Higher Retreatment Rate Research Articles

Efficacy of Tailored Treatment Strategies for Chronic Subdural Hematoma Based on Hematoma Characteristics and Volume: A Retrospective Observational Study

We assessed the effectiveness of a treatment strategy based on hematoma characteristics and volume. From September 2022 to December 2023 (the Study period), a 2-center retrospective observational study of initial chronic subdural hematoma was performed. The baseline period was from January 2018 to December 2019. Patients were classified into the high and low retreatment rate groups (Groups H and L, respectively). During the Study period, Group H was treated with drainage and middle meningeal artery embolization, while Group L was treated with drainage or middle meningeal artery embolization alone. During the Baseline period, all the patients were treated with drainage alone. The primary and secondary endpoints were group retreatment rates and severe procedure-related complications requiring surgical intervention and permanent sequelae, respectively. Fifty-two patients were included during the Study period (31 in Group H and 21 in Group L) and 53 during the Baseline period (32 in Group H and 21 in Group L). Three (5.8%) and 9 (17.0%) patients required retreatment in the Study and Baseline periods, respectively (P= 0.12). One (3.2%) and 9 (28.1%) patients in Group H required retreatment during the Study and Baseline periods, respectively (P= 0.01). Similarly, 2 patients (9.5%) and no patient in Group L required retreatment during the Study and Baseline periods, respectively (P= 0.49). No severe complications were reported throughout. Chronic subdural hematoma treatment strategies that consider to hematoma volume and characteristics have the potential to identify and reduce treatment rates in cases with high retreatment rates.

Treatment of large intracranial aneurysms using the Woven EndoBridge (WEB): a propensity score-matched analysis

The Woven EndoBridge (WEB) device is primarily used for treating wide-neck intracranial bifurcation aneurysms under 10 mm. Limited data exists on its efficacy for large aneurysms. We aim to assess angiographic and clinical outcomes of the WEB device in treating large versus small aneurysms. We conducted a retrospective review of the WorldWide WEB Consortium database, from 2011 to 2022, across 30 academic institutions globally. Propensity score matching (PSM) was employed to compare small and large aneurysms on baseline characteristics. A total of 898 patients were included. There was no significant difference observed in clinical presentations, smoking status, pretreatment mRS, presence of multiple aneurysms, bifurcation location, or prior treatment between the two groups. After PSM, 302 matched pairs showed significantly lower last follow-up adequate occlusion rates (81% vs 90%, p = 0.006) and higher retreatment rates (12% vs 3.6%, p < 0.001) in the large aneurysm group. These findings may inform treatment decisions and patient counseling. Future studies are needed to further explore this area.

Residual Stone Fragments after Percutaneous Nephrolithotomy: Shockwave Lithotripsy vs Retrograde Intrarenal Surgery

Abstract Background Post-PCNL treatment for 0.5-1.5 cm calculi is contentious. SWL has noninvasiveness, less anaesthetic, and improved subjective acceptability, but a lower stone-free rate and higher retreatment rate (RR). Retrograde intrarenal surgery (RIRS) is increasingly employed to treat after PCNL residual calculi with a greater success rate (SR), but with disadvantages of invasiveness and anaesthesia. Aim To compare the outcomes of retrograde intrarenal surgery (RIRS) to extracorporeal shockwave lithotripsy (SWL) for treating patients with RSFs after a previous standard PCNL. Subject and Methods A retrospective study of 70 adult patients with residual stone fragments after a standard PCNL submitted to RIRS or SWL (35 patients per each group) in ain shams university hospitals and police hospitals. Results There no significant difference between the groups regarding ASA, PCNL Guy’s classification, percutaneous tracts, stone composition and postoperative complications. There a significant difference between the groups regarding inferior calyx located stone and postoperative hospital stay. &amp;gt;2 mm stones were significantly more frequent in SWL group compared to RIRS group. Conclusion From the findings of this study we can conclude that RIRS has better SFR for the treatment of RSFs after standard PCNL

