PD34-09 VESICO-VAGINAL FISTULA PREVALENCE AND REPAIR PATTERNS: A LARGE RETROSPECTIVE POPULATION-BASED COHORT ANALYSIS
Notice bibliographique
Résumé
You have accessJournal of UrologyCME1 May 2022PD34-09 VESICO-VAGINAL FISTULA PREVALENCE AND REPAIR PATTERNS: A LARGE RETROSPECTIVE POPULATION-BASED COHORT ANALYSIS Sarah Neu, Jennifer Locke, Bo Zhang, Refik Saskin, and Sender Herschorn Sarah NeuSarah Neu More articles by this author , Jennifer LockeJennifer Locke More articles by this author , Bo ZhangBo Zhang More articles by this author , Refik SaskinRefik Saskin More articles by this author , and Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002585.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In North America vesicovaginal fistula (VVF) are most commonly due to iatrogenic injury and have a significant negative impact on quality of life. Failed surgical repair of VVF can lead to ongoing morbidity. The objective of our study is to determine the change in rate of VVF repair and failures over time, and to determine risk factors for surgical repair failure. METHODS: We completed a population-based, retrospective cohort study including all women in Ontario, Canada, aged 18 and older between 2005-2018. Patients who underwent VVF repair were identified using linked administrative databases and compared to those who required a second VVF repair for primary repair failure. Broken line regression was used to determine changes in the rate of VVF repair over time. Multivariable cox proportional hazard analysis was used to identify risk factors for VVF repair failure. RESULTS: 814 patients were identified as having undergone VVF repair. Of these patients, 117 required a second surgical repair (14%). Mean age at time of surgery was 52 years (SD 15). Most patients had undergone prior gynecological surgery (68%), and 76% were due to iatrogenic injury. Most repairs were performed by urologists (60%) and completed trans-vaginal (66%). Annual rate of VVF repair significantly decreased by 0.14/100,000 women in each year from 2005-2009, and insignificantly decreased from 2010-2018. No significant change in VVF re-repair rates were found. Predictors of VVF re-repair included iatrogenic injury as etiology of VVF (HR 2.1, 95% CI 1.3-3.9, p=0.009), and having the primary repair done with cystoscopic fulguration (HR 6.1 95% CI 3.1-11.1, p<0.0005,); protective factor was surgeon number of years in practice (21+ years - HR 0.5, 95% CI 0.3-0.9, p=0.02). Surgeons with more than 21 years of experience halve half as many patients requiring second VVF repair. CONCLUSIONS: VVF repair rates have decreased over time, however re-repair rates have remained constant over a 13-year time-period. Iatrogenic injury as the cause of VVF is twice as likely to result in the need for a re-repair, compared to other causes, and repair done with cystoscopic fulguration were 6 times as likely to fail compared to a trans-vaginal or abdominal approach. Surgeon years in practice may protect against the need for a second VVF surgery. Source of Funding: University of Toronto Functional Urology Program © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e563 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Neu More articles by this author Jennifer Locke More articles by this author Bo Zhang More articles by this author Refik Saskin More articles by this author Sender Herschorn 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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
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 tête enseignante, 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 ».