Bibliographic record
Abstract
Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is the gold standard therapy for large renal calculi.The optimal puncture site for collecting system access remains controversial, with many suggesting increased morbidity from supracostal puncture.We report a retrospective review of 318 consecutive PCNL cases over a sixty month time period performed by two surgeons in a teaching environment.Materials and Methods: Perioperative data was collected on 318 consecutive PCNL cases performed for intra-renal nephrolithiasis from May 2004 to June 2009.Patient demographics, stone, operative, postoperative and follow-up data were collected.Complications were assessed using the Clavien system and stone outcomes were assessed with KUB x-rays and CT scans.Successful treatment outcome was defined as stone free or sandlike (1 mm or less) particles on CT scan.Results: Three hundred and eighteen patients undergoing PCNL in the prone-flexed position (57.9% male) with a mean age of 52.9 years (SD 14.4) and mean BMI 27.8 kg/m 2 (SD 6.0) were analyzed.Sixteen (5.4%) of the tracts were above the 11 th rib, 120 (40.8%) were above the 12 th rib and 158 (53.7%) were infracostal.Multiple tracts were used in 16 (5%) of patients.There were no significant differences between patients undergoing supracostal versus infracostal puncture with respect to side, stone area, number of tracts, number of stones, or the presence of staghorn or struvite calculi, although there was a trend to larger stones and more staghorn calculi in the supracostal group.Success rates in the supracostal group (89.8%) were equivalent to the infracostal group (94.1%).Complication rates across groups were low, with no significant difference in complications between the supracostal and infracostal puncture groups, respectively, across Clavien grade I (12 vs. 1), grade II (4 vs. 11), grade IIIa (4 vs. 0), grade IIIb (2 vs. 0), and grade IVa (1 vs. 2), p = 0.067.All four (2.6%) Clavien grade IIIa complications in the supracostal group were pleural complications requiring chest drain insertion.No patients required a blood transfusion or angioembolisation.Conclusion: When indicated, supracostal access can provide excellent outcomes, particularly for patients with complex stone disease while obviating the need for multiple tracts or retreatment.Although complications, particularly pleural, occur more frequently in those patients undergoing supracostal puncture, the incidence is low and acceptable considering the significant advantages in this patient population.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.004 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.639 | 0.371 |
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; the direct Gemma label and the distilled Codex classifier agree on what is shown here.
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".