Outcomes In Female Patients Research Articles

Interdisciplinary Surgical Approaches in Vaginal and Perineal Reconstruction of Advanced Rectal and Anal Female Cancer Patients.

Relapsing or far advanced rectal and anal cancers remain difficult to treat and require interdisciplinary approaches. Due to modern standard protocols all patients receive irradiation and neoadjuvant chemotherapy—and in case of a relapse a second irradiation—rendering the surgical site prone to surgical site infections and oftentimes long lasting sinus and septic complications after exenteration in the pelvis. Despite an improved overall survival rate in these patients the downside of radical tumor surgery in the pelvis is a major loss of quality of life, especially in women when parts of the vagina need to be resected. Derived from our experince with over 300 patients receiving pelvic and perineal reconstruciton with a transpelvic vertical rectus abdominis myocutaneous (tpVRAM) flap we studied the impact of this surgical technique on the outcomes of female patients with or without vaginal reconstruction following pelvic exenteration. We found out that the tpVRAM flap is reliably perfused and helps to reduce long term wound healing desasters in the irradiated perineal/vaginal/gluteal region.

MP41-01 EVALUATION OF URINARY CONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN FEMALES USING A VALIDATED QUESTIONNAIRE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-01 EVALUATION OF URINARY CONTINENCE FOLLOWING OPEN RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN FEMALES USING A VALIDATED QUESTIONNAIRE Seyedeh-Sanam Ladi Seyedian*, Wesley Yip, Zhoobin Bateni, Saum Ghodoussipour, Jie Cai, Gus Miranda, Sumeet Bhanvadia, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Seyedeh-Sanam Ladi Seyedian*Seyedeh-Sanam Ladi Seyedian* More articles by this author , Wesley YipWesley Yip More articles by this author , Zhoobin BateniZhoobin Bateni More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Jie CaiJie Cai More articles by this author , Gus MirandaGus Miranda More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (ONB) following radical cystectomy (RC) is less frequent in female patients compared to males, due to unclear functional outcomes. We prospectively evaluated the continence outcomes in female patients undergoing open RC and ONB with a validated pad usage questionnaire. METHODS: From May 2012 onwards, we prospectively followed patients after open RC with ONB with a validated, pictorial, pad usage questionnaire that assesses the number, size, and wetness of pads, as well as catheter use, at follow-up clinic visits. In our IRB approved database, 42 ONB were performed for female patients after open RC from May 2012 to May 2018 (38% of all urinary diversions in female patients). 32 patients had complete data from interval clinic visits with at least 1 year of follow-up. Daytime continence was defined as no pad usage or an almost dry pad. RESULTS: A total of 32 female ONB patients with median age of 65 years (range: 42-81) and BMI of 25.6 (range: 18-35) were included. Median follow-up was 3 years (range: 1-7). The need to catheterize was noted in 10 patients (36%), either due to complete retention (7%), high post-void residuals (25%), or to empty their neobladder prior to sleeping (4%). Neobladder-vaginal fistulae developed in 4 patients (14%), with 1 ultimately converting to a continent cutaneous diversion after failed conservative management and the other 3 undergoing primary repairs. Daytime continence rates with and without intermittent catheterization increased from 64% and 36% at 4 months post-operatively, to 90% and 60% at 4 years, respectively. Nighttime continence rates with and without catheterization increased from 57% and 24% at 4 months, to 90% and 60% at 4 years, respectively (Figure1). Daytime continence rate was significantly less in females compared to males (P=0.024), while there was no significant difference in nighttime continence rate between them (P=0.58). CONCLUSIONS: Open RC and ONB in selected female patients can have good functional outcomes. Day and nighttime continence improve over time and majority of patients achieve continence by 2 years. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e595-e595 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seyedeh-Sanam Ladi Seyedian* More articles by this author Wesley Yip More articles by this author Zhoobin Bateni More articles by this author Saum Ghodoussipour More articles by this author Jie Cai More articles by this author Gus Miranda More articles by this author Sumeet Bhanvadia More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P278: Association of Alcohol Use With Poor Outcomes in Takotsubo Cardiomyopathy

