Clinical Outcomes Comparing Mini Versus Standard PCNL Without Postoperative Nephrostomy Tube: A Multi-institutional Randomized Controlled Trial From the EDGE Consortium
Bibliographic record
Abstract
OBJECTIVE: To investigate whether a smaller tract size for percutaneous nephrolithotomy (PCNL) may result in fewer complications including blood loss, while retaining similar stone-free rates and operative time, utilizing a modern approach without postoperative nephrostomy tube. METHODS: We performed a randomized controlled trial at five participating EDGE institutions in North America. Patients were randomized to receive 17.5Fr miniature tract vs 30Fr standard sized tract for PCNL without postoperative nephrostomy tubes. RESULTS: Demographic variables were similar. Mean decrease in hemoglobin was 1.84 g/dL for standard and 1.67 g/dL for mini (p = .654), with similar blood transfusion rates. Differences in stone-free rates (71% standard vs 77% mini) emergency room visits (13% vs 23%), additional procedural interventions (9% vs 3%), and intrarenal pressure measurements were not statistically significant. Mean pain scores in the post-anesthesia care unit were low in both groups (2.53 standard vs 1.88 mini, p = .440). Clavien-Dindo complication rates were 14% for standard and 15% for mini (p = .593). There were 11% and 5% of patients in standard and mini groups who experienced at least 2/4 systemic inflammatory response syndrome (SIRS) criteria (p = .370). CONCLUSION: Results from a multi-institutional randomized controlled trial evaluating mini versus standard PCNL without postoperative nephrostomy tubes indicate no statistically significant differences in intraoperative, postoperative, or stone-free outcomes. Surgeons should be empowered to utilize the PCNL tract size that best meets the needs of their patient, institution, and practice.
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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 | 0.007 | 0.010 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 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".