693 Treatment Differences of Ruptured Versus Unruptured Wide Neck Aneurysms: Insights From the EVERRUN Registry

INTRODUCTION: Wide neck aneurysms (WNAs) are more challenging to treat compared to narrow neck aneurysms, requiring more advanced techniques. The Wide Neck / EVERRUN Registry compared endovascular versus microsurgical techniques for unruptured and ruptured aneurysms. METHODS: Saccular and not previously treated WNA were examined. WNA definition was aneurysm neck=4mm or dome-to-neck-ratio (DTNR)&lt;2. Differences in treatment strategy (EVT vs. MS) and angiographic results were the primary outcomes. Angiographic outcome was assessed immediately following treatment and at last follow-up using the Raymond-Roy scale (core lab review, adequate occlusion: RR 1-2). Statistical significance set at p&lt;0.05. All analysis performed using R(v.4.2.1). RESULTS: 310 WNA were included (87 ruptured (R) aneurysms vs. 223 unruptured (U)). There were no significant differences in the rate of EVT vs. MS between ruptured (R) vs. unruptured (U) aneurysms (Clipping, R: 36.8%, U: 37.7%). Amongst EVT, ruptured WNA were treated more with stand-alone coiling (R: 27.6%, U: 5.8%) and balloon-assisted coiling (R: 32.2%, U: 10.8%). Unruptured aneurysms were more commonly treated with flow diversion (R: 1.1%, U: 22.9%) and stent-assisted coiling (R: 2.3%, U: 21.5%) (p &lt; 0.05 for all). Ruptured aneurysms had higher rates of adequate angiographic occlusion after initial treatment (R: 88.5%, U: 74.3%) (p &lt; 0.05). There was no difference in final adequate occlusion at follow-up (R: 90.1%, U: 90.7%). Ruptured WNA had higher retreatment rates (R: 14.3%, U: 3.1%) (p &lt; 0.05). Ruptured WNA had more procedural complications (R: 28.7%, U: 17%) (p &lt; 0.05). Rates of good mRS (0-2) at one year were higher in unruptured WNA patients (R: 72.8%, U: 90.3%) (p &lt; 0.05). CONCLUSIONS: WNA rupture status significantly influences the EVT choice, likely based on the need for DAPT. The lower initial adequate occlusion in the unruptured cohort is likely due to more flow diverter use. Ruptured WNAs were more difficult to treat as evidenced by higher rates of retreatment and procedural complications, however this did not impact the final angiographic outcomes.

The impact of regular aspirin use on aneurysm recanalization rates after endovascular coiling.

Intracranial aneurysms (IAs) pose a significant health risk, often leading to subarachnoid hemorrhage and severe neurological outcomes. Endovascular coiling has been a principal treatment method, but it comes with the challenge of high recanalization rates. Aspirin has recently emerged as a potential agent to reduce these rates. In this study, the authors aimed to investigate the impact of regular aspirin use on aneurysm recanalization rates following endovascular coiling in a 10-year single-institution study. A retrospective analysis was conducted on a dataset of 2236 aneurysms treated by a single neurosurgeon over a period of 10 years. The primary outcome measure was aneurysm recanalization, defined by a change in the Raymond-Roy Occlusion Classification of at least one grade. A total of 525 aneurysms were coiled, 109 of which involved patients who reported regular use of aspirin. The recanalization rate was significantly lower in the aspirin group (9.2%) compared with the control group (23.6%) (OR 0.33, 95% CI 0.15-0.66; p = 0.001). On analysis of the specific mechanisms of recanalization, aneurysm sac growth was less frequent in the aspirin group (5.5%) compared with the control group (18%) (OR 0.265, 95% CI 0.09-0.63; p = 0.002). Additionally, patients in the control group had a higher retreatment rate (18%) than patients in the aspirin group (5.5%) (OR 0.265, 95% CI 0.09-0.63; p = 0.002). Regular use of aspirin appears to be associated with reduced rates of aneurysm recanalization after endovascular coiling. However, caution is advised in interpretation of these results given the retrospective nature of this study. Further randomized controlled trials are needed to confirm these findings.

The impact of postoperative aspirin in patients undergoing Woven EndoBridge: a multicenter, institutional, propensity score-matched analysis

BackgroundThe Woven EndoBridge (WEB) device is frequently used for the treatment of intracranial aneurysms. Postoperative management, including the use of aspirin, varies among clinicians and institutions, but its impact on...

Aspects of co-infection with viral hepatitis in tuberculosis patients

This study focuses on the impact of viral hepatitis (VH) co-infection on patients with tuberculosis (TB), specifically regarding liver impairment and treatment outcomes. The research is a descriptive, retrospective analysis of patients diagnosed with pulmonary TB and VH, who were hospitalized for treatment from 2019 to 2021. A comparison was made between the parameters of the study group (91 patients with pulmonary TB and VH) and the control group (113 patients with pulmonary TB but no VH). The odds ratio (OR) was calculated to determine the probability of developing TB in the presence of risk factors, with a 95% confidence interval (CI) used to assess precision. Data analysis was performed using Microsoft Office 2007 Excel. The study revealed a significant predominance of males in patients with pulmonary TB and VH, with the most common age range being between 30 and 50 years. Infiltrative pulmonary TB was the most frequent diagnosis, and microbiological confirmation of TB remained a challenge. The occurrence of complications was notably high in patients with pulmonary TB and VH. The study also observed a high rate of retreatment and cases of death among patients with TB and VH as treatment outcomes. Overall, the research provides valuable insights into the severity, progression, and treatment response of TB patients with co-existing viral hepatitis.

