20 minute read
UROLOGIE
from Abstractboek 2020
by az groeninge
CENTRUM UROLOGIE
ARTIKELS
ABSTRACT 1
Office-based approach to urinary tract infections in 50 000 patients: results from the REWIND study.
Cai T, Palagin I, Brunelli R, Van Bruwaene S, et al. International Journal of Antimicrobial Agents, 2020, 56(1), DOI: 10.1016/j.ijantimicag.2020.105966
OBJECTIVE The REWIND study sought to describe the real-world clinical and prescribing practices for the management of urinary tract infection (UTI) in Italy, Belgium, Russia and Brazil in order to compare current practices with international, European and national guidelines.
MATERIALS/METHODS An integrated mixed-methods approach was adopted that used information from primary care electronic medical records in longitudinal patient databases available in Italy and Belgium, and surveys of physicians in Russia (general practitioners) and Brazil (gynaecologists).
RESULTS In total, 49 548 female patients were included in the study. Antibiotics were the most common management option for UTI in Italy (71.1%, n = 27 600), Belgium (92.4%, n = 7703), Russia (81.9%, n = 1231) and Brazil (82.4%, n = 740). Fosfomycin trometamol was the first-choice antibiotic for the treatment of UTI in all countries. Ciprofloxacin was also commonly prescribed in Italy (24.6%, n = 6796), Belgium (17.8%, n = 1373), Russia (14.9%, n = 184) and Brazil (9.6%, n = 71), while prescription of nitrofurantoin was common in Belgium (24.5%, n = 1890) alone.
CONCLUSION Despite differences in study designs and data sources, fosfomycin trometamol was found to be the most commonly prescribed treatment for UTI in all participating countries. In Belgium, real- world prescribing practices for UTI adhered more closely to European guidelines than national guidelines. Although not recommended in international and European guidelines for lower UTI management, the use of fluoroquinolones was still widespread. ABSTRACT 2
Rates and predictors of perioperative complications in cytoreductive nephrectomy: analysis of the registry for metastatic renal cell carcinoma.
Roussel E, Campi R, Larcher A, Van Bruwaene S, et al. European urology oncology, 2020, 3(4), 523-529
INTRODUCTION Cytoreductive nephrectomy (CN) plays an important role in the treatment of a subgroup of metastatic renal cell carcinoma (mRCC) patients.
OBJECTIVE We aimed to evaluate morbidity associated with this procedure and identify potential predictors thereof to aid patient selection for this procedure and potentially improve patient outcomes.
MATERIALS/METHODS Data from 736 mRCC patients undergoing CN at 14 institutions were retrospectively recorded in the Registry for Metastatic RCC (REMARCC).
Outcome measurements and statistical analysis: Logistic regression analysis was used to identify predictors for intraoperative, any-grade (AGCs), low-grade, and high-grade (HGCs) postoperative complications (according to the Clavien-Dindo classification) as well as 30-d readmission rates.
RESULTS Intraoperative complications were observed in 69 patients (10.9%). Thrombectomy (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75, p = 0.009) and adjacent organ removal (OR 2.7, 95% CI 1.38-5.30) were significant predictors of intraoperative complications at multivariable analysis. Two hundred seventeen patients (29.5%) encountered AGCs, while 45 (6.1%) encountered an HGC, of whom 10 (1.4%) died. Twenty-four (3.3%) patients had multiple postoperative complications. Estimated blood loss (EBL; OR 1.49, 95% CI 1.08-2.05, p = 0.01) was a significant predictor of AGCs at multivariable analysis. CN case load (OR 0.13, 95% CI 0.03-0.59, p = 0.009) and EBL (OR 2.93, 95% CI 1.20-7.15, p = 0.02) were significant predictors solely for HGCs at multivariable analysis. Forty-one patients (11.5%) were readmitted within 30 d of surgery. No significant predictors were identified. Results were confirmed in a subanalysis focusing solely on patients treated in the contemporary targeted therapy era.
CONCLUSION Morbidity associated with CN is not negligible. Predictors of high-grade postoperative morbidity are predominantly indicators of complex surgery. EBL is a strong predictor of postoperative complications. CN case load correlates with lower high-grade morbidity and highlights the benefit of centralization of complex surgery. However, risks and benefits should be balanced when considering CN in mRCC patients.
