Comparison of retrograde flexible ureteroscopy and percutaneous nephrolithotomy in treating intermediate-size renal stones (2-3cm): a meta-analysis and systematic review
Bibliographic record
Abstract
ABSTRACT Purpose: To systematically assess the effectiveness and safety of retrograde flexible ureteroscopy (FURS) versus percutaneous nephrolithotomy (PCNL) in treating intermediate-size renal stones (2-3cm). Materials and Methods: PubMed, Ovid MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL) and EMBASE were researched to identify relevant studies up to May 2018. Article selection was performed through the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. The Newcastle-Ottawa Scale was applied to assess the methodological quality of case-control studies. Results: Six retrospective case-controlled trials were included for meta-analysis. The pooled results showed that PCNL was associated with a higher initial stone-free rate (SFR). After more complementary treatments, FURS provided a final SFR (OR: 1.69; 95% CI, 0.93-3.05; P = 0.08) comparable to that achieved by PCNL. PCNL was associated with a higher rate of overall intraoperative complications (OR: 1.48; 95% CI, 1.01-2.17; P = 0.04) and longer hospital stay (MD: 2.21 days; 95% CI, 1.11 to 3.30; P < 0.001). Subgroup analysis by Clavien-graded complication showed PCNL had significantly higher rates of minor complications (OR: 1.58; 95% CI, 1.04-2.41; P = 0.03). No significant difference was noted in major complications (OR: 1.14; 95% CI, 0.53-2.45; P = 0.73) or operative times (MD: −9.71 min; 95% CI, −22.02 to 2.60; P = 0.12). Conclusions: Multisession FURS is an effective and safe alternative to PCNL for the management of intermediate-size renal stones (2-3cm). It is advisable to balance the benefits and risks according to the individual characteristics of patients and to decide with patients by discussing the advantages and disadvantages of each procedure.
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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 | 0.011 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.027 | 0.048 |
| Bibliometrics | 0.007 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| 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".