Clinical applications of the IAU guideline on retrograde intrarenal surgery
Notice bibliographique
Résumé
Kidney stones represent one of the most common human medical conditions. Surgical management of stone disease has undergone immense change in the last 40 years based on advances in technology and operative techniques. Currently, the vast majority of stones can be managed by shock wave lithotripsy (SWL), percutaneous nephrolithotomy (PCNL), ureteroscopy (URS) or a combination of these modalities [1]. Accumulated experience has demonstrated that both stone factors (size, location, composition) and patient factors (body mass index, renal anatomy, and presence of obstruction with or without infection) are crucial to consider for a well-planned stone removal that will result in high stone-free rates with minimal or no complications. Due to its effectiveness, PCNL has been the preferred approach for stones >2 cm in an intrarenal location [2]. The procedure carries a certain level of invasiveness, however, with violation of the renal parenchyma and the possibility of significant bleeding or injury to adjacent organs. This has encouraged endourologists to explore less invasive alternatives, most notably a retrograde approach with flexible ureteroscopy (fURS) and laser lithotripsy with or without concurrent removal of stone fragments using a variety of retrieval devices [3, 4]. fURS for <2 cm stones located above the iliac vessels has demonstrated superior stone-free rates in a single procedure when compared to SWL. PCNL is still recommended by both the AUA and European Association of Urology guidelines as the first-line approach for stones in an intrarenal location which are >2 cm in size [5, 6]. However, recent years have seen an expanded role for fURS to include larger stones, particularly in patients with other comorbidities such as obesity, musculoskeletal conditions precluding positioning for PCNL or in those on anticoagulants for a variety of associated medical disorders [7-10]. Improvements in endoscope technology, availability of high-powered holmium lasers with variable pulse parameters, new technologies such as the thulium fibre laser and advancements in ancillary devices, such as ureteric access sheaths with suction capabilities, have all facilitated this global trend towards the increased use of fURS. It remains to be seen, by way of well-conducted randomized prospective trials, whether results with fURS in a standard patient with a >2 cm intrarenal stone will provide the same stone-free rates in a single procedure and with low rates of sepsis compared to the well-documented results with PCNL. Currently available guidelines have generally focused at a high level on indications, contraindications and patient selection for deployment of the various surgical approaches to kidney stone patients. The International Alliance on Urolithiasis guidelines on retrograde intrarenal surgery, in addition to covering these overarching considerations, also provide many practical recommendations on the step-by-step approach to retrograde intrarenal surgery for urolithiasis. The guidelines will thus be immediately applicable to daily practice and very helpful to both trainees and practising urologists alike. The field of surgical stone management continues to evolve very rapidly. The International Alliance of Urolithiasis plans to review the guidelines every 2 years and I would encourage them to keep up the great work. Stay tuned! Patent and Royalties Cook Percutaneous Stone Basket.
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 | 0,009 | 0,026 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,004 | 0,003 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,005 | 0,005 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,006 |
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 ».