Retrograde intrarenal surgery with flexible and navigable suction ureteral access sheaths vs. percutaneous nephrolithotomy for 2–3 cm kidney stones
Bibliographic record
Abstract
INTRODUCTION: The management of renal stones measuring 2-3 cm remains a clinical challenge, with percutaneous nephrolithotomy (PCNL) traditionally favored over retrograde intrarenal surgery (RIRS) due to higher stone-free rates (SFR); however, advancements in flexible ureteroscopy and the introduction of flexible and navigable suction ureteral access sheaths (FANS-UAS) have expanded the role of RIRS for larger stones. This study compares the efficacy and safety of PCNL vs. FANS-UAS-assisted RIRS for medium-sized renal calculi. METHODS: This retrospective study included 116 patients (50 RIRS, 66 PCNL) with 2-3 cm renal stones treated at a single institution. RIRS was performed using an 11/13 Fr FANS-UAS, while PCNL followed standard techniques. Outcomes assessed included operative time, hospitalization, hemoglobin drop, SFR (defined as no fragments ≥1 mm on three-month computed tomography), and complications (Clavien-Dindo). RESULTS: Baseline characteristics were comparable between groups (p>0.05). RIRS demonstrated significantly shorter operative times (63.1±11.3 vs. 97.3±15.1 minutes, p<0.001) and hospitalization (28.3±17.9 vs. 81±24.8 hours, p<0.001), with less hemoglobin drop (0.4±0.5 vs. 2.1±1.7 g/dL, p<0.001). SFRs were similar at three months (70% RIRS vs. 74.2% PCNL, p=0.677). PCNL had higher complication rates, including three grade III events (vs. none in RIRS), although not statistically significant (p=0.277). CONCLUSIONS: FANS-UAS-assisted RIRS offers comparable SFRs to PCNL for 2-3 cm stones, with advantages in operative efficiency, hospitalization, and perioperative safety. These findings suggest RIRS as a viable minimally invasive alternative, warranting further randomized trials to validate its role in this setting.
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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".