Divergent glacier area and elevation changes across the Tibetan Plateau in the early 21st century

With accelerated warming, mountain glaciers in most parts of the world have been in a state of continuous retreat in recent decades. Assessing glacier change and analyzing its influencing factors are essential for developing climate change mitigation and adaptation measures for a given region. This study provides a spatially explicit assessment and quantification of glacier changes in the early 21st century on the Tibetan Plateau (TP) at individual glacier and basin scales. We established a one-to-one correspondence between the Second Chinese Glacier Inventory (CGI-2, collected from 2004 to 2011) and a dataset of glacier inventory in Western China during 2017–2018 (CGI-2018). The majority of TP’s glaciers decreased in size with a mean area retreat rate during the investigated period of 4.1%/decade. In addition, a mean change of the median elevation of the glaciers of 6.7 m/decade was detected. Approximately 2.5% of the total number of glaciers mapped in CGI-2 disappeared, while 681 of them divided to 1758 glaciers as they retreated. The observed variations follow local trends and have different regional characteristics. Generally, the glaciers with the lowest retreat rates are found in the Karakorum and Kunlun Mountains, while those with high retreat rates are concentrated along the Gangdis and Tangula ranges. The observed changes in glaciers are mainly attributed to a significant increase in temperature. Other factors including glacier size, debris cover, orientation and mean elevation also contribute to the heterogeneity of glacier variability. This study provides for the first time a detailed spatially explicit analysis of the glacial changes on the TP in the early 21st century, substantially improving the understanding of glacier response patterns and supporting more sustainable utilization of regional water resources in the TP in the context of climate warming in the 21st century.

Incidence and risk factors of unplanned retreatment following dental general anesthesia in children with severe early childhood caries.

This study aimed to retrospectively describe the unplanned retreatment of dental general anesthesia (DGA) in children with severe early childhood caries (S-ECC) and explore potential factors that may influence the outcome of DGA treatment. Medical records of children with S-ECC who received DGA treatment were screened, and necessary data were extracted. The Kaplan-Meier method and Cox proportional hazards model were used to estimate the DGA survival rate and explore the potential factors affecting the success rate of DGA treatment. Medical records of 852 children were included; 509 (59.7%) children with 1,212 (10.7%) teeth underwent unplanned retreatment. Restoration failure (30.12%) and new caries (29.46%) accounted for the most significant proportion of all failures. The median survival times were 510 and 1,911 days at the child and tooth levels, respectively. Unplanned retreatment risk was associated with the age of S-ECC children, frequency of follow-up, and fluoride application (hazard ratio = 0.97, 0.78, 0.69, P < 0.001). The treatment outcome of DGA administered to children with S-ECC was satisfactory at the tooth level from the perspective of the incidence of unplanned retreatment. Restoration failure was the main reason for the high unplanned retreatment rate. Strategies for a better outcome of DGA include improving the professional knowledge and skills of pediatric dentists and enhancing compliance of parents/patients. Health education and regular topical fluoride application may improve the success rate of DGA treatment.

Extracorporeal shock wave lithotripsy for treatment of large pediatric renal pelvic stone burden more than 2 cm

