MP17-07 OUTCOMES OF CONSERVATIVE MANAGEMENT OF SPLENIC INJURY INCURRED DURING PCNL
Bibliographic record
Abstract
You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP17)1 Apr 2019MP17-07 OUTCOMES OF CONSERVATIVE MANAGEMENT OF SPLENIC INJURY INCURRED DURING PCNL Eric Raffin*, Ben Chew, Bodo Knudsen, Nicole Miller, and Vernon Pais Eric Raffin*Eric Raffin* More articles by this author , Ben ChewBen Chew More articles by this author , Bodo KnudsenBodo Knudsen More articles by this author , Nicole MillerNicole Miller More articles by this author , and Vernon PaisVernon Pais More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555432.07297.c6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Splenic injury is a rare complication after left sided percutaneous nephrolithotomy (PCNL). A total of only 11 occurrences have been reported in the literature. Although initial observation is often espoused, the outcomes of non-operative, conservative management are not well established and the implications of splenic injury are not fully defined in this context. We sought to describe outcomes of conservative management of splenic injury incurred at PCNL. METHODS: We performed a multi-institutional retrospective review of individual patients who underwent PCNL complicated by trans-splenic nephrostomy access injury. Demographic info, intraoperative data, management strategies, and outcomes were reviewed. RESULTS: There were a total of 6 patients with splenic injury after left PCNL. 67% were male. Average age was 49.8 years. Average BMI was 28.9 kg/m2. The average stone size was 42.6mm (range 12-91). All patients had at least one supracostal, upper pole access done under fluoroscopic guidance. Splenic injury was identified by CT in the 5 of 6 (83%) who had imaging on first postoperative day. All were managed conservatively with nephrostomy dwell time of 2-21 days, none of whom had further sequelae or delayed bleed. The remaining 1 patient (17%) – who had neither nephrostomy tube in place nor imaging post-op – presented 5 days postoperatively with a delayed bleed and underwent emergent splenectomy. CONCLUSIONS: The majority of patients incurring splenic injury during PCNL can be successfully managed conservatively with maintenance of nephrostomy tube for 2 days or greater. Although rare, this complication underscores the role of routine postoperative CT to allow timely diagnosis, particularly in those undergoing upper pole, supracostal left sided percutaneous renal access. Clinicians must remain vigilant for potential delayed bleeding during the first postoperative week and counsel patients accordingly. Source of Funding: None Lebanon, NH; Vancouver, Canada; Coumbus, OH; Nashville, TN; Lebanon, NH© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e257-e257 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Raffin* More articles by this author Ben Chew More articles by this author Bodo Knudsen More articles by this author Nicole Miller More articles by this author Vernon Pais More articles by this author Expand All Advertisement PDF downloadLoading ...
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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 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 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".