PD04-08 ASSESSING THE THRESHOLD FOR INJURY WHEN PASSING AN URETERAL ACCESS SHEATH: HOW MUCH FORCE IS TOO MUCH?
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Résumé
You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (PD04)1 Apr 2019PD04-08 ASSESSING THE THRESHOLD FOR INJURY WHEN PASSING AN URETERAL ACCESS SHEATH: HOW MUCH FORCE IS TOO MUCH? Shlomi Tapiero*, Kamaljot S. Kaler, Linda M. Huynh, Mitchell L. O'Leary, Vinay G. Cooper, Zachary A. Valley, Renai H. Yoon, Roshan M. Patel, Zhamshid Okhunov, Michael Klopfer, Jaime Landman, and Ralph V. Clayman Shlomi Tapiero*Shlomi Tapiero* , Kamaljot S. KalerKamaljot S. Kaler , Linda M. HuynhLinda M. Huynh , Mitchell L. O'LearyMitchell L. O'Leary , Vinay G. CooperVinay G. Cooper , Zachary A. ValleyZachary A. Valley , Renai H. YoonRenai H. Yoon , Roshan M. PatelRoshan M. Patel , Zhamshid OkhunovZhamshid Okhunov , Michael KlopferMichael Klopfer , Jaime LandmanJaime Landman , and Ralph V. ClaymanRalph V. Clayman View All Author Informationhttps://doi.org/10.1097/01.JU.0000555056.73845.53AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Ureteral injury is a potential complication of ureteral access sheath (UAS) deployment. The amount of force that results in clinical ureteral injury has yet to be defined. Herein, we present our clinical experience using a novel UAS Force Sensor (UAS-FS) during routine ureteroscopy. METHODS: UAS deployment force was measured with a UAS-FS, developed in collaboration with engineers at our institution (Figure 1). Continuous UAS-FS measurements were recorded from the urethral meatus until either the UAS reached the desired ureteral deployment site or 10 Newtons (N) was recorded. A 16 Fr UAS was used in each initial attempt. Fluoroscopic images were obtained at 2 N, 4 N, 6 N, 8 N, and 10 N. In general, if 8 N was reached, the 16 Fr UAS was exchanged for a 14 Fr or 11 Fr UAS. Ureteroscopic assessment of the ureter at the end of each case was quantitated using the post-ureteroscopic lesion scale (PULS). RESULTS: UAS deployment force was measured in 72 ureters among 65 patients. The 16 Fr UAS was deployed in 51 ureters (71%) at a maximal force of 5.4 N (1.9-11.6). In the remaining cases, a 14 Fr or 11 Fr UAS was passed in 19% and 10% with a maximal force of 4.6 N (1.4-9.1) and 3.1 N (1.2-5.0), respectively (p=0.08). Maximum peak force was most commonly recorded (31%) at the distal ureter. PULS 0, 1, and 2 were recorded in 31%, 36%, and 15% of cases, respectively (not recorded in 17%) (Table 1). A single PULS 3 was noted following deployment of a 14 Fr UAS at a peak pressure of 8.9 N. Of note, when the force applied was <5 N, the PULS score was consistently ≤1. On multivariate analysis, successful deployment of a 16 Fr UAS was associated with pre-stented ureters (p=0.04). Preoperative treatment with tamsulosin was not associated with lower PULS (p=0.32), lower peak force applied (p=0.39), or with an increase in deployment of the 16 Fr UAS (p=0.45). CONCLUSIONS: Using an UAS-FS, ureteral access deployment force could be continuously measured in the clinical setting. Limiting the deployment force to <5 N consistently resulted in a PULS score of ≤1. Source of Funding: none Orange, CA; Calgary, Canada; Orange, CA; Irvine, CA; Orange, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e76-e77 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shlomi Tapiero* More articles by this author Kamaljot S. Kaler More articles by this author Linda M. Huynh More articles by this author Mitchell L. O'Leary More articles by this author Vinay G. Cooper More articles by this author Zachary A. Valley More articles by this author Renai H. Yoon More articles by this author Roshan M. Patel More articles by this author Zhamshid Okhunov More articles by this author Michael Klopfer More articles by this author Jaime Landman More articles by this author Ralph V. Clayman More articles by this author Expand All Advertisement PDF downloadLoading ...
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 | 0,002 | 0,009 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,004 | 0,003 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,113 | 0,062 |
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 ».