The high recurrence rates in pediatric urolithiasis indicate the need for none invasive or a minimally invasive treatment such as SWL. Therefore, EAU, ESPU and AUA recommend SWL as a first line treatment for renal calculi ≤ 2, and RIRS or PCNL for renal calculi > 2cm. SWL is superior to RIRS and PCNL as it is inexpensive, outpatient procedure, and it has a high SFR in well selected cases specially pediatrics. On the other hand, SWL therapy has a limited efficacy with a lower SFR, and high retreatment rate and/or additional interventions for treatment of larger and harder renal calculi. We carried out this study to evaluate the efficacy and safety of SWL for treatment of renal stones > 2cm to extend its indications for pediatric renal calculi. Between January 2016 and April 2022, we reviewed the records of patients with renal calculi treated by SWL, mini-PCNL, RIRS and open surgery in our institution. Forty-nine eligible children aged 1-5 years old, presented with renal pelvic and/or calyceal calculi measuring 2-3.9cm and underwent SWL therapy were picked up and participated in the study. The data of an additional eligible 79 children with the same age and had renal pelvic and/or calyceal calculi > 2cm up to stag horn calculi and underwent mini-PCNL, RIRS and open renal surgery were also picked up and participated in the study. We retrieved the following preoperative data from the records of the eligible patients; age, gender, weight, length, radiological findings (stone size, side, site, number and radio-density), renal function tests, routine laboratory findings, and urine analysis. The outcomes data in the form of; operative time, fluoroscopy time, hospital stay, SFRs, retreatment rates and complication rates were also retrieved from the records of patients treated with SWL and other techniques. Also, we collected the SWL characteristics in terms of; position, number and frequency of shocks, voltage, time of the session and U/S monitoring to assess stone fragmentation. All SWL procedures were performed according to the institution's standards. The mean age of patients treated with SWL was 3.23±1.19 years old, the mean size of the treated calculi was 2.31±0.49 and the mean length of the SSD was 8.2±1.4cm. All patients had NCCT scan and the mean radio-density of the treated calculi was 572 ± 169.08 HUs based on NCCT scans Table (1). Single- and two-session SFRs of SWL therapy were 75.5% (37/49 patients) and 93.9% (46/49 patients), respectively. The overall success rate was 95.9% (47/49 patients) after three-session of SWL. Complications experienced by 7 patients (14.3%) in the form of fever (4.1%), vomiting (4.1%), abdominal pain (4/1%), and hematuria (2%). All complications were managed in outpatient settings. Our results were obtained on the basis of preoperative NCCT scans for all patients and postoperative plain KUB films and real-time abdominal U/S. Furthermore, single-session SFRs for SWL, mini-PCNL, RIRS and open surgery were 75.5%, 82.1%, 73.7% and 90.6%, respectively. Two-session SFRs by the same technique were 93.9%, 92.8%, and 89.5% for SWL, mini-PCNL and RIRS, respectively. A lower overall complication rate and higher overall SFR were found with SWL therapy compared to other techniques, Fig. (1). Being a non-invasive outpatient procedure with a low complication rate and good spontaneous passage of stone fragments is the main advantage of SWL. In this study, the overall SFR is 93.9% where 46 out of 49 patients were completely rendered stone free after three session of SWL with overall success rate 95.9%. Badawy etal. reported overall success rates of 83.4% for renal stones with a mean stone size of 12.5±7.2mm. In children with renal stones measuring 18.2mm, Ramakrishnan etal. reported a 97% SFR in accordance with our results. The high overall success rate (95.9%) and SFR (93.9%) in our research were attributed to the regular use of ramping procedure, low shock wave rate, percussion diuretics inversion (PDI) approach and alpha blocker therapy in all participants and short SSD. The limitations of our study are small sample of patients and its retrospective nature. The non-invasive nature and replicability of the SWL procedure, along with the high success and low complication rates, give us a new insight to consider its application for treating pediatric renal calculi > 2cm over the other more invasive techniques. Short SSD, the use of ramping procedure, low shock wave rate, 2min break, PDI approach and alpha blockers therapy help better success of SWL. IV.

Vesicourethral Anastomotic Stenosis Following Radical prostatectomy: Risk Factors, Natural History, and Treatment Outcomes.

Vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy (RP) is a complication with significant adverse quality of life implications. Herein, we identify groups at risk for VUAS and further characterize natural history and treatment patterns. Years 1987-2013 of a prospectively maintained RP registry were queried for patients with the diagnosis of VUAS, defined as symptomatic and inability to pass a 17Fr cystoscope. Patients with follow up less than 1-year, preoperative anterior urethral stricture, transurethral resection of prostate, prior pelvic radiotherapy, and metastatic disease were excluded. Logistic regression was performed to identify predictors of VUAS. Functional outcomes were characterized. Out of 17,904 men, 851 (4.8%) developed VUAS at a median 3.4 months. Multivariable logistic regression identified associations with VUAS including adjuvant radiation, BMI, prostate volume, urine leak, blood transfusion, and non-nerve sparing techniques. Robotic approach (OR 0.39, P < .01) and complete nerve sparing (OR 0.63, P < .01) were associated with reduced VUAS formation. VUAS was independently associated with 1 or more incontinence pads/day at 1 year (OR 1.76, P < .001). Of the patients treated for VUAS, 82% underwent endoscopic dilation. The 1- and 5-year VUAS retreatment rates were 34% and 42%, respectively. Patient related factors, surgical technique, and perioperative morbidity influence the risk of VUAS after RP. Ultimately, VUAS is independently associated with increased risk of urinary incontinence. Endoscopic management is temporizing for most men with a high rate of retreatment by 5 years.

Rapid, buoyancy-driven ice-sheet retreat of hundreds of metres per day.

