PD06-05 STRESS INCONTINENCE SURGERY IS NOT ASSOCIATED WITH PELVIC MALIGNANCY: THE RESULTS OF A LARGE POPULATION-BASED STUDY
Bibliographic record
Abstract
You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (PD06)1 Apr 2019PD06-05 STRESS INCONTINENCE SURGERY IS NOT ASSOCIATED WITH PELVIC MALIGNANCY: THE RESULTS OF A LARGE POPULATION-BASED STUDY Humberto R Vigil*, Christopher Wallis, Joseph LaBossiere, Sender Herschorn, and Lesley Carr Humberto R Vigil*Humberto R Vigil* More articles by this author , Christopher WallisChristopher Wallis More articles by this author , Joseph LaBossiereJoseph LaBossiere More articles by this author , Sender HerschornSender Herschorn More articles by this author , and Lesley CarrLesley Carr More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555189.18045.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Stress incontinence surgery is common and was revolutionized by the midurethral sling. In the wake of regulatory warnings, unsubstantiated claims regarding mesh have permeated public discourse. Despite no supporting evidence, concerns continue to exist regarding a link between mesh and malignancy. We sought to evaluate the association between stress incontinence surgery, including transvaginal mesh, and carcinogenesis in a large population-based cohort. METHODS: A retrospective cohort of adult women who underwent stress incontinence surgery from 1994-2016 in Ontario was captured from the Institute for Clinical Evaluation Sciences database. Women were identified using physician billing codes in Ontario for the different stress incontinence procedures. The primary outcome of interest was the diagnosis of pelvic cancers. These were defined using ICD-9 and ICD-10 billing codes. Pelvic cancers included urological and gynaecological malignancies. The standardized incidence rate (SIR) was calculated as the ratio of the observed number of pelvic cancer cases divided by the age-stratified expected number of pelvic cancer cases based on the Ontario population. Subgroup analyses were performed for individual malignancies and midurethral sling patients. Multivariable logistic regression modeling examined for risk factors of pelvic malignancy. RESULTS: A total of 120,999 women underwent a procedure for stress incontinence in the form of urethropexy, combined abdominal/vaginal sling, bulking agent or midurethral sling in Ontario during the study period. Midurethral sling accounted for 63% of procedures performed. Median follow up was 9.3 years (IQR 5.4-14.4). Expected cancer cases over a total exposure time of 1,221,668 person-years was 1,146. 935 pelvic cancers were observed with a frequency of 0.77%. The SIR for any cancer diagnosis compared to the general population of Ontario was 0.816, 95% CI 0.764-0.870. In patients who underwent a midurethral sling only, the expected number of cancer cases over an exposure time of 562,457 person-years was 576. 479 pelvic cancers were observed with an SIR of 0.831, 95% CI 0.758-0.909. On multivariable analysis, midurethral sling was not associated with an increased risk of pelvic cancer when compared to the other stress incontinence procedures. CONCLUSIONS: Stress incontinence surgery including the transvaginal implantation of mesh was not associated with an increased risk of pelvic malignancy in a large population-based cohort. Source of Funding: None Toronto, Canada; Edmonton, Canada; Toronto, Canada© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e138-e138 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Humberto R Vigil* More articles by this author Christopher Wallis More articles by this author Joseph LaBossiere More articles by this author Sender Herschorn More articles by this author Lesley Carr More articles by this author Expand All 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 | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 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".