Introduction: Recent studies have demonstrated poor outcomes in patients with takotsubo cardiomyopathy (TCM). It is important to determine the predictors of these outcomes for appropriate risk stratification and to decrease the overall disease burden. Physical stressors and preexisting heart failure have been associated with poorer outcomes, however, the impact of alcohol use (ETOH) has not been discussed. Aim: To determine if underlying alcohol use is associated with poorer outcomes in patients with TCM. Methods: We recruited 6750 patients from 2011, 2012 National Inpatient Sample, 6325 had TCM alone while 425 had TCM and ETOH use. Our outcomes of interest were overall mortality, mechanical hemodynamic support (MHS) acute respiratory failure(ARF), cardiac arrest (SCA), cardiogenic shock, and atrial fibrillation. All clinical characteristics were defined as per the International Classification of Diseases 9th revision (ICD-9) codes. Logistic regression was used to estimate the odds ratio of the outcomes in the study compared to the control group while stratified analysis was used to adjust for age and sex both accounting for underlying comorbidities. Results: There was no significant difference between the two groups in the rates of atrial fibrillation (11.1% vs 10.4%; P= 0.656), cardiogenic shock (6.2% vs 4.7%; P= 0.201), MHS (2.3% vs 1.4%; P= 0.221) and overall mortality (4.1% vs 3.8%; p=0.702). Rates of ARF (29.9%, vs 18.2%; P< 0.0001) and SCA (4.9% vs 3.0%; P=0.025) were higher in patients with TCM+ETOH compared to TCM alone. Table 1 displays the adjusted odds ratios for the outcomes. Compared to the participants with TCM alone, odd ratios of ARF was significantly higher in patients with TCM+ETOH. Table 2 displays the stratified analysis based sex. Compared with TCM alone, female patients with TCM+ETOH are more likely to develop ARF, cardiogenic shock and SCA. Conclusion: Preexisting alcohol use is associated with poorer outcomes in female patients with TCM.

Clinical features, comorbid mental disorders and treatment outcomes in female patients with alcohol and drug use disorder admitted to an outpatient treatment unit: A retrospective study

Clinical features, comorbid mental disorders and treatment outcomes in female patients with alcohol and drug use disorder admitted to an outpatient treatment unit: A retrospective study

Flexible cystoscopy can improve anxiety and subjective feelings of bladder cancer patients during follow-up.

IntroductionThe effect of repeated cystoscopy on bladder cancer (BC) patient anxiety and feelings is rarely evaluated.AimTo compare the difference of patients’ anxiety and subjective feelings caused by different cystoscopes.Material and methodsWe prospectively included 192 BC patients who accepted regular cystoscopy follow-up after transurethral resection of bladder tumor (TURBT): 93 in the flexible group and 99 in the rigid group. The method of anesthesia and the order of examinations were consistent between different groups. We analyzed the anxiety level before cystoscopy, the maximum pain during the examination and the change of lower urinary tract symptoms (LUTS) before and after cystoscopy. Meanwhile, we analyzed the rate of gross hematuria and pyuria after cystoscopy. The anxiety and pain levels were evaluated by the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and visual analogue scale (VAS). LUTS was reflected by the Core Lower Urinary Tract Symptom Score (CLSS). We distinguished gender during analysis.ResultsThe median APAIS score of male patients undergoing flexible or rigid cystoscopy was 8 vs. 12 (p < 0.01), and this result for females was 8 vs. 9 (p = 0.048). The median pain scores for men in the two groups was 1 vs. 2 (p < 0.01), respectively, and this outcome in female patients was 0 vs. 1 (p < 0.01). Patients in the rigid group had more CLSS change (0 vs. 1, p < 0.01). There was no difference in pyuria or gross hematuria rate after examination. Analysis in respective groups showed that men have more severe pain than women, 1 vs. 0 (p = 0.001) in the flexible group and 2 vs. 1 (p = 0.009) in the rigid group.ConclusionsA flexible cystoscope can improve anxiety and subjective feelings of BC patients during cystoscopy follow-up.