Rates of ice-sheet grounding-line retreat can be quantified from the spacing of corrugation ridges on deglaciated regions of the seafloor1,2, providing a long-term context for the approximately 50-year satellite record of ice-sheet change3-5. However, the few existing examples of these landforms are restricted to small areas of the seafloor, limiting our understanding of future rates of grounding-line retreat and, hence, sea-level rise. Here we use bathymetric data to map more than 7,600 corrugation ridges across 30,000 km2 of the mid-Norwegian shelf. The spacing of the ridges shows that pulses of rapid grounding-line retreat, at rates ranging from 55 to 610 m day-1, occurred across low-gradient (±1°) ice-sheet beds during the last deglaciation. These values far exceed all previously reported rates of grounding-line retreat across the satellite3,4,6,7 and marine-geological1,2 records. The highest retreat rates were measured across the flattest areas of the former bed, suggesting that near-instantaneous ice-sheet ungrounding and retreat can occur where the grounding line approaches full buoyancy. Hydrostatic principles show that pulses of similarly rapid grounding-line retreat could occur across low-gradient Antarctic ice-sheet beds even under present-day climatic forcing. Ultimately, our results highlight the often-overlooked vulnerability of flat-bedded areas of ice sheets to pulses of extremely rapid, buoyancy-driven retreat.

MP78-08 OUTCOMES OF URETHROPLASTY FOR SYNCHRONOUS ANTERIOR URETHRAL STRICTURE

You have accessJournal of UrologyCME1 Apr 2023MP78-08 OUTCOMES OF URETHROPLASTY FOR SYNCHRONOUS ANTERIOR URETHRAL STRICTURE Marcus Jamil, Alexandra Hansma, Nejd Alsikafi, Benjamin Breyer, Joshua Broghammer, Jill Buckley, Sean Elliott, Bradley Erickson, Jeremy Meyers, Andrew Peterson, Keith Rourke, Thomas Smith, Bryan Voelzke, Lee Zhao, and Alex Vanni Marcus JamilMarcus Jamil More articles by this author , Alexandra HansmaAlexandra Hansma More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Jill BuckleyJill Buckley More articles by this author , Sean ElliottSean Elliott More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Jeremy MeyersJeremy Meyers More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Keith RourkeKeith Rourke More articles by this author , Thomas SmithThomas Smith More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , Lee ZhaoLee Zhao More articles by this author , and Alex VanniAlex Vanni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of male anterior urethral stricture disease (USD) has been well described. Less is known regarding the management strategies and outcomes in patients with synchronous USD (SUSD). SUSD is the presence of two distinct urethral strictures separated by a healthy intervening urethral segment. This study sought to assess the functional outcomes following repair of SUSD. METHODS: Patients with documented SUSD within a multi-institutional database were retrospectively assessed and compared to patients with solitary USD. Patients who underwent single-stage or staged anterior urethroplasty, including meatoplasty and perineal urethrostomy were included. Patients with a posterior urethral stricture or bladder neck involvement were excluded. Stricture classification according to the LSE (Length, Urethral Segment, Etiology) was performed. Stricture recurrence between cohorts was assessed, defined as undergoing repeat treatment. Logistic regression was performed to assess predictors of failure. RESULTS: 168 of the 2,299 patients had SUSD (7.3%). Patients with SUSD had a significantly shorter mean primary stricture length than those with solitary USD, 3.6 cm vs. 4.7 cm, p<0.001. Mean stricture length for the secondary stricture was 2.6 cm. Patients with SUSD had a larger proportion of strictures classified as S2b, S2c and S2d than in those with solitary USD (p<0.001). Patients with SUSD were more likely to be due to Lichen Sclerosus (LS) or hypospadias (Table 1). On univariate analysis, SUSD had a higher stricture retreatment rate, 8.0% vs. 13.1%, p=0.02. On multivariable analysis, SUSD was not associated with higher retreatment rates, OR 1.37 (0.79–2.28), p=0.2. Patients with SUSD and stage S1a, S1b, S2c, S2d and S3 stricture location demonstrated higher rates of stricture recurrence than controls (Table 2). CONCLUSIONS: Patients with SUSD have higher rates of stricture recurrence following urethroplasty compared to patients with solitary USD on univariate analysis. Patients with LS and hypospadias are more likely to have SUSD. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1134 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcus Jamil More articles by this author Alexandra Hansma More articles by this author Nejd Alsikafi More articles by this author Benjamin Breyer More articles by this author Joshua Broghammer More articles by this author Jill Buckley More articles by this author Sean Elliott More articles by this author Bradley Erickson More articles by this author Jeremy Meyers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Bryan Voelzke More articles by this author Lee Zhao More articles by this author Alex Vanni More articles by this author Expand All Advertisement PDF downloadLoading ...

