MP89-04 DOES GRADE MATTER? A SYSTEMATIC REVIEW OF THE IMPACT OF VARICOCELE GRADE ON RESPONSE TO TREATMENT.
Bibliographic record
Abstract
You have accessJournal of UrologyInfertility: Therapy I1 Apr 2017MP89-04 DOES GRADE MATTER? A SYSTEMATIC REVIEW OF THE IMPACT OF VARICOCELE GRADE ON RESPONSE TO TREATMENT. Clark Judge, Christopher Deibert, Doron Stember, and Peter Stahl Clark JudgeClark Judge More articles by this author , Christopher DeibertChristopher Deibert More articles by this author , Doron StemberDoron Stember More articles by this author , and Peter StahlPeter Stahl More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2802AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The treatment options for couples affected by varicocele-associated subfertility include varicocelectomy and assisted reproduction. Our goal was to investigate varicocele grade as a prognostic factor that could be potentially incorporated into shared decision making with affected patients. METHODS Pubmed, Embase, and MEDLINE databases were searched for studies evaluating the impact of varicocele grade on response to treatment through May 1, 2016. We analyzed all studies of varicocelectomy in infertile men with palpable varicoceles that reported outcomes stratified by varicocele grade. Heterogeneity of semen quality reporting precluded data compilation and meta-analysis. Therefore the impact of varicocele grade on post-treatment semen quality was analyzed by structured data synthesis. The impact of varicocele grade on pregnancy rates was studied by data extraction and meta-analysis using a binary random effects model. Quality assessment was conducted using the Newcastle-Ottawa Scale (NOS). RESULTS One randomized controlled trial and 11 cohort studies described outcomes of varicocelectomy stratified by varicocele grade in 1,394 infertile men with palpable varicocele. For men with only grade 1 varicocele, only 1 of 5 studies reported improved concentration and just 1 of 6 showed improved motility. In contrast, 5 of 5 studies that evaluated concentration and 4 of 5 studies that evaluated motility after repair of grade 2/3 varicoceles reported positive treatment responses. Four of 6 studies that directly compared concentration response to varicocelectomy in men with grade 1 and grade 2/3 varicoceles reported greater improvements in men with larger varicoceles. Three of 6 studies that directly compared motility response to varicocelectomy in men with grade 1 and grade 2/3 varicoceles reported greater improvements in men with larger varicoceles. Morphology changes were less consistently related to varicocele grade. Meta-analyses of the included studies did not reveal improved pregnancy rates after treatment of either grade 1 or grade 2/3 varicoceles. Quality assessment determined that 4 of the 11 non-randomized studies were of high quality. CONCLUSIONS Improved semen quality after varicocelectomy has been consistently reported for men with grade 2/3 varicoceles. In contrast, improvement is uncommon for men with grade 1 varicoceles. Incorporation of varicocele grade into patient counseling may improve our ability to select patients for varicocelectomy that are most likely to benefit from surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1203 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Clark Judge More articles by this author Christopher Deibert More articles by this author Doron Stember More articles by this author Peter Stahl More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...
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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 | 0.015 | 0.066 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.011 |
| Bibliometrics | 0.007 | 0.009 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
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".