Reply Letter to: Loh-Doyle JC, Ashrafi A, Nazemi A, et al. Dual Prosthetic Implantation After Radical Cystoprostatectomy and Neobladder: Outcomes of the Inflatable Penile Prosthesis and Artificial Urinary Sphincter in Bladder Cancer Survivors
Bibliographic record
Abstract
We read with interest the study by Loh-Doyle et al1 regarding the outcomes of 39 bladder cancer survivors with orthotopic neobladder (NB) who underwent inflatable penile prosthesis (IPP) and artificial urinary sphincter (AUS) placement after cystectomy. The authors concluded that IPP and AUS could safely coexist in patients with NB without an increased risk of device-related complications. We believe that the authors should be commended for the innovation of their preliminary data, which focused on a very specific topic gaining an increasing space in the urologic prosthetic literature.2 However, the significance of their findings should be considered in the context of the study limitations. Timing of device implantation is of utmost importance. In this study, before 2011, the decision to perform a synchronous or metachronous dual implantation was based on shared decision-making between the patient and the surgeon. On the contrary, after 2011, a staged approach with AUS typically preceding IPP placement was proposed. This heterogeneity in patient management is critical and is not helpful in answering one of the biggest questions of genitourinary prosthetic surgery: the ideal timing of prosthesis implantation to treat both erectile disfunction and urinary incontinence after pelvic surgery. Obvious advantages of the combined approach include a single surgical and anesthesia session and a faster return to functionality. In this context, several authors failed to find an increased risk of complications with combined AUS and IPP placement in post-prostatectomy patients.3 However, recent findings showed that men who underwent IPP insertion with a prior or synchronous AUS had an increased risk of reoperation and explantation.2 Additionally, the authors did not report the presence of corporal fibrosis or penile curvature during surgery.
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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 | 0.005 | 0.052 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.005 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.023 | 0.021 |
| Insufficient payload (model declined to judge) | 0.008 | 0.007 |
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".