Effect of nilotinib on pregnancy outcome in female patients with chronic myeloid leukemia

目的观察尼洛替尼（NIL）治疗期间女性慢性髓性白血病（CML）患者的妊娠结果。方法回顾性收集2015年3月至2019年1月接受NIL治疗期间妊娠的CML患者的治疗情况和生育相关信息。结果11例患者，妊娠时中位年龄28（25～40）岁。妊娠前NIL中位治疗34（3～48）个月。11例患者共妊娠12例次，计划妊娠2例次，意外妊娠10例次（83.3％）。10例次意外妊娠患者，妊娠早期NIL暴露剂量600 mg/d者9例（90.0％），NIL中位暴露4（4～7）周，NIL暴露4周者8例次（80.0％）。已知生育结果8例次，其中5例次生产正常婴儿，2例次自然流产，1例次生产并指畸形男婴，其母亲妊娠早期NIL 600 mg/d暴露7周。11例女性患者共生产7例婴儿，男4例，女3例，出生时中位身高50（41～54）cm，中位体重3.2（3.0～4.6）kg。目前，7例患者所生子女生长发育均正常，中位年龄19（4～41）个月。12例次患者妊娠时疾病状态：完全分子学反应3例次、分子学反应4.0（MR4.0）2例次、主要分子学反应（MMR）3例次、未达MMR 4例次，妊娠期间中位停药35（15～36）周，无患者失去完全血液学反应。结论妊娠早期NIL 600 mg/d暴露4周的女性CML患者可生产正常婴儿，但仍有自然流产和生产先天畸形儿的可能。

Avoiding Bladder Catheters During AtrialFibrillation Ablation.

This study sought to determine if atrial fibrillation (AF) ablation can be performed safely without bladder catheterization. Patients undergoing AF ablation often receive bladder catheters. Catheterization is associated with potential complications. The ABCD-AF (Avoiding Bladder Catheters During Atrial Fibrillation) ablation study evaluates the advantages of performing AF ablation without routine catheterization. In this single-center, prospective, randomized controlled trial, 80 patients received bladder catheterization (group A), and 80 patients received only as-needed catheterization (group B). The primary endpoint was a composite of cystitis, urethral injury, hematuria, dysuria, or urinary retention. The mean patient age was 63 ± 13 years, and 33% of patients were female. The primary outcome was reached in 45 patients in group A and 11 patients in group B (p<0.001). Urinary tract infection occurred in 7 patients in group A and 2 patients in group B (p=0.17). Urinary retention occurred in 12 patients in group A and 5 patients in group B (p=0.07). Randomization to catheterization carried an odds ratio of 8.1 (95% confidence interval [CI]: 3.7 to 17.5; p<0.001), and male sex carried an odds ratio of 3.8 (95% CI: 1.7 to 8.6; p=0.001) for the primary endpoint. On subgroup analysis, randomization to undergo catheterization had no association with the primary outcome in female patients but had an odds ratio of 14.6 (95% CI: 5.6 to 38.1; p<0.001) in male patients. In multivariable analysis, sex and catheter status remained independently associated with the primary outcome. Bladder catheterization can be safely avoided in patients undergoing AF ablation and is associated witha significant reduction in adverse outcomes, especially in men.

P620The prognostic value of the ratio of transmitral early filling velocity to early diastolic strain rate in type 1 diabetes patients