Prostatic Artery Embolization (PAE) - Endo-vascular Treatment of Lower Urinary Tract Symptoms Presumed Secondary to Benign Prostatic Obstruction

Prostatic Artery Embolization (PAE) - Endo-vascular Treatment of Lower Urinary Tract Symptoms Presumed Secondary to Benign Prostatic Obstruction Abstract: Based on the available evidence on efficacy and safety in the short to midterm, Prostatic Artery Embolization (PAE) is now endorsed by international evidence-based guidelines as a treatment of lower urinary tract symptoms presumed secondary to benign prostatic obstruction (LUTS/BPO) for selected patients. As PAE has a unique treatment approach (i.e., endovascular instead of transurethral), its profile and ideal application differ clearly from other treatments of LUTS/BPO, which must be considered for patient selection. Performance in local anesthesia with ongoing anticoagulation and no upper prostate size limitation represent advantages of the technique. Limited availability, an inferior relief of obstruction associated with higher retreatment rates and inferior outcomes in small prostates represent disadvantages. This should be considered for patient selection and counselling.

NEURODEVELOPMENTAL OUTCOMES AFTER ANTI-VEGF TREATMENT FOR RETINOPATHY OF PREMATURITY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction: The objective of this study was to assess the neurodevelopmental outcomes in preterm infants who have undergone intravitreal anti-vascular endothelial growth factor (anti-VEGF), either as monotherapy or in combination with laser therapy, for treatment of retinopathy of prematurity (ROP). Secondary, efficacy of anti-VEGF was also evaluated.&#x0D; Methods: Literature search was conducted using 7 online databases (CENTRAL, PubMed, ScienceDirect, SCOPUS, EBSCO, ProQuest, and JSTOR). Studies were selected based on the established inclusion and exclusion criteria. Primary outcomes were neurodevelopmental impairment (NDI), severe NDI (sNDI), neurodevelopmental scores, and cerebral palsy (CP) incidence. Secondary outcomes included impairment and severe impairment of each domain (motor, cognitive, and language) and retreatment of ROP.&#x0D; Result: Seventeen studies were included. Random-effects model meta-analysis showed no differences were observed between anti-VEGF compared to control group in NDI (unadjusted odds ratio (uOR) 1.28; 95% confidence interval (CI) 0.85 to 1.94), sNDI (uOR 1.33; 95% CI 0.92 to 1.93), and CP outcomes . Meta-analysis showed insignificant result with lower overall scores, motor, cognitive, and language domains associated with anti-VEGF treatment. Secondary outcomes showed inferior cognitive impairment (OR 1.41; 95% CI: 1.03 to 1.92) and higher retreatment rate (OR 47.55; 95% CI: 12.35 to 183.09) in anti-VEGF group.&#x0D; Conclusion: There were no differences in neurodevelopmental outcomes between anti-VEGF and control group. Despite not causing any adverse neurodevelopmental effect, clinicians should carefully weigh the benefits and risks of anti-VEGF injection for treating infants with ROP, since it has higher retreatment rate.

Treatment Patterns and Patient Outcomes in Relapsed/Refractory Multiple Myeloma (RRMM) Stratified By Exposure to Lenalidomide or Anti-CD38 Therapy and Double-Class Refractory Status: A Retrospective Electronic Health Record Database Study