PATIENT SUMMARY We studied patients with metastatic renal cancer to evaluate the outcomes associated with the surgical removal of the primary kidney tumor. We found that this procedure is often complex and adverse events are not uncommon. High intraoperative blood loss and a small number of cases performed at the treating center are associated with a higher rate of postoperative complications.
ABSTRACT 3 Surgical safety.
Van Bruwaene S
World Journal of Urology, 2020, 38, 1349–1350
ABSTRACT I am writing this editorial in the heat of the COVID-19 crisis. A huge challenge in dealing with this pandemic is the lack of knowledge about the treatment, risk factors, preventive measures, economic impact of such measures, etc. due to the speed at which it hit us. The current topic issue about surgical safety is the exact opposite of that situation. About 200 years ago, abdominal procedures were almost uniformly fatal due to infection and surgeons chose speed over precision to limit the horrible screaming of their unanesthetized patients. Thousands of scientific breakthroughs later we have perfected the craft and scrutinized every little detail of it. But, we must continue to be vigilant. In 2004, the World Health Organization (WHO) still counted 7 million surgical patients worldwide who suffered significant (often avoidable) complications with 1 million of them dying during or immediately following surgery. What efforts are possible in everyday practice to get those numbers as low as possible?
Each surgery starts with selecting the right patient and balancing risks versus benefits. The safest form of surgery is sometimes not performing surgery at all—primum non nocere. The patient, family, anesthetist and surgeon need to be on the same page with all parties properly informed, prepared and consented. Many other stakeholders have their own specific responsibility in that pre-surgical space like hospitals, medical device companies, governments through reimbursement criteria, etc.
Within the confines of the operating theatre, it is mainly focus, teamwork and skill that improve outcomes. The efficiency of the WHO checklist is purported to result from behavioral change in the operating theatre, creating an atmosphere of effective communication and a culture of safety, just as much as from actually ticking the boxes. The anesthetist, our indispensable ally on the other side of the blood–brain barrier, can make or break the surgery by appropriate fluid and pharmacological management. Trained nurses who master the magical skill of reading a surgeons’ mind can make that life-saving difference.
And then, whether we like it or not, the surgeon obviously plays a lead role in the success of any procedure. The years of see one, do one, teach one have long gone. Surgical training has improved, learning curves are calculated and proficiency criteria are defined. But training does not stop after residency. High-volume centers are showing better outcomes, experienced surgeons show better results. Even 200 years ago, specialization was a leading force in improvement of quality. Subspecialization or centralization might be the modern extension to this.
Last but not least, the evolution of the world into digitalization, big data, artificial intelligence, etc. takes surgical safety to another level. Keeping track of complications, patient-reported outcomes and success rates is at the verge of being common practice. Trustworthy feedback on performance drives intrinsic motivation for improvement. Furthermore, an unprecedented amount of surgical knowledge is at the surgeons’ fingertips thanks to the internet, social media, online courses, etc.
In summary, surgeons around the world have been motivated and creative at successfully improving their craft. When we finally beat COVID-19, with similar determination, there is definitely more growth ahead.
Development and external validation of a multiparametric Magnetic Resonance Imaging and international society of urological pathology based add-on prediction tool to identify prostate cancer candidates for pelvic lymph node dissection.
ABSTRACT 4
Development and external validation of a multiparametric Magnetic Resonance Imaging and international society of urological pathology based add-on prediction tool to identify prostate cancer candidates for pelvic lymph node dissection.
Everaerts W, Isebaert S, Van Bruwaene S, et al. Journal of Urology, 2020, 203(4), 713-718
OBJECTIVE We sought to expand current prediction tools for lymph node invasion in patients with prostate cancer using current state-of-the-art available tumor information, including multiparametric magnetic resonance imaging based tumor stage and detailed biopsy information.
MATERIALS/METHODS We selected patients with prostate cancer for study who had available registered information on ISUP (International Society of Urological Pathology) based biopsy grading and multiparametric magnetic resonance imaging, and who had undergone radical prostatectomy with extended pelvic lymph node dissection. We developed a lymph node invasion prediction tool in 420 patients and externally validated it in 187. A concordance index was estimated to quantify the discriminative performance of the model.
RESULTS In the development cohort a median of 21 lymph nodes were removed per patient and 71 patients (16.9%) were diagnosed with lymph node invasion. Statistically significant predictors of lymph node invasion were the initial prostate specific antigen value, multiparametric magnetic resonance imaging based T stage, maximum tumor length in 1 core in mm and ISUP grade group corresponding to the maximum tumor involvement in 1 core. The predictive accuracy of this lymph node invasion prediction tool was 79.7% after fivefold internal cross validation and 72.5% after external validation.