Abstract Background Cardiovascular disease is one of the main causes of morbidity and mortality in patients suffering from type 1 diabetes mellitus. It is of great importance to identify early signs of cardiac pathology such as elevated left ventricular (LV) filling pressure. The ratio of transmitral early filling velocity to early diastolic strain rate (E/e'sr) has in recent studies proved to be an accurate measure of left ventricular (LV) filling pressure. Furthermore, E/e'sr has demonstrated strong prognostic value across different study populations. Purpose The aim of this study was to assess the prognostic value of E/e'sr in a large cohort of patients with type 1 diabetes mellitus in relation to cardiovascular morbidity and mortality. Methods In this prospective study, 1082 patients with type 1 diabetes mellitus (mean age 50±15 years, 53% male, mean duration of diabetes 26 years) underwent a comprehensive echocardiographic examination including both conventional measurements and two-dimensional speckle tracking in which E/e'sr along with other echocardiographic measurements were obtained. The primary outcome was defined as a major cardiac event (heart failure, stroke, myocardial infarction or cardiovascular death). Results During follow-up (median: 6.2 years, IQR: 5.7, 6.9) 144 (13.3%) met the composite outcome. E/e'sr was significantly associated with the composite outcome (E/e'sr: HR 1.36 95% CI [1.25–1.47], p&lt;0.001, per 0.10m increase) (figure). E/e'sr remained an independent predictor after multivariable adjustment for age, gender, duration of diabetes, BMI, HbA1c, smoking status, level of physical activity, systolic blood pressure, cholesterol level, eGFR, albuminuria, LV ejection fraction, LV dimensions and left atrial volume index (E/e'sr: HR 1.16 95% CI [1.04–1.28], p=0.006, per 0.10m increase). Interestingly, E/e'sr was especially good as a prognosticator in female patients (p for interaction = 0.008) in a univariable model: (female: HR 1.53 95% CI [1.37–1.71], p&lt;0.001, per 0.10m increase) (male: HR 1.23 95% CI [1.10–1.38], p&lt;0.001, per 0.10m increase). In the same multivariable model as before, E/e'sr remained an independent predictor of the outcome in female patients whereas the same was not true for male patients (female: HR 1.39 95% CI [1.18–1.66], p&lt;0.001, per 0.10m increase) vs (male: HR 1.05 95% CI [0.92–1.21], p=0.46, per 0.10m increase). Conclusion In patients with type 1 diabetes, E/e'sr provides independent prognostic information regarding cardiovascular morbidity and mortality. Furthermore, E/e'sr seems to have stronger prognostic value in female patients with type 1 diabetes.

Health and Disease After Assisted Reproductive Technology

Long-term health outcomes after ART have largely focused on offspring health and perinatal parameters. Longer-term health outcomes in female patients remain difficult to fully assess. Hypothetical concerns about the effects of endocrine manipulation on hormone-sensitive conditions, e.g. breast disease, are confounded by variable factors in patients and treatments. Obstetric and perinatal factors endow an additional layer of complexity to the overall analysis and more research is required to appreciate all aspects of ART. Notwithstanding the knowledge gap, clinicians must endeavour to individualise management plans, taking into account the pros and cons of ART in the context of immediate, maternity-related and long-term health risks for their patients.This review of recent literature examines current ART practice in terms of female health and disease as we strive for best practice in an ever-changing clinical and demographic fertility landscape.

Does myotonic dystrophy affect ovarian reserve, response to controlled ovarian stimulation and ivf-preimplantation genetic diagnosis outcome in female patients?

Introduction Myotonic dystrophy type 1 (DM1) is the most common adult-onset muscular dystrophy with incidence of 1 in 8,000 worldwide. The relationship between DM1 and female infertility remains controversial. This study investigated ovarian reserve, ovarian response to stimulation and IVF-PGD outcome in women with DM1 Materials & Methods This study included female patients with DM1 who performed IVF-PGD cycles in Cheil General Hospital & Women's Healthcare Center from January 2013 to December 2017. During this period, a total of 12 women undergoing PGD for DM1 were compared with 10 age matched women undergoing PGD for X-linked disorders (XLD). Ovarian reserve markers, response to controlled ovarian stimulation, embryo quality, and clinical pregnancy rate were compared. Results Day 3 FSH, E2 and anti-mullerian hormone concentration (median, range: 7.5 (4.6-14.8) verse 7.0 (5.7-10.0) mIU/ml; 22.3 (15.9-53.2) verse 27.5 (9.4-54.3) pg/ml; 1.8 (0.7-7.3) verse 3.6 (1.0-7.5) ng/ml, respectively), the mean number of oocytes retrieved and metaphase II oocytes (15.7±12.7 verse 15.6±6.2; 11.9±10.3 verse 12.4±4.9 respectively), fertilization rate (77.3% verse 83.9%) and prevalence of top quality embryo (39.3% vs 33.4%) showed no significant difference between DM1 and XLD groups. Clinical pregnancy rates (17% vs 21%) were similar in both groups Conclusions The results showed that DM1 does not influence ovarian reserve and reproductive outcomes in female patients. Further studies with sufficient number of cases are required to elucidate the impact of DM1 on female infertility.

