Randomized controlled, multicentre clinical trial comparing a dual‐probe ultrasonic lithotrite with a single‐probe lithotrite for percutaneous nephrolithotomy
Bibliographic record
Abstract
Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Studies have indicated that not all ultrasonic lithotripters are created equal when it comes to efficiency of stone fragmentation and removal. To improve the efficiency of stone fragmentation and removal, combination pneumatic and ultrasonic devices have been developed. This study demonstrates that one available combination device, the Cyberwand, did not decrease the time to removal of the target stone nor did it increase the stone free rate compared to a standard ultrasonic lithotripter. OBJECTIVES • To compare the Cyberwand (Gyrus/ACMI, Southborough, MA, USA), a dual‐probe ultrasonic lithotrite, with a single‐probe ultrasonic lithotrite. • The Cyberwand incorporates coaxial high‐ and low‐frequency ultrasonic probes that work synergistically. PATIENTS AND METHODS • An institutional review board‐approved, multicentre, randomized controlled trial to compare the Cyberwand to the Olympus LUS‐II (Olympus America, Inc., Melville, NY, USA) single‐probe lithotrite was performed. • Patients undergoing a percutaneous nephrolithotomy (PCNL) with a target stone >2 cm in diameter were eligible for the study. • The primary outcome was the time to removal of the targeted stone. RESULTS • A total of 57 PCNLs were performed after randomization: 25 Cyberwand and 32 LUS‐II. • There was no difference ( P > 0.05) observed between the two devices for target stone surface area (Cyberwand 526.6 cm 3 vs LUS‐II 540.1 cm 3 ), time to clearance of target stone (Cyberwand 15.8 min vs LUS‐II 14.2 min) and target stone clearance rate (Cyberwand 61.9 mm 2 /min vs LUS‐II 75.8 mm 2 /min). • Of the patients with stone analysis, hard stones (calcium oxalate monohydrate, brushite and cystine) were noted in 14 (56.0%) of the 25 Cyberwand and 18 (62.1%) of the 29 LUS‐II patients. • Fifteen of the 25 (60.0%) Cyberwand and 20 of the 32 (62.5%) LUS‐II patients were stone‐free after the initial PCNL. • Those patients not rendered stone‐free went on to receive a secondary PCNL. • Device malfunction occurred in eight of 25(32.0%) Cyberwand and five of 32 (15.6%) LUS II patients. • Complications were similar in both treatment groups. CONCLUSION • No appreciable difference between the dual‐probe Cyberwand and the standard ultrasonic Olympus LUS‐II lithotrites can be identified.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.009 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.005 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".