The “incidental anesthetic” — an opportunity for the endoscopic correction of vesicoureteral reflux in children
Bibliographic record
Abstract
Introduction: The endoscopic management of vesicoureteral reflux(VUR) with subureteric injection (STING) has become more popular.The low morbidity associated with the STING procedure hasled to some authors advocating its use as a first-line therapy. Manyparents are uncomfortable with this procedure being performedin children because of the potential morbidity associated with generalanesthesia. We present an alternative without added anestheticmorbidity: offering the parents a STING when their childis undergoing an anesthetic for another surgical indication.Methods: We reviewed the records of 10 children who underwentincidental dextranomer/hyaluronic acid copolymer (DHA) injectionover a 2-year period.Results: We considered the treatment outcome after a single STINGprocedure to be successful in 8 (80%) patients and a failure in 2(20%). Distribution of VUR grade, according to the highest gradeper patient, was high in 5 (50%) patients, moderate in 3 (30%)and low in 2 (20%). We observed no complications.Conclusion: The idea of performing STING in children under incidentalanesthetic introduces yet another possibility in the paradigmof VUR care. Though the long-term efficacy of DHA remains to bedetermined, this option reduces the potential morbidity of DHA asfirst-line therapy while favourably altering the cost benefit.Introduction : L'injection sub-urétérale endoscopique est uneméthode de plus en plus utilisée pour la prise en charge d'un refluxvésico-urétéral (RVU). La faible morbidité associée à cette techniquea amené certains auteurs à recommander son emploi entraitement de première ligne. Bien des parents ne sont pas à l'aiseavec cette suggestion en raison du risque de morbidité lié àl'anesthésie générale. Nous présentons ici une solution de rechangequi n'augmente pas la morbidité liée à l'anesthésie, soit le recoursà l'injection sub-urétérale endoscopique pendant que l'enfantest déjà sous anesthésie pour une autre intervention chirurgicale.Méthodes : Les dossiers de 10 enfants ayant subi une injectionde copolymère de dextranomère / acide hyaluronique (DxAH) aucours d'une période de 2 ans ont été passés en revue.Résultats : Après une seule injection sub-urétérale, l'issue du traitement a été jugée excellente chez 8 patients (80 %) et un écheca été constaté chez 2 patients (20 %). La distribution des stadesde RVU en fonction du stade le plus élevé noté chez chaque patientétait la suivante : grade élevé, 50 %, modéré, 30 % et faible, 20 %.Aucune complication n'a été observée.Conclusion : L'idée de recourir à une injection sub-urétérale pendantune autre intervention nécessitant une anesthésie ajoute uneoption dans l'algorithme de traitement du RVU. Même si l'efficacitéà long terme du DxAH reste à établir, cette option a l'avantagede réduire le risque de morbidité lié au DxAH comme traitementde première ligne tout en modifiant pour le mieux l'équationcoûts-avantages.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 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".