Opportunities for augmentation cystoplasty revision without additional bowel harvest: “Hourglass” deformity or non-detubularized augment
Bibliographic record
Abstract
INTRODUCTION: We describe our experience performing bladder augmentation revision without additional bowel harvest for certain suboptimal cystoplasty configurations. METHODS: We identified patients with prior bladder augmentation who underwent augmentation revision without additional bowel harvest at our institution. These patients were identified to have either "hourglass" deformity or non-detubularized augment previously. Revision was performed using an open technique by detaching the prior augment and performing detubularization and/or completion cystotomy as needed. Baseline characteristics, perioperative courses, and followup information were reviewed. Preand postoperative cystography and urodynamics were assessed. RESULTS: Seven patients underwent bladder augmentation revision without the use of additional bowel. Three patients were found to have a non-detubularized augment, while the other four had a narrow connection from the native bladder to augment. Cystography demonstrated correction of "hourglass" deformity for the four patients, and urodynamics revealed resolution of phasic contractions after detubularization. Six of seven patients reported significant improvements in symptoms, such as frequency, urgency, and incontinence. One patient ultimately required Indiana pouch urinary diversion. All patients are performing intermittent catheterization at last followup. CONCLUSIONS: Patients with a prior bladder augmentation with inadequate urine storage should have testing to identify the possibility of a non-detubularized augment or "hourglass" deformity. These patients can be safely offered a revision without the need for additional bowel harvest.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
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".