinical trials. This misrepresentation of the study may lead to a huge public health problem, since Ivermectin is a medication that is not FDA approved for COVID treatment, and currently has proven to be ineffective in clinical trials, which are truly the gold standard to evaluate the efficacy of a medication.