Abstract 241: An Investigation of Sex Differences in the BRIDGE Transitional Care Clinic Population

Background: Although cardiovascular disease (CVD) is the leading cause of death in men and women, women are less likely than men to received certain evidence-based treatments for CVD or be enrolled in CVD clinical trials. This study sought to identify sex differences in outcomes among patients referred to the BRIDGE transitional care clinic following hospitalization for a cardiac event. Methods: Retrospective data on patients referred to BRIDGE from 2008-2016 were analyzed. Demographics and outcomes (readmissions, emergency department [ED] visits, death) were compared between male and female patients in five populations: 1) the total BRIDGE population, 2) acute coronary syndrome (ACS) patients, 3) congestive heart failure (CHF) patients, 4) atrial fibrillation/flutter (AF) patients, and 5) patients who attended BRIDGE clinic. Results: Of 4159 patients, 1710 (41.1%) were female. In the total population, women were significantly older than men (66.8 v 64.8, p=0.010), were less likely to be married (45.2% v 68.2%, p≤0.001), and had higher Charlson Comorbidity Index (CCI) scores (4.90 v 4.60, p=0.001). Women were also less likely to have ACS (20.7% v 28.6%, p≤0.001), more likely to have CHF (25.1% v 20.9%, p=0.001), and were more likely to have an ED visit within 6 months post-discharge. No significant differences were seen in outcomes between males and females in the CHF and AF populations; however, female ACS patients were more likely to have had an ED visit within 6 months of discharge than male ACS patients. In regards to transitional care, women were less likely to attend their BRIDGE appointment (68.7% v 72.4%, p=0.008). Among BRIDGE attendees, females were older (66.8 v 64.9, p=0.001), less likely to be married (45.9% v 68.8%, p=0.001), and had higher CCI scores (4.80 v 4.55, p=0.016) than males. Female attendees were more likely than male attendees to have had an ED visit both within 30 days and 6 months. Conclusions: Among the total population, BRIDGE attendees, and ACS patients, women were more likely to visit the ED than men. Additionally, women were less likely than men to attend their BRIDGE transitional care appointment. Efforts should be made to improve BRIDGE clinic attendance among women and develop targeted strategies to improve outcomes for female patients, specifically those with a primary diagnosis of ACS.

Do Female Athletes Return to Sports After Hip Preservation Surgery for Femoroacetabular Impingement Syndrome?: A Comparative Analysis.

