Primary Ureteric Stent Insertion Under Local Anaesthetic or Sedoanalgesia in Non-pregnancy
Bibliographic record
Abstract
Background and Objective To characterise the evidence surrounding local anaesthetic ureteric stent insertion (LAUSI) in contexts outside of pregnancy, a procedure typically performed under general anaesthetic (GAUSI), as it has never been the subject of a systematic review. Materials and Methods A systematic review of the Medline, EMBASE, PubMed, AMED, BNI, EMCARE, HMIC and PsycINFO databases was conducted to examine the published evidence in line with the Preferred Reporting Items of Systematic Review and Meta-analyses (PRISMA) guidelines surrounding the technique, patient demographics, setting, type of LA± sedoanalgesia used, cystoscopy and fluoroscopy usage, patient tolerability and pain, efficacy, complications and cost-effectiveness. Around 1,460 papers were systematically screened for inclusion. Results Seventeen studies were identified; one randomised controlled trials (RCT), four non-randomised comparative studies, and 12 case-series describing LAUSI. The 17 studies encompassed a total of some 1545 LAUSI. The clinical indications were similar to those for GAUSI. Successful LAUSI rate ranged from 71-98.9% in studies overall, with a pooled mean success rate of 89.3% overall (86.8% in LA only, 91.75% in LA ± sedoanalgesia). The tolerability of a LAUSI patient across 14 studies had a pooled mean rate of 91.8% (88.6% in LA only, 95% in LA ± sedoanalgesia). The procedure time was reported in seven studies, and it ranged from 5.35±0.87 to 65.0±27.5 minutes. The four comparative studies showed no difference in complication rates between LAUSI and GAUSI. All five studies reporting on cost-effectiveness showed LAUSI to be superior to GAUSI. Conclusions LAUSI is a safe, effective, and cost-effective alternative to GAUSI, which is under-utilised. Further research in the form of RCTs is required to formally establish its place and acceptability amongst urologists.
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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 | 0.013 | 0.050 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".