CONCLUSION We report a contemporary, externally validated prediction tool for lymph node invasion in patients with prostate cancer. This prediction tool is a response to the paradigm shift from systematic to targeted biopsies by incorporating additional core specific biopsy information instead of the percent of positive cores. This new tool will also overcome stage migration, which is a potential risk when multiparametric magnetic resonance imaging information is used in digital rectal examination based nomograms. ABSTRACT 5
Treatment of high-grade non-muscle-invasive bladder carcinoma by standard number and dose of BCG instillations versus reduced number and standard dose of BCG instillations: results of the European Association of Urology Research Foundation Randomised Phase III clinical trial “NIMBUS”.
Grimm M, van der Heijden A, Colombel M, Van Bruwaene S, et al. European Urology, 2020, 78(5), 690-698
INTRODUCTION Intravesical instillation of bacillus Calmette-Guérin (BCG) is an accepted strategy to prevent recurrence of non–muscle-invasive bladder cancer (NMIBC) but associated with significant toxicity.
OBJECTIVE NIMBUS assessed whether a reduced number of standard-dose BCG instillations are noninferior to the standard number and dose in patients with high-grade NMIBC.
MATERIALS/METHODS A total of 345 patients from 51 sites were randomised between December 2013 and July 2019. We report results after a data review and safety analysis by the Independent Data Monitoring Committee based on the cut-off date of July 1, 2019.
The standard BCG schedule was 6 wk of induction followed by 3 wk of maintenance at 3, 6, and 12 mo (15 instillations). The reduced frequency BCG schedule was induction at wks 1, 2, and 6 followed by 2 wk (wks 1 and 3) of maintenance at 3, 6, and 12 mo (nine instillations). The primary endpoint was time to first recurrence. Secondary endpoints included progression to ≥ T2 and toxicity.
RESULTS In total, 170 patients were randomised to reduced frequency and 175 to standard BCG. Prognostic factors at initial resection were as follows: Ta/T1: 46/54%; primary/recurrent: 92/8%; single/multiple: 57/43%; and concomitant carcinoma in situ: 27%. After 12 mo of median follow-up, the intention-to-treat analysis showed a safety-relevant difference in recurrences between treatment arms: 46/170 (reduced frequency) versus 21/175 patients (standard). Additional safety analyses showed a hazard ratio of 0.40 with the upper part of the one-sided 97.5% confidence interval of 0.68, meeting a predefined stopping criterion for inferiority.
CONCLUSION The reduced frequency schedule was inferior to the standard schedule regarding the time to first recurrence. Further recruitment of patients was stopped immediately to avoid harm in the reduced frequency BCG arm.
ABSTRACT 6
A trial-based cost-utility analysis of metastasis-directed therapy for oligorecurrent prostate cancer.
De Bleser E, Willems R, Decaestecker K, Billiet I, et al. Cancers, 2020, 12(1), 132
INTRODUCTION The optimal management of patients with oligorecurrent prostate cancer (PCa) is unknown. There is growing interest in metastasis-directed therapy (MDT) for this population.
OBJECTIVE The objective was to assess cost-utility from a healthcare payer’s perspective of MDT and delayed androgen deprivation therapy (ADT) in comparison with surveillance and delayed ADT, and with immediate ADT.
MATERIALS/METHODS A Markov decision-analytic trial-based model was developed, projecting health and economic outcomes over a 5-year time horizon with one-month cycles. Clinical data were derived from the STOMP trial and literature. Utility data were obtained from literature. MDT was either performed via stereotactic body radiotherapy (SBRT) or surgically by means of metastasectomy. Treatment costs were derived from official government documents. The main outcome was the incremental cost-effectiveness ratio (ICER) that assessed value for money of MDT versus surveillance with delayed ADT and of MDT versus immediate ADT. A willingness-to-pay (WTP) threshold of €40,000 per quality adjusted life year (QALY) was used. Probabilistic and one-way sensitivity analysis were performed to capture the uncertainty related to key input parameters. Finally, scenario analyses were conducted to determine the impact of input parameters with different scenarios.
