Upper tract imaging after ureteroscopic holmium:YAG laser lithotripsy: when is it necessary?
Bibliographic record
Abstract
INTRODUCTION/OBJECTIVE: Advances in ureteroscope design and refinements of ancillary instrumentation have resulted in an expanded role for ureteroscopy in the management of urinary calculi. Technological enhancements coupled with improved endourologic skills have also been associated with a reduction in procedural-related complications. Historically, postoperative imaging with ultrasound (U/S) or intravenous pyelogram (IVP) had been advocated to rule out persistent obstruction due to retained stone fragments or ureteral stricture. The purposes of this study were to evaluate the incidence of postoperative ureteral obstruction in a contemporary series of patients undergoing ureteroscopic holmium:YAG laser lithotripsy without basket extraction of fragments and to identify patient, stone and operative factors predictive of which patients will benefit from postoperative imaging. MATERIALS AND METHODS: The charts and imaging studies of 89 consecutive patients undergoing a total of 94 holmium:YAG ureteroscopic lithotripsy procedures between December 1998 and December 2000 were retrospectively reviewed. Preoperative, intraoperative and postoperative data were collected and analyzed. The primary outcome measure was the incidence of postoperative ureteral obstruction documented on upper tract imaging. Secondary outcome measures included interventions required for postoperative obstruction and other nonobstructive postoperative complications. RESULTS: Twenty-eight females and 61 males were studied, with a mean patient age of 54 (range 13-80) years. Fifty-five percent of patients underwent related procedures prior to referral to our tertiary endourology centre. Complete clinical and radiological follow-up is available for 68 of 89 (76.4%) patients, with a mean follow-up duration of 24.2 weeks. Overall stone-free rate was 97%. Six patients had evidence of urinary tract obstruction on follow-up radiological assessment, two from residual stone fragments and four from ureteral stricture. Each of these four patients had at least one preoperative risk factor for ureteral stricture. CONCLUSIONS: Routine postoperative upper tract imaging is not necessary in all patients undergoing uncomplicated ureteroscopic holmium:YAG laser lithotripsy. Indications for upper tract imaging include chronic stone impaction, significant ureteral trauma, pre-existing renal function impairment, endoscopic evidence of stricture and postoperative flank pain or fever.
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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 | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 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".