Background:Female patients undergoing surgery for femoroacetabular impingement syndrome (FAIS) often experience inferior clinical outcomes and higher failure rates when compared with male patients. The influence of athletic status on hip arthroscopic outcomes in female patients, however, is unclear.Purpose:To compare patient-reported outcomes (PROs) of athletic and nonathletic female patients undergoing hip arthroscopic surgery for FAIS, and to determine the return-to-sports rate in the athlete group.Study Design:Cohort study; Level of evidence, 3.Methods:Two-year PROs were assessed in female patients who had undergone hip arthroscopic surgery for FAIS by a single surgeon. Patients who self-identified as athletes were compared with nonathletes. Preoperative and postoperative PRO scores including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport-Specific (HOS-SS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction were analyzed and compared between athletes and nonathletes. Subanalysis was performed based on patient age and body mass index (BMI).Results:A total of 330 female patients undergoing hip arthroscopic surgery for FAIS were identified. Of these, 221 patients identified as athletes (mean age, 29.1 ± 11.1 years; mean BMI, 23.0 ± 3.5 kg/m2) and 109 as nonathletes (mean age, 39.3 ± 11.4 years; mean BMI, 27.8 ± 5.8 kg/m2). Both groups demonstrated improvements in HOS-ADL, HOS-SS, mHHS, VAS for pain, and VAS for satisfaction scores (P < .001 for all). Athletes had significantly higher postoperative PRO scores compared with nonathletes (P < .001 for all). A 1:1 matched-pair subanalysis of 97 athletes and 97 nonathletes controlling for age and BMI indicated that these relationships held independently of potential demographic confounders (P < .001 for all). The number of patients meeting the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) for the HOS-ADL, HOS-SS, and mHHS was significantly higher in athletes aged ≤25 years versus those aged >25 years and for athletes versus nonathletes (P < .05 for all). Further, 189 of 194 athletes returned to sports at a mean of 6.0 ± 3.9 months postoperatively, with 93.7% reporting returning to the same or higher level of competition.Conclusion:Among female patients undergoing hip arthroscopic surgery for FAIS, patients considered athletes achieved superior clinical outcomes compared with patients considered nonathletes. In addition, younger female athletes had higher rates of achieving the MCID and PASS for all PRO measures.

A Single-Center Retrospective Study of Patients with Double Primary Cancers: Breast Cancer and EGFR-Mutant Non-Small Cell Lung Cancer

Background: Second primary malignancies (SPM) in the lung are not common in breast cancer (BC) patients. EGFR-mutant lung cancer (LC) is a separate molecular subset, and the co-existence of EGFR-mutant LC and BC has not been explored. We hypothesized that EGFR-mutant LC patients could have higher rates of primary BC than those with EGFR-wild type (WT). Methods: We collected data on clinical and molecular characteristics and outcomes of female patients with LC and a previous or simultaneous history of primary BC treated in our hospital from 2008 to 2014. Results: Data on treatment, follow-up, and EGFR mutation status were available for 356 patients. 17.7% (11/62) of patients with EGFR mutations had BC, compared to 1.02% (3/294) of EGFR-WT patients (p < 0.001). Both tumors were metachronous in 81.8%, with LC diagnosed 9 years after the diagnosis of BC. 5 of the 6 (83.3%) BC patients treated with radiotherapy developed LC in an area within the radiation field. No EGFR mutations were detected in BC tissue and no HER2 expression was detected in LC samples. Conclusion: SPM in the lung and breast occur more frequently among EGFR-mutant compared to EGFR-WT LC patients. Radiotherapy for BC may increase the risk of developing primary LC.

Abstract WP452: Matrix Metalloproteinase Expression as Sex-specific Biomarker of Secondary Injury and Functional Outcomes After Spontaneous Hypertensive Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) affects approximately 2 million individuals per year. Incidence of ICH is roughly equal in men and women, but few studies have examined the influence of sex on long-term outcomes after ICH and secondary injury. Previous studies have shown that women in the post-partum period and post-menopausal women are especially susceptible to poor functional outcomes after ICH. Matrix metalloproteinases (MMPs) promote vessel rupture during ICH and may lead to poorer outcomes in female patients due to blood-brain barrier breakdown. We hypothesized that MMP isoform levels would be predictive of injury severity, secondary injury and long-term functional outcomes after ICH in males and females. Methods and Results: Patients from our prospectively collected ICH database were included. We included patients with deep hypertensive ICH, and excluded secondary ICH. Baseline clinical, radiographic and laboratory data were collected. Neurologic deterioration was defined as increase in NIHSS score and/or reduction in GCS score. Functional outcomes were assessed by modified Rankin Scale (mRS) and EuroQol at 90 DPI. Discharge disposition was recorded. With a total of 55 patients (n = 39 male, 16 female) we demonstrated a significantly higher risk of IVH (p = 0.012) and neurologic deterioration (p = 0.005) in females compared to males. We found that MMP levels in serum reliably predict injury severity in males, and secondary injury in females. Using multiplex ELISA we demonstrated that serum MMP-2 levels are negatively correlated with IVH severity (p = 0.028) in females. Additionally, serum levels of MMP-3 (p= 0.011) in males and MMP-10 (p= 0.044) in females predicted long-term functional outcomes in a sex-specific manner. Conclusion: Our work demonstrates the importance of studying sex-specific factors in ICH outcomes. We have found that there is a potential use of serum MMP expression as a sex-specific diagnostic tool for physicians treating patients after ICH. To our knowledge, this is the first sex-specific study to examine serum MMP levels and their correlation with clinicoradiologic measures after ICH. Further research to confirm these findings is necessary.

