MP61-16 OUTCOMES OF URINARY DIVERSION CREATED FOR LATE ADVERSE EFFECTS OF GYNECOLOGIC RADIOTHERAPY
Notice bibliographique
Résumé
You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (MP61)1 Apr 2019MP61-16 OUTCOMES OF URINARY DIVERSION CREATED FOR LATE ADVERSE EFFECTS OF GYNECOLOGIC RADIOTHERAPY Daniel Smith*, Joseph Pariser, Jacob Albersheim-Carter, Rachel Moses, Diana O'Dell, John Stoffel, Jeremy Myers, and Sean Elliott Daniel Smith*Daniel Smith* More articles by this author , Joseph PariserJoseph Pariser More articles by this author , Jacob Albersheim-CarterJacob Albersheim-Carter More articles by this author , Rachel MosesRachel Moses More articles by this author , Diana O'DellDiana O'Dell More articles by this author , John StoffelJohn Stoffel More articles by this author , Jeremy MyersJeremy Myers More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556818.71349.c2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Severe urinary adverse effects of radiation are seen in 17% of women treated for gynecologic malignancies. This incidence continues to climb through at least 25 years post-radiation. Reconstructive options are fraught with morbidity as surgical repair of vesicovaginal fistula and radiation-induced ureteral stricture are prone to failure due to local effects of radiotherapy. Urinary diversion represents an option for devastated anatomy, though some patients are notably frail. We sought to elucidate the risks of urinary diversion in patients with a history of radiation for gynecologic malignancy. METHODS: A retrospective review was performed of patient records during the period of 2008 - 2018 from three tertiary centers. Women were identified who underwent continent or incontinent urinary diversion for urinary adverse effects of gynecologic radiotherapy. Indications for diversion included: radiation cystitis, fistula, incontinence, perineal wounds, and urinary tract stricture disease. Sarcopenia was determined by Slice-o-matic software (Tomovision, Quebec, CA) by skeletal muscle index (SMI) based on preoperative CT when available. Outcomes include any post-operative complication within 90 days of surgery as well as 30-day readmission rate. Long-term outcomes, including ureteral stenosis, stomal complications, fistula, renal dysfunction, and bowel function, were also examined. RESULTS: A total of 34 patients from three institutions were included for analysis. The majority were white/Caucasian (73.5%). Median body mass index (BMI) was 24 kg/m2 (interquartile range [IQR] 19.4 - 30). 26/34 (76.5%) underwent non-continent diversion. Median estimated blood loss (EBL) was 300 (IQR 150 - 500). 25/34 (73.5%) of women experienced complications within 90 days; 9/34 (26.5%) experienced high grade (Clavien grade 3 and above) complications. 11/34 (32.4%) of women were readmitted within 30 days. Patients who experienced high grade complications had more sarcopenia (SMI 38.1 vs. 45.7, p=0.047) compared to those who did not. CONCLUSIONS: Urinary diversion for late adverse effects of gynecologic radiotherapy is fraught with complications. Patients experiencing high grade complications had lower skeletal muscle index. Patients and surgeons should consider risks and benefits when deciding to proceed with urinary diversion, especially in the setting of a frail patient. Source of Funding: None Minneapolis, MN; Salt Lake City, UT; Ann Arbor, MI; Salt Lake City, UT; Minneapolis, MN© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e884-e884 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Smith* More articles by this author Joseph Pariser More articles by this author Jacob Albersheim-Carter More articles by this author Rachel Moses More articles by this author Diana O'Dell More articles by this author John Stoffel More articles by this author Jeremy Myers More articles by this author Sean Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,036 | 0,006 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».