MP35-09 LOWER URINARY TRACT SYMPTOM NON-RESPONSE (″LUTS FAILURE″) AFTER URETHROPLASTY
Bibliographic record
Abstract
INTRODUCTION AND OBJECTIVE: Urethroplasty is a highly effective treatment for urethral stricture. However, some patients fail to experience significant improvement in lower urinary tract symptoms (LUTS) despite being stricture-free. We aim to identify the incidence of ″LUTS failure″ after urethroplasty and examine associated factors. METHODS: Patients undergoing urethroplasty over a 6-year period (January 2012 – December 2018) were offered enrollment in a study examining urinary function after urethroplasty. Urinary function and urinary quality of life (UQOL) were assessed pre-operatively and at 6 months postoperatively using the international prostate symptoms score (IPSS). ″LUTS failure″ was defined as less than 3-point improvement in IPSS. Stricture recurrence was defined as the inability to pass a 16Fr flexible cystoscope. Patients not completing pre- and post-operative IPSS questionnaires and patients with stricture recurrence were excluded from analysis. Descriptive statistics were used to summarize findings while multivariate binary logistic regression was used to determine the association between clinical factors and LUTS failure. RESULTS: Of the 828 patients undergoing urethroplasty over this period, 387 patients completed IPSS scores pre- and post-operatively and of these 372 (96.1%) were stricture free on cystoscopy at 6 months. Mean patient age was 49.5 years, mean stricture length was 4.3cm and 84.4% of patients failed prior endoscopic treatment. Stricture location, etiology and urethroplasty technique were typical of that found in most industrialized nations. As expected, mean IPSS (19.0 vs. 5.4; p<0.0001) and median UQOL (5 vs. 1; p<0.0001) were improved post-urethroplasty. Despite being stricture free on cystoscopy, 13.7% of patients did not experience improvement in IPSS (″LUTS failure″) and 10.2% did not report improvement in UQOL. On multivariate binary logistic regression, increasing patient age (OR 1.04, 95% CI 1.01-1.06, p=0.006), lichen sclerosus (OR 7.6, 95% CI 1.1-51.0, p=0.04) and hypospadias strictures (OR 8.3, 95% CI 1.3-54.0, p=0.03) were associated with "LUTS failure" while stricture location (p=0.46), length (p=0.07), previous urethroplasty (p=0.86), prior endoscopic treatment (p=0.50), type of urethroplasty (p=0.17) and other etiologies were not. Increasing patient age was the sole factor associated with a lack of improvement in UQOL (OR 1.03, 95% CI 1.01-1.06, p=0.02). CONCLUSIONS: While the majority of patients experience improvement in lower urinary tract function after urethroplasty, 13.7% experience ″LUTS failure″ despite being stricture-free on cystoscopy and 10.2% report no improvement in UQOL. Both occurrences are independently associated with increasing patient age and may be related to concurrent benign prostatic hyperplasia or alternately detrusor dysfunction related to longstanding bladder outlet obstruction. Source of Funding: Northern Alberta Urology Foundation
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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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| 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) | 0.008 | 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".