Nocturia in female patients: Current clinical features, treatment patterns and outcomes at a tertiary referral centre

ABSTRACTObjective: To report the current clinical features, treatment patterns and outcomes of female patients who were seen at a tertiary referral centre with a primary diagnosis of nocturia, and to assess the predictive factors of therapeutic management failure.Patients and methods: A retrospective chart review of all new female patients seen in a single-centre functional urology practice with the diagnosis of nocturia was performed. Up to three visits within a 12-month period from the time of presenting were reviewed. The primary endpoint was patient-reported improvement assessed at each follow-up visit and the change in the number of nocturia episodes.Results: In all, 239 female patients were included for analysis. The prevalence of nocturnal polyuria, reduced bladder capacity, and global polyuria were 75%, 40.2%, and 18.1%, respectively. Within the first two visits, 72.7% of patients had started a treatment beyond behavioural therapies. Anticholinergics were the most commonly initiated treatment (47.2% of patients). At the latest considered visit, 80 patients reported improvement in nocturia (45.5%) and there was a mean – 0.8 decrease in the number of nocturia episodes from 4 to 3.2, which was statistically significant (P < 0.001). There was no statistically significant association between any of the bladder diary findings and treatment outcomes. A smaller number of nocturia episodes was the only predictive factor of therapeutic management failure in multivariate analysis (odds ratio 0.10; P = 0.01).Conclusions: Whilst the prevalence of nocturnal polyuria in women with nocturia is high, the therapeutic management until 2016 seemed to rely mostly upon overactive bladder medications with a relatively low success rate.Abbreviations: BD: bladder diary; BPS: bladder pain syndrome; ICD(−9)-(10): International Classifications of Disease (ninth revision) (10th revision); NPI: Nocturnal Polyuria Index; OAB: overactive bladder; OR: odd ratio; POP: pelvic organ prolapse

Gender-specific discrepancy in subjective global assessment for mortality in hemodialysis patients

Although subjective global assessment (SGA) is a widely used representative tool for nutritional investigations even among dialysis patients, no studies have examined gender-specific differences in the ability of SGA to predict mortality in hemodialysis (HD) patients. A total of 2,798 dialysis patients were enrolled from clinical research center for end-stage renal disease (CRC for ESRD) between 2009 and 2015. The cohort was divided into two groups based on nutritional status as evaluated by SGA: ‘good nutrition’ and ‘mild to severe malnutrition’. Multivariate Cox proportional regression analyses were performed to investigate gender-specific differences in SGA for mortality among incident and prevalent HD patients. ‘Mild to severe malnutrition’ was significantly correlated with increased mortality compared with ‘good nutrition’ for all HD, incident and prevalent HD patients. Compared with ‘good nutrition’, ‘mild to severe malnutrition’ was also more significantly associated with increased mortality in male patients in the incident and prevalent HD groups. However, no significant associations between nutritional status evaluated by SGA and mortality were observed for female patients. SGA of HD patients can be useful for predicting mortality, especially in male HD patients. However, SGA alone might not reflect adverse outcomes in female patients.

Obesity Negatively Impacts Outcome in Female Patients with Chronic Lymphocytic Leukemia (CLL) Treated with Fludarabine, Cyclophosphamide and Rituximab (FCR): An Analysis of Three Phase III Studies of the German CLL Study Group (GCLLSG)

Obesity Negatively Impacts Outcome in Female Patients with Chronic Lymphocytic Leukemia (CLL) Treated with Fludarabine, Cyclophosphamide and Rituximab (FCR): An Analysis of Three Phase III Studies of the German CLL Study Group (GCLLSG)

Invited Commentary

Invited Commentary

AMS-800 Artificial urinary sphincter in female patients with stress urinary incontinence: A systematic review.

