MP61-16 OUTCOMES OF URINARY DIVERSION CREATED FOR LATE ADVERSE EFFECTS OF GYNECOLOGIC RADIOTHERAPY
Bibliographic record
Abstract
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 ...
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".