MP30-08 IS STRESS INCONTINENCE AND PELVIC ORGAN PROLAPSE SURGERY ASSOCIATED WITH THE DEVELOPMENT OF AUTOIMMUNE RHEUMATIC DISEASE? THE RESULTS OF A POPULATION-BASED COHORT STUDY
Bibliographic record
Abstract
You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (MP30)1 Apr 2020MP30-08 IS STRESS INCONTINENCE AND PELVIC ORGAN PROLAPSE SURGERY ASSOCIATED WITH THE DEVELOPMENT OF AUTOIMMUNE RHEUMATIC DISEASE? THE RESULTS OF A POPULATION-BASED COHORT STUDY Humberto Vigil*, Rano Matta, Arielle Mendel, Lesley Carr, and Sender Herschorn Humberto Vigil*Humberto Vigil* More articles by this author , Rano MattaRano Matta More articles by this author , Arielle MendelArielle Mendel More articles by this author , Lesley CarrLesley Carr More articles by this author , and Sender HerschornSender Herschorn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000869.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Regulatory warnings for mesh-based stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures have led to an unsupported claim that mesh directly stimulates the immune system and predisposes to autoimmune rheumatic disease (ARD). We sought to evaluate the association between SUI and POP on the development of ARD in Ontario, Canada. METHODS: Adult women who underwent surgery for SUI or POP between January 1, 2002 and December 31, 2015 were identified from an administrative database. Surgical codes were used to identify women undergoing mesh and non-mesh procedures. The remaining population of women during this period were divided into two control groups according to diagnostic codes: SUI or POP with no surgery and the general population. The primary outcome was a composite of any ARD diagnosis (rheumatoid arthritis, connective tissue disorders, seronegative spondyloarthropathies and vasculitis) developing at least 3-months following SUI or POP surgery or diagnosis. Secondary outcomes included the development of the individual ARDs. A 4-level categorical Cox-proportional hazards model was used to estimate the risk of primary and secondary outcomes with the general population as the reference group, adjusting for patient-level baseline covariates. RESULTS: 281,122 women were diagnosed with SUI or POP and did not undergo surgery. Of the 139,904 women who underwent surgery, 79,222 and 60,682 underwent repair with and without mesh, respectively. Median age was 43 (IQR 29-57). Overall, 84,992 (1.45%) women were diagnosed with an ARD. Compared to the general population, women with SUI or POP had an increased risk of ARD independent of treatment modality (mesh HR 1.17 [95%CI 1.13-1.21]; non-mesh HR 1.16 [95%CI 1.12-1.20]; no surgery HR 1.11 [95%CI 1.09-1.13]). In terms of ARDs, women with SUI or POP had the greatest risk of developing rheumatoid arthritis (mesh HR 1.28 [95%CI 1.21-1.34]; non-mesh HR 1.32 [95%CI 1.24-1.39]; no surgery HR 1.14 [95%CI 1.11-1.17]) and seronegative spondyloarthropathies (mesh HR 1.36 [95%CI 1.24-1.48]; non-mesh HR 1.23 [95%CI 1.11-1.36]; no surgery HR 1.19 [95%CI 1.12-1.25]). CONCLUSIONS: SUI and POP are associated with an increased risk of ARD irrespective of management approach. Risk factors for SUI and POP may account for the increased risk of ARD; however, further work is required to clarify this novel finding. Source of Funding: N/A © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e441-e441 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Humberto Vigil* More articles by this author Rano Matta More articles by this author Arielle Mendel More articles by this author Lesley Carr More articles by this author Sender Herschorn 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 | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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".