Notice bibliographique
Résumé
Urethral stricture disease and its management are complex. The UREThRAL stricture score (USS) as described by Wiegand and Brandes is a novel method to describe and quantify urethral stricture disease.1 To develop the USS, they chose factors they believed to be important and assigned a point value to each domain. The appealing UREThRAL acronym was used to recall the domains of etiology, number of strictures, luminal obliteration, location and length. Retrospectively they analyzed a group of postoperative urethral reconstructive patients to see if the score correlated with a subjective surgical complexity score. As they point out, there would be some debate as to the value of the surgical complexity score. Excision and primary anastomosis is doubtlessly the simplest of the open urethral reconstructive techniques and most would agree that combined graft and flap tissue transfer is used for the most complex stricture disease. Variability in surgical training and surgeon preference would be a significant confounder to the treatment complexity score. The value of a quantifiable urethral stricture score would be in comparing the scores to patient outcomes. Outcome measures continue to be one of the major hurdles to overcome in providing good quality research in reconstructive urology. Measurement of patient outcomes following urethral reconstructive surgery is not standardized. Many different methods have been used in the past to evaluate “success” following urethroplasty. Cystoscopy, urethral x-ray studies, uroflow and post-void residuals have been used to capture outcomes. Assessing the quality of life – the most important outcome – has yet to be standardized. Investigators have used non-validated questionnaires (like the AUA symptom score). Recently, Jackson and colleagues have taken a first step to develop a stricture specific health related quality of life questionnaire.2 The current challenge facing reconstructive urology is to develop a validated and standardized method of assessing patients pre- and postoperatively. In the development of The UREThRAL stricture score, the authors have delineated the important factors in determining the complexity of a stricture. This is valuable reminder to all urologists. At the initial evaluation of stricture disease, the factors pointed out by the authors (etiology, number of strictures, luminal obliteration, location and length) are the keys to determine the severity of the stricture itself. The length, as the authors point out, is heavily weighted and it is accepted to be the most likely determinant of both outcome and treatment.3,4 Longer and more complex strictures should signal the urologist to consider early open surgical intervention rather than pursuing futile and repeated endoscopic management (urethrotomy/dilatation). The poor outcomes5 and cost ineffectiveness6 of repeated endoscopic treatment of urethral strictures are well-described in the literature. Failed endoscopic treatment may be a useful additional factor in the USS. This may encourage earlier consideration for urethral reconstruction, which would benefit the patient and the health care system.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,011 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».