Classification of the renal papillary abnormalities by flexible ureteroscopy: evaluation of the 2016 version and update

Abstract

Introduction To assess the use of the 2016 proposed classification of the renal papillary abnormalities during flexible ureteroscopy that aims to standardize their description. Patients and methods We performed a prospective monocentric single operator collection of the data using this classification during 88 consecutive flexible ureteroscopies required for renal stones treatment. Outcome measurements and statistical analysis: data of stones analysis (microscopy and infrared spectrophotometry) and of serum and urines biochemical samples have been compared with the results of the classified endoscopic descriptions. Results Mean duration of description was 81.4 s. We reported that 83% of the patients had Randall plaques (RP), as only 4.5% of the patients had no abnormality. Concerning the papillary stones and anchored stones were observed in 30.7% and aspect of intraductal crystallization (Sc) in 15.9%. Erosions were present in 55.7% and extrophic papillae in 8%. Sa1 and Pa2 were significantly correlated to RP, anchored stones (Sa) to papillary erosions and calcium phosphate stones to intraductal crystallization. Hypercalciuria was significantly higher in Sa2 than Sa1 stones. Conclusions The different descriptions in the 2016 classification were confirmed by the results of this study. Papillary abnormalities are consequences of stones development. Their descriptions could also improve the follow-up and the diagnosis of a metabolic lithogenesis. We recommend their systematic description during ureteroscopy. Some improvements are proposed to update this classification.

Toward improved endoscopic examination of urinary stones: a concordance study between endoscopic digital pictures vs microscopy

“…As Almeras et al . [21] described a higher incidence of IVa2 stones when intrapapillary crystallisation occurred and others descriptions correlated to different lithogenesis mechanisms, the description of papillary abnormalities during flexible ureteroscopies would certainly add a diagnostic value to this ESR.…”

Endoscopic Papillary Abnormalities and Stone Recognition (EPSR) during Flexible Ureteroscopy: A Comprehensive Review

“…The appearance of one papilla is not accurate enough to predict the type and the severity of the disease, and a papillary abnormality could be also explained by the appearance of neighboring papillae. Almeras et al [25] reported a mean duration of 81.4 s (range: 48-149; median 64) in exploring the entire kidney. A scoring system [20] and a classification [21] have been proposed to standardize the descriptions and store the data.…”

“…Since Randall's works [11] in the 1930s, it is known that papillary calculi resulted from subepithelial lesions [12][13][14][15][16][17]. The advent quality of images with flexible retrograde ureteroscopy has allowed the in vivo description of papillary abnormalities [18][19][20][21] that can be related to various lithogenesis mechanisms [22][23][24][25][26][27][28]. Since Randall's works [11] in the 1930s, it is known that papillary calculi resulted from subepithelial lesions [12][13][14][15][16][17].…”

Recommandations du Comité Lithiase de l’Association Française d’Urologie pour la prise en charge des calculs urinaires durant la crise sanitaire liée à la pandémie à COVID-19

“…Cependant, la réalisation des bilans métaboliques qui a été arrêtée durant la phase critique de l'épidémie ainsi que le confinement devra être reconsidérée avec leur allègement, notamment pour les patients à fort risque de récidive. L'analyse morpho-constitutionnelle et spectrophotométrique infrarouge des calculs, la description endoscopique des calculs [17] et la description des anomalies papillaires [18,19] apportent des informations essentielles et rapides pour initier une orientation diagnostique et préventive.…”