RESULTS The analysis showed that MDT is cost-effective compared to surveillance (ICER: €8,393/QALY) and immediate ADT (dominant strategy).The multiple cost-effectiveness acceptability curve (CEAC), based on the probabilistic analysis, showed that, of the three treatment options, MDT has the highest probability of being cost-effective if the WTP threshold exceeds €10,000 (Figure 1). The ICER is most sensitive to the utilities in the different health states and the first month MDT cost. At a WTP threshold of €40,000 per QALY, the first month MDT and SBRT costs should not exceed €8,136 and €7,435, respectively, to be cost-effective compared to surveillance.
CONCLUSION The Markov-model suggests that MDT for oligorecurrent PCa is potentially cost-effective in comparison with surveillance and delayed ADT, and in comparison, with immediate ADT. However, larger phase III trials are needed to confirm the efficacy of MDT.
ABSTRACT 7
Quality control indicators for transurethral resections of bladder tumors: benchmarking centers in a Belgian multi-center prospective registry.
Muilwijk T, Akand M, Raskin Y, Van Bruwaene S, et al. European Urology Open Science, 2020, 19, DOI:10.1097/ JU.0000000000000846.03
INTRODUCTION Quality control indicators (QCIs) can objectively evaluate guideline adherence and may serve as benchmark between hospitals. We assessed the performance of 3 Belgian centers on 6 QCIs in the treatment of NMIBC using a prospective transurethral resection of bladder tumor (TURBT) registry and compared clinical outcome between centers.
MATERIALS/METHODS TURBT procedures were collected using eCRFs in a prospective TURBT registry in 3 centers between 06-2013 and 03-2017. Exclusion criteria were: pT0 (except for re-TUR), pT2 before current TURBT, cN+, or cM+ disease. Outcomes of interest were recurrence-free survival (RFS), overall survival (OS), and cystectomy-free survival (CFS). 6 QCIs were assessed for their indication: complete resection status (CRS), repeat resection (re-TUR), detrusor muscle (DM) in resection specimen, single instillation of Mitomycin C (MMC), adjuvant intravesical BCG, and therapy ≤6 weeks after diagnosis.Centers were anonymized. QCIs were assessed per center and compared using X2 square test. Kaplan-Meier plots were used for visualization of outcome and log-rank to compare between centers.
RESULTS A total of 1350 TURBTs were collected, 1165 TURBTs met inclusion criteria for a total of 907 patients. Median follow
up was 21.8 mo (IQR: 12.1-34.3). RFS, OS, and CFS at 4-yr were 63.5%, 78.9%, and 93.1% respectively. There was no significant difference in RFS and OS between centers; CFS differed significantly. There was a significant difference in the following QCIs between centers: re-TUR (p=5E-6), DM (p=1.1E-10), MMC (p=0.0001), BCG (p=4.2E-5), and timing ≤6 weeks (p=0.0001). There was no significant difference for CRS between centers (p=0.09). We found a significant difference between centers: in RFS for the subgroup QCI MMC (p=0.02); and in RFS for the subgroup QCI timing ≤6 weeks (p=0.013). A significant higher score on QCI MMC and on QCI timing ≤6 weeks correlated with a lower recurrencerate in both of these subgroups.
ABSTRACT 8
Update in prostate cancer 2019.
Van Bruwaene S, Dirix P, Van Poppel H Belgian Journal of Medical Oncology, 2020, 14(1), 13-21
ABSTRACT The prostate cancer (PCa) landscape has changed dramatically over the past few years. New paradigm-shifting data are published nearly every month. This review aims to give a brief overview of the most important publications of 2018-2019. From the ever-lasting discussion about PSA screening, with the recent publication of the CAP trial, over diagnostics where multi-parametric MRI has caused a true revolution, to hypofractionation in radiotherapy and the dramatic treatment shifts in metastatic hormone sensitive and non-metastatic castrate resistant PCa. All exciting data that will change clinical practice.
ABSTRACT 9
Making surgery safer in an increasingly digital world: the internet—friend or foe?
Van Puyvelde H, Basto M, Chung ASJ, Van Bruwaene S World Journal of Urology, 2020, 38(6), 1391-1395
OBJECTIVE The internet has resulted in huge efficiency gains in health care, the ability to deal with massive data accumulation and better manage patient data. However, potential and real pitfalls exist, including breeches in security of data and patient confidentiality, data storage issues, errors, and user interface issues. MATERIALS/METHODS A MEDLINE review was performed using MeSH terms “health care” and “information technology.” Cross-referencing was used to explore the different opportunities and challenges the internet has to offer.
