Ureteral Access Sheath Use and Stenting in Ureteroscopy: Effect on Unplanned Emergency Room Visits and Cost
Why this work is in the frame
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Bibliographic record
Abstract
PURPOSE: We studied the impact of stented and unstented ureteroscopy on unplanned emergency room (ER) return visits, medical costs, and whether use of a ureteral access sheath precluded uncomplicated ureteroscopy. PATIENT AND METHODS: A series of 161 consecutive patients undergoing ureteroscopy for renal or ureteral stones was evaluated retrospectively. We examined sex, age, stone size, stone location, use of a ureteral access sheath, use of a ureteral stent, unplanned ER visits, unplanned imaging, and interventions. Medical costs were calculated according to British Columbia Medical Services Plan rates. RESULTS: In the 107 stented and 54 unstented patients, the mean stone sizes were 9 and 7 mm, respectively (P = 0.01), and ureteral access sheaths were used in 55% and 35% (P = 0.002). Stent use did not differ by patient age or sex or stone location. The ER return rates were 17% v 22% for the stented and unstented patients, respectively (P = 0.40), with emergency CT scans being performed in 28% v 75% of the returning patients (P = 0.02), hospital readmission in 22% v 58% (P = 0.05), and urgent decompression in 0 v 25% (P = 0.04). Among patients who were not stented, 37% of those treated using ureteral access sheaths v 14% treated without access sheaths returned to the ER (P = 0.04). The median costs were CDN dollars 1212 for stented and CDN dollars1071 for unstented patients (P < 0.0001). CONCLUSIONS: The unplanned ER return rate is similar whether patients are stented or unstented after ureteroscopy. The median cost saving for unstented patients is approximately CDN dollars140. Use of a ureteral access sheath precludes uncomplicated ureteroscopy, and a ureteral stent should be placed in these cases.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
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 it