Introduction: While new treatments have been introduced for multiple myeloma, patients typically experience repeated relapses and progress through complex treatment pathways involving multiple lines of treatment (LOT). It remains unclear to what extent novel therapies are being utilized in treatment regimens for patients with RRMM. This study assessed treatment patterns and outcomes in patients with RRMM to better understand the current treatment landscape, unmet needs, and challenges in real-world clinical settings. Methods: This longitudinal retrospective cohort study utilized the COTA de-identified database, which contains data from curated electronic health records of partnered US healthcare centers (index date Nov 16, 2015 to Apr 15, 2022). Study investigators identified adult patients with active RRMM who had received ≥1 prior LOT. In addition, subcohorts were created based on patients' prior exposure and refractory status: 1) prior exposure to lenalidomide (LEN-E); 2) refractory to both a proteasome inhibitor (PI) and an immunomodulatory therapy (double-class refractory [DCR]); 3) prior exposure to an anti-CD38 agent (daratumumab or isatuximab; CD38-E); 4) no prior exposure to an anti-CD38 agent (CD38-N). Demographics, clinical characteristics, and treatment patterns were analyzed descriptively. Time-to-event outcomes including (but not limited to) progression-free survival (PFS), duration of therapy (DOT), and time to next therapy (TTNT) were evaluated with Kaplan-Meier survival analysis. Results: In total, 1368 patients with ≥1 prior LOT were identified in the overall 2L+ population, comprising 4 overlapping subcohorts: LEN-E: 1305, DCR: 649, CD38-E: 717, CD38-N: 963; 57% were treated in an academic setting. Median age at index was 66.5 (range 27.7-96.2) yrs and 55% were male; baseline characteristics were similar across cohorts (Table). Mean time from diagnosis to index LOT was 18.5 mo (SD: 27.0). Prior to index LOT, 19.9% of patients received autologous stem cell therapy, and 25.7% of those with known ISS staging (n=997) had stage 3 disease; 43.9% had ≥1 high-risk cytogenetic features. In the overall 2L+ population at index LOT, the most common therapies were treatment regimens containing anti-CD38 agents (monotherapy or combination; 20.8%), other PI/immunomodulatory combinations (13.2%), triplets containing carfilzomib and dexamethasone (DEX) (12.9%), triplet therapy with bortezomib (BOR)/LEN/DEX (12.4%), and stem cell transplant (12.4%). In general, at later LOTs, there was a decline in use of doublets (2L: 17.0%, 3L: 13.6%, 4L: 9.6%; 5L: 11.1%) and triplets (2L: 29.3%, 3L: 15.0%, 4L: 15.4%, 5L: 11.8%), while a greater proportion of patients received anti-CD38 agents (3L: 39.5%, 4L: 42.9%, 5L: 43.9%). Treatment sequences varied greatly across cohorts. Following index LOT, 63.5% of 2L+ patients began a subsequent LOT (LOT+1). Across the subcohorts, rates of beginning LOT+1 ranged from 57.3% (CD38-E) to 69.8% (DCR) (Table 1). Given their prior exposure to anti-CD38 therapy prior to index LOT, a notably high proportion of patients in the CD38-E cohort (N=717) received an anti-CD38 agent at index LOT (49.8%), LOT+1 (28.2%), and/or LOT+2 (18.1%). Overall, median DOT was short across overall 2L+ patients and sub-cohorts, and generally remained constant across LOTs (Figure). Median PFS and TTNT varied between cohorts, with shorter durations in DCR and CD38-E cohorts. In the CD38-E patients, TTNT and PFS declined markedly across patients indexed on increasing LOTs from 2L to 6L+ (TTNT: 19.7 mo to 6.3 mo; PFS: 19.2 mo to 5.3 mo), with similar patterns seen in the LEN-E and DCR cohorts. Conclusions: Despite development of novel therapies for MM, patients continue to receive recycled therapies at later LOTs, as demonstrated by the high rate of retreatment with prior therapies, including anti-CD38 agents. Standard of care varies by LOT and prior treatment exposure or refractory status, with no dominant regimens across cohorts. TTNT and PFS remain suboptimal across all cohorts, especially in later LOTs. These findings support the need for increased uptake of new treatments with novel mechanisms of action earlier in the patient journey, including at first relapse. This approach may provide a broader range of treatment regimens and offer additional benefits to patients with RRMM. Funding: GSK (217353) Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Incremental Healthcare Cost Implications of Retreatment Following Ureteroscopy or Percutaneous Nephrolithotomy for Upper Urinary Tract Stones: A Population-Based Study of Commercially-Insured US Adults.

This study describes the incremental healthcare costs associated with retreatment among adults undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for upper urinary tract stones (UUTS). The IBM® MarketScan® Commercial Database was used to identify adults aged 18-64 years with UUTS treated with URS or PCNL between January 2010 and December 2019. Patients had 12 months of continuous insurance coverage before (baseline) and after (follow-up) the first (index) procedure. The primary outcome was total all-cause healthcare costs measured over the 365-day follow-up period, not inclusive of index costs. Generalized linear models were used to estimate the incremental costs associated with retreatment within 90 (early) or 91-365 days post-index (later) relative no retreatment. The models adjusted for demographics, comorbidities, stone(s) location, treatment setting, procedural characteristics (eg, 1-step vs 2-step PCNL) and index year. Approximately 23% (27,402/119,800) of URS patients were retreated (82% had early retreatments). The adjusted mean total cost was $10,478 (95% CI: $10,281-$10,675) for patients with no retreatment, $25,476 (95% CI: $24,947-$26,004) for early retreatment ($14,998 incremental increase, p<0.01), and $32,868 [95% CI: $31,887-$33,850] for later retreatment ($22,391 incremental increase, p<0.01). Approximately 36% (1957/5516) of PCNL patients were retreated (78% had early retreatments). The adjusted mean total cost was $13,446 (95% CI: $12,659-$14,273) for patients with no retreatment, $37,036 [95% CI: $34,926-$39,145]) for early retreatment ($23,570 incremental increase, p<0.01), and $35,359 (95% CI: $32,234-$38,484) for later retreatment ($21,893 incremental increase, p<0.01). Retreatment during the first year following URS or PCNL was needed in 23% and 36% of patients, respectively, and was associated with an economic burden of up to $23,500 per patient. The high rate of retreatment and associated costs demonstrate there is an unmet need to improve mid- to long-term results in URS and PCNL.