RESULTS As health professionals, we are fast adopting technologies at our fingertips, such as WhatsApp and video capabilities, into our clinical practice to increase productivity and improve patient care. However, the potential security breaches are significant for the health professional and health service. Further, electronic medical records have theoretical advantages to improve patient care, reduce medication errors, and expedite referrals. The downside is a less personalized approach to patient care, as well as the potential for these systems to be even more cumbersome. In regard to the acquisition of knowledge, there is no doubt the internet is our friend. Health care professionals as well as patients have unlimited resources for learning, including podcasts videos, apps, simulators, and wearable devices. Unfortunately, this comes with a risk of misinformation and poorly referenced data with little to no regulation of content.
CONCLUSION In this increasing digital world, it is our task as health care providers to embrace these new technologies but develop guidelines and control systems to minimize the pitfalls.
ABSTRACT 10
REWIND (REal World INternational Database) study: what is the office-based approach to treating urinary tract infections?
Cai T, Van Bruwaene S, Plalagin I, et al. European Urology Open Science, 2020, 19(2), DOI: 10.1016/j.ijantimicag.2020.105966
Er is geen abstract beschikbaar.
ABSTRACT 11
Surveillance or metastasis-directed therapy for oligometastatic prostate cancer recurrence (STOMP): five-year results of a randomized phase II trial.
Ost P, Reynders D, Decaestecker K, Billiet I, et al. Journal of Clinical Oncology, 2020, 38(6 suppl), 10
INTRODUCTION Multiple randomized phase II trials suggest that metastasis-directed therapy (MDT) for oligometastatic prostate cancer (PCa) improves progression-free survival, but the majority of trials lack longer follow-up. We present the updated 5-year results from the STOMP-trial.
MATERIALS/METHODS In this multicentre, randomised, phase II study, asymptomatic PCa patients were eligible in case of a biochemical recurrence following primary PCa treatment with curative intent and presenting with up to 3 extracranial on choline PET-CT and a serum testosterone levels > 50 ng/ml. Patients were randomly assigned (1:1) to either surveillance or MDT of all detected lesions. Randomisation was balanced dynamically on two factors: PSA doubling time (≤3 vs. > 3 months) and nodal vs non-nodal metastases. The primary endpoint was androgen deprivation therapy (ADT)-free survival. Castrate resistant prostate cancer-free survival (CRPC) was a secondary endpoint. Tests were performed two-sided; p values less than 0.20 were deemed significant.
RESULTS The 5-year ADT-free survival was 8% for the surveillance group and 34% for the MDT group (Figure 1, hazard ratio 0.57 [80% CI: 0.38-0.84], log-rank p = 0.06). There was no significant difference in effect for the different stratification factors (interaction test). The 5-year CRPC-free survival was 53% for the surveillance group and 76% for the MDT group (hazard ratio 0.62 [80% CI: 0.35−1.09]; log−rank p = 0.27). At a median follow for survival of 5.3 years (IQR 4.3-6.3), the 5-year overall survival was 85%, with 6 out of 14 deaths attributed to prostate cancer.
CONCLUSION The updated STOMP trial outcomes confirm the earlier reported significant difference in ADT free survival in favor of the MDT group compared to surveillance. Prostatecancer related mortality is low within the first 5 years of diagnosis of oligorecurrent prostate cancer.
PRESENTATIES
ABSTRACT 12
68Ga PSMA PET/CT in het PET-centrum West-Vlaanderen: wat kunnen we leren uit 2 jaar ervaring in een secundair centrum?
Dewulf K, Lesage K, Beels L, Van Bruwaene S, et al. February 2020, Elautprijs, Dendermonde - België
Zie Nucleaire geneeskunde pagina 60.
ABSTRACT 13
Prospectieve data als verweer tegen uitroeiing midurethrale slings (MUS): pilootproject az groeninge Kortrijk.
Ferong K, Vossaert P, Ghesquière S, Platteeuw L, Van
Bruwaene S
February 2020, Elautprijs, Dendermonde - België
Zie Gynaecologie pagina 21.
ABSTRACT 14
Automatische data extractie en machine learning: een pilootproject in prostaatkanker.
