Percutaneous nephrostomy versus retrograde ureteral stent in adult patients with malignant ureteral obstruction : comparing changes in the renal function and clinical outcomes
Bibliographic record
Abstract
Background: Urinary diversion (UD) in malignant ureteral obstruction (MUO) is required to relieve symptoms, initiate systemic therapies, and save lives, especially in bilateral ureteral obstruction. Percutaneous nephrostomy (PCN) and retrograde ureteral stent (RUS) are the most common interventional methods. However, these interventional methods' success, efficacy, and complication rates vary. Methods: Clinical outcomes and changes in renal function following UD in patients with MUO treated at Vancouver General Hospital (VGH) from January 2015 to October 2021 were analyzed retrospectively. A total of 159 patients were identified, of whom 81 underwent PCN (38 males (46%) and 43 females (53%), mean age ± SD 65.7± 12.9 years, range 35 to 95 years) and 78 underwent RUS insertion (27 males (35%) and 51 females (65%), mean age 66.4 ± 13.1 years, range 24 to 90 years). Renal function changes were compared between the two groups using serum creatinine and estimated glomerular filtration rate (eGFR) data at baseline, at intervention, and at different time points after intervention (1 week and 1,3,6, and 12 months). Clinical endpoints assessed included the success rate of UD, procedural complications, and the need for another UD method. Results: The renal function was comparable between the two study arms except at the time of the intervention, in which the PCN median creatinine was 290 vs 127 in the RUS (p <0.001) and median eGFR 17 vs 44 (p<0.001). The success rate of intervention was high in both groups and there was no statistically significant difference (97.9% in the PCN group and 93.5% in RUS group (p=0.104)). Compared to the PCN group, the RUS group had a higher rate of residual hydronephrosis following intervention (55% vs 17%, p <0.001), however, residual hydronephrosis was not associated with serum creatinine levels (correlation coefficient 0.075, p=0.419). Complications in the two groups were comparable (PCN 50.6% vs RUS 50%, p=0.367). The median overall survival for all MUO patients was 12.1 months. It was 11.4 months in the PCN group and 13.3 months in the RUS group (p=0.480). Conclusion: PCN and RUS are safe and effective UD methods for decompressing kidneys affected by MUO.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 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".