Rapid coastal erosion of ice-bonded deposits on Pelly Island, southeastern Beaufort Sea, Inuvialuit Settlement Region, western Canadian Arctic

This paper quantifies rates of shoreline change and investigates the influence of surficial geology on shoreline dynamics between 1950 and 2018 on Pelly Island, located 10 km off the Mackenzie Delta. Long-term changes in shoreline position were calculated using imagery analysis and Analysing Moving Boundaries Using R (AMBUR). The influence of shoreline exposure to predominant storm direction and influence of surficial geology were examined for northwestern and southeastern zones. The average annual linear regression rate (LRR) rate during the 1950–2018 observation period was −3.8 m·a−1. The end point rate (EPR) was calculated for seven observation periods: 1950–1972, 1972–1985, 1985–2000, 2000–2018, 2000–2013, 2013–2018, and 1950–2018. A mean EPR of −5.5 ± 0.7 m·a−1 was calculated for the 2000–2018 period, and a maximum retreat rate of 46.7 ± 2.1 m·a−1 was recorded during the 2013–2018 observation period. By comparing the rate of change for sections of historical shorelines with differing surficial geology and exposure to storms, it was possible to draw conclusions on why Pelly Island continues to have the highest retreat rates in the Mackenzie–Beaufort region. Greater retreat rates were observed in lacustrine deposits (5.3 m·a−1) compared with moraine deposits (2.7 m·a−1). In addition, shoreline exposure to the predominant storm direction from the northwest was found to be a major influence on rates of shoreline change in all observation periods.

The pCONUS2 and pCONUS2 HPC Neck Bridging Devices

IntroductionBifurcation aneurysms represent an ongoing endovascular challenge with a variety of techniques and devices designed to address them. We present our multicenter series of the pCONUS2 and pCONUS2 HPC devices when treating bifurcation aneurysms.MethodsWe performed a retrospective review of our prospectively maintained databases at 3 tertiary neurointerventional centers to identify all patients who underwent coil embolization with the pCONUS2 or pCONUS2 HPC device between February 2015 and August 2021. We recorded baseline demographics, aneurysm data, complications, immediate and delayed angiographic results.ResultsWe identified 55 patients with 56 aneurysms, median age 63 years (range 42–78 years), 67.3% female (n = 37). The commonest aneurysm location was the MCA bifurcation (n = 40, 71.4%). Average dome height was 8.9 ± 4.2 mm (range 3.2–21.5 mm), average neck width 6.4 ± 2.5 mm (range 2.6–14 mm), and average aspect ratio 1.3 ± 0.6 (range 0.5–3.3). The pCONUS2 was used in 64.3% and the pCONUS2 HPC in 35.7%. The procedural technical success rate was 98.2%. Intraoperative complications occurred in 5 cases (8.9%), 4 of which were related to the coils with partial thrombus formation on the pCONUS2 HPC seen in 1 case that was resolved with heparin. In relation to the procedure and treatment of the aneurysm the overall permanent morbidity was 1.8% (n = 1/55) and mortality 0%. Delayed angiographic follow-up (48 aneurysms) at median 12 months postprocedure (range 3–36 months) demonstrated adequate occlusion of 83.4% of aneurysms.ConclusionThe pCONUS2 and pCONUS2 HPC devices carry a high technical success rate, low complication and retreatment rate, and good rates of adequate occlusion. Larger prospective confirmatory studies are required.

The Efficacy of Flexible Ureterorenoscopy Compared with Extracorporeal Shock Wave Lithotripsy for &lt;20 mm Renal Stone: A Systematic Review and Meta-Analysis

ABSTRACT Introduction: Renal stone is a common urological problem that has increased over the years. Extracorporeal shock wave lithotripsy (ESWL) is a noninvasive treatment for patients with &lt;20 mm renal stones, but it also has a lower stone-free rate (SFR) and a higher re-treatment rate (RR) compared to other modalities. On the other hand, flexible ureterorenoscopy (F-URS) can be used to manage larger renal stones and is associated with higher SFR. Thus, we created this study to assess the efficacy and safety of F-URS versus ESWL for patients with &lt;20 mm renal stones. Methods: This systematic review and meta-analysis study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline and used PICO analysis to systematically search the included studies from several databases, such as PubMed and ScienceDirect. Sixteen relevant studies were included for qualitative and quantitative analysis. Cochrane risk-of-bias tool for randomized trials (RoB) 2.0 was used as bias analysis for RCT studies and the Newcastle-Ottawa Scale for observational studies. Results: A total of 2487 patients were included in this study. The SFR was significantly higher in the F-URS group (P &lt; 0.00001), while the auxiliary procedure was significantly higher in the ESWL group (P &lt; 0.00001). However, neither significant difference was observed in the mean operative time, RR Clavien–Dindo classification, and complication rate-based symptom outcomes in both the groups. Conclusion: F-URS and ESWL are safe and effective in treating &lt;20 mm renal stones. In terms of SFR, F-URS is superior compared to ESWL. However, a lower complication rate was observed in ESWL.