Van Puyvelde H, Van Bruwaene S February 2020, Elautprijs, Dendermonde - België
INTRODUCTION In medische dossiers liggen eindeloze schatten aan informatie verborgen. Deze data zijn gegeerd voor wetenschappelijke analyses, facturatiedoeleinden, kwaliteitscontroles,… Momenteel is de enige manier om deze informatie in gestructureerde data om te zetten, het manueel ingeven inclusief urenlang uitpluizen van medische verslagen. In tijden van machine learning, big data analysis en artificiële intelligentie biedt geautomatiseerde data-extractie nieuwe perspectieven. In dit pilootproject werd een software oplossing getest in het kader van KPI (Key Performance Indicators) voor prostaatkanker. Hierbij werd geëvalueerd of de gewenste parameters volledig en correct konden worden geëxtraheerd.
Het bedrijf BT Clinical Computing ontwikkelde een Snomed CT®-assisted Natural Language Parser (taalontleding door computer) om relevante termen uit medische dossiers te extraheren. Er werden 9 chirurgische prostaatkankerpatiënten geïncludeerd in de studie. Vooropgestelde
parameters die automatisch dienden geëxtraheerd te worden waren initieel PSA (iPSA), finale Gleason score, gebruik radiotherapie en gebruik hormonale therapie. Alle urologisch relevante verslagen werden geanalyseerd door de zoekmachine. In eerste instantie werden Snomed CT® termen uit de dossiers geëxtraheerd. Vervolgens werden de dossiers gescreend op outcome-gerelateerde termen die ontbraken in de Snomed- terminologie om op die manier een groot aantal gedetailleerde ruwe data te bekomen. Hierna werd duplicate en incorrecte informatie via een automatisch ETL (Extraction Transformation Load) algoritme geëlimineerd. Uiteindelijk werden op de data extra parameter-specifieke regels toegepast op basis van het studieprotocol van de medische onderzoekers. De eindresultaten, bekomen via manuele en automatische data - extractie, werden vergeleken met het dossier. Een resultaat werd geklasseerd als ‘False positive’ als dit niet overeenkwam met de juiste waarde uit het dossier en ‘True Positive’ als de juiste waarde wel gevonden werd. Voor elke variabele werd de Precisie (TP/TP+FP) berekend. Bij fouten in automatische extractie werd nagegaan of dit te wijten was aan onvoldoende ruwe data extractie uit het dossier (type 1 fout), niet selecteren van gevonden ruwe data door het ETL algoritme (type 2 fout) of incorrect behouden ruwe data die door ETL algoritme had moeten geëlimineerd worden (type 3 fout). Toestemming ethische commisie is lopende: AZGS2019088.
Uit de medische dossiers van 9 patiënten werden in totaal 228 relevante brieven geanalyseerd. Hieruit werden 1262 relevante outcome-variabelen geëxtraheerd als ruwe data. Deze ruwe Snomed CT codes werden na ETL gereduceerd tot 279 outcome-variabelen. Hieruit werd de hoogst genoteerde PSA binnen 3 maanden na study entry gedefinieerd als iPSA. Verder werd de meest gedetailleerde (Gleason 3+4 ipv Gleason 7) en laatst genoteerde als finale Gleason score gedefinieerd. Indien radiotherapie termen werden weerhouden < 1 jaar na study entry werd dit als adjuvant en daarna als salvage gedefinieerd. Voor hormonale therapie werd gekeken of patiënt dit gekregen heeft (term gevonden ja/nee) en werd ook het zwaarst vermelde product (androgeen deprivatie > bicalutamide) weerhouden. CONCLUSION Automatische data-extractie uit medische verslagen kan een extreme efficiëntie-winst betekenen. Voor de betrokken variabelen schommelde de accuraatheid van de automatische extractie tussen de 55-100%. Dit was het gevolg van onvoldoende extractie van relevante outcome-variabelen uit de dossiers, alsook te stricte dan wel onvoldoende eliminiatie via het ETL algoritme. Optimalisatie en uitbreiding van de huidige resultaten lijkt met parameter-specifieke aanpassingen mogelijk. De studie toonde ook aan dat manueel ingegeven data niet feilloos zijn. Verdere validatie op een grote dataset is noodzakelijk voor verdere oppuntstelling van de technologie.
ABSTRACT 15
Mid-urethral slings (MUS) at risk of extinction? A prospective single-center study.
Ferong K, Vossaert P, Verleyen P, Ghesquière S, Platteeuw L, Van Bruwaene S November 2020, International Continence Society, Online
Zie Gynaecologie pagina 21.