To perform a systematic review of studies reporting the outcomes of AMS-800 artificial urinary sphincter (AUS) implantation in female patients with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency (ISD). A systematic literature search of the Medline and Embase databases was performed in June 2018 in accordance with the PRISMA statement. No time limit was used. The protocol was registered in PROSPERO (CRD42018099612). Study selection and data extraction were performed by two independent reviewers. Of 886 records screened, 17 were included. All were retrospective or prospective non-comparative case series. One study reported on vaginal AUS implantation, 11 on open AUS implantation, two on laparoscopic AUS implantation, two on robot-assisted AUS implantation and one compared open and robot-assisted implantations. The vast majority of patients had undergone at least one anti-incontinence surgical procedure prior to AUS implantation (69.1-100%). The intraoperative bladder neck injury rates ranged from 0% to 43.8% and the intraoperative vaginal injury rates ranged from 0 to 25%. After mean follow-up periods ranging from 5 to 204 months, the complete continence rates ranged from 61.1% to 100%. The rates of explantation, erosion and mechanical failure varied from 0% to 45.3%, 0% to 22.2% and 0% to 44.1%, respectively. AMS-800 AUS can provide excellent functional outcomes in female patients with SUI resulting from ISD but at the cost of a relatively high morbidity. High level of evidence studies are needed to help better define the role of AUS in the female SUI armamentarium.

Effects of stage and grade of cancer on fertility preservation outcome in female patients

To evaluate the effects of cancer stage and grade on fertility preservation outcome and ovarian stimulation response. Retrospective cohort study. We evaluated 402 fertility preservation treatment cycles. The inclusion criteria were age 18-38 years, first stimulation cycle, GnRH-antagonist protocol only, and early follicular phase stimulation start only. Patients with ovarian pathology, previous ovarian surgery and previous chemo- or radiotherapy were excluded. Women with low-stage cancer (stage I, II and no lymph node involvement) were compared with those with high-stage disease (stage III, IV or lymph node involvement). Similarly those with low-grade (grade I, II) and high-grade (grade III, IV) disease were compared. Primary outcome was the number of mature oocytes retrieved. Secondary outcomes included total number of oocytes retrieved, total number of vitrified oocytes, and number of frozen embryos. A power calculation was performed. A sample size of 60 in each group has 80% power of showing a 20% difference in primary outcome with an alpha of 5%. To determine factors associated with good fertility preservation outcome (over 10 mature oocytes retrieved), we used multivariate logistical regression. A total of 147 patients were included in the analysis. The demographic and ovarian reserve parameters of study groups in stage- and grade-based analyses were similar. Compared to women with low-stage cancer (n = 83), those with high-stage cancer (n = 64) required a higher dose of gonadotropin (p = 0.02). The number of mature oocytes retrieved and frozen oocytes as well as the number of immature oocytes (GV and MI) and maturation rate were similar between the two groups. However, in cycles where fertilization of retrieved oocytes was performed (n = 53), the fertilization rate (p = 0.03) and the number of vitrified embryos (p = 0.01) were higher in the low-stage group. Compared to patients with low-grade cancer (n = 62), those with high-grade disease (n = 85) had significantly lower number of mature retrieved (10.5 (7-15) vs. 8 (5-10.5); p = 0.002) and totally vitrified (11.5 (8-15) vs. 10 (6.5-11); p = 0.005) oocytes. Similarly the number of vitrified embryos was lower in high-grade group (p=0.03) in cycles where the fertilization was performed. In multivariate logistical analysis, the grade of cancer was found to be one of the factors significantly associated with good fertility preservation outcome (p=0.004; OR=3.93; 95%CI 1.50 - 10.33), along with AFC and number of follicles >14 mm on the trigger day. In women with malignancy, the grade of cancer has a significant negative impact on the number of mature oocytes retrieved and cryopreserved embryos.