The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability

Schoenthaler, Martin; Buchholz, Noor; Farin, Erik; Ather, M Hammad; Bach, Christian; Bach, Thorsten; Denstedt, John D.; Fritsche, Hans‐Martin; Grasso, Michael; Hakenberg, Oliver W.; Herwig, Ralf; Knoll, Thomas; Kuehhas, Franklin E.; Liatsikos, Evangelos; Liske, P.; Marberger, Michael; Osther, Palle Jørn Sloth; Santos, Jose’ Manuel Reis; Sarıca, Kemal; Seitz, Christian; Straub, Michael; Traxer, Olivier; Trinchieri, Alberto; Turney, Ben; Miernik, Arkadiusz

doi:10.1007/s00345-013-1185-1

Cited by 66 publications

(34 citation statements)

References 19 publications

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“…As these results concur with other studies' findings, PULS can justifiably be considered a reproducible grading system for ureteral lesions after URS [4,5,10,11]. Being so very reliable, the PULS scoring system enables us to standardise the placement of postoperative ureteral stents.…”

Section: Discussionsupporting

confidence: 79%

“…Prior to trial initiation, the participating surgeons were instructed on how to apply the PULS classification [4,5]. Every operating room was outfitted with a laminated chart containing graphics illustrating the 6 PULS grades (0-5; Fig.…”

Section: Trial Criteria and Data Collectionmentioning

confidence: 99%

“…1) in 2012 -the empirically developed standardised classification of intraoperative ureteral lesions following URS whose aim it is to help standardise the postoperative placement of a ureteral stent. The same working group published robust interrater reliability (Kendall's W = 0.69, p < 0.001) between URS-experienced endourologists and trainees (n = 20 and n = 17) evaluating 100 standardised video sequences [5].…”

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Ureteral Damage in Ureteroscopic stone Treatment: Results of the German Prospective Multicentre Benchmarks of Ureterorenoscopic Stone Treatment-Results in Terms of Complications, Quality of Life, and Stone-Free Rates Project

et al. 2018

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Background: The Post-Ureteroscopic Lesion Scale (PULS) is a validated, standardised scale that classifies iatrogenic ureteral lesions during ureteroscopy (URS). Objective: To determine risk factors for the various PULS-grades caused by URS. Method: We prospectively investigated the independent influence of various risk factors in correlation with PULS-Grade 1+ and 2+ on 307 patients with ureterorenoscopic stone treatment from 14 German urologic departments. Results: The following are the outcomes of the study: 117 (38.4%) and 188 (61.6%) of the calculi (median stone size 6 mm) were found in the kidney or ureter; 70% and 82.4% underwent preoperative or postoperative ureteral stenting; 44.3 and 7.2% received laser or ballistic lithotripsy; 60% of the patients presented with PULS grade 1+ and 8% with PULS grade of 2+. Only intracorporal lithotripsy revealed a significant independent risk factor for PULS grade 1+ or 2+. Both laser and ballistic therapies raised the probability of PULS grade 1+ by the factors 3.6 (p < 0.001) and 3.9 (p = 0.021), respectively. The ORs in conjunction with PULS grade 2+ were 3.1 (p = 0.038) and 5.8 (p = 0.014) respectively. Neither endpoint exhibited a significant difference regarding the lithotripsic procedure (laser vs. ballistic). Conclusion: Intracorporal lithotripsy is associated with a significant increase in damage to the ureter; further research is needed to determine its long-term effects.

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Section: Discussionsupporting

confidence: 79%

Section: Trial Criteria and Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk Factors for Ureteral Damage in Ureteroscopic stone Treatment: Results of the German Prospective Multicentre Benchmarks of Ureterorenoscopic Stone Treatment-Results in Terms of Complications, Quality of Life, and Stone-Free Rates Project

et al. 2018

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“…Finally, a semirigid ureteroscope was inserted through the UAS, and during retraction of the sheath the ureter was inspected for visible lesions, which were characterized and registered using the PULS classification system [11]. …”

Section: Methodsmentioning

confidence: 99%

Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model

Lildal

Andreassen

Christiansen

et al. 2016

Advances in Urology

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Objective. High intraluminal pressure during ureterorenoscopy (URS) increases risk of infectious and haemorrhagic complications. Intrarenal pressure may be reduced by the use of ureteral access sheaths (UASs), which on the other hand may cause ureteral damage. We have previously shown that the β-agonist isoproterenol (ISO), when administered topically in the irrigation fluid, is able to inhibit ureteral muscle tone and lower intrarenal pressure during URS. The aim of this study was to examine the effect of ISO on the success rate of UAS insertion in a porcine model. Materials and Methods. 22 pigs in which a UAS could not initially be placed were randomized to endoluminal irrigation with either ISO (0.1 μg/mL) or saline before a new insertion trial. Subsequently, it was registered whether the UAS could be passed without resistance. During extraction of the sheath, any ureteral lesions were characterized ureteroscopically using the PULS classification system. Surgeons were blinded to randomization. Results. In the ISO group, the observed effect of irrigation was 63% successful UAS insertions, compared to 27% in the saline group. No serious lesions (

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“…In addition, whether ureteral perforation was defined as the presence of visible fat and/or contrast extravasation was not clearly defined by Schuster et al [10]. The post-ureteroscopic lesion scale and the ureteral access sheath-related ureteral wall injury endoscopic classification have been therefore proposed to standardize the classification of ureteral wall injuries [28,29]. …”

Section: Discussionmentioning

confidence: 99%

Is Prolonged Operation Time a Predictor for the Occurrence of Complications in Ureteroscopy?

et al. 2015

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Objective: To determine the impact of duration of ureteroscopy for urolithiasis on complication rates (CRs) of the procedure. Methods: A retrospective analysis of 2,010 patients, treated between 2006 and 2011, was done. The operation time (OT) and the occurrence of complications were compared. Results: The overall CR was 14.3% [298 complications, minor complications (Clavien I-II) 91.7%]. The median OT was 35 min [interquartile range (IQR) 20-61]. The OT differed significantly between those without complications [34 min (IQR 20-60)] and those with complications [45 min (IQR 25-76)] (p < 0.0001). The correlation between the OT and the occurrence of complications (r = -0.009648, p < 0.0001) was very weak and passed the level of significance (r = 0.2). The effect size was of minor relevance (Cohen's d = 0.27972). Conclusions: Longer OT correlates significantly with a higher CR. The effect is however shown to be minor and the overall rate of complications, especially severe ones, is low.

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The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability

Cited by 66 publications

References 19 publications

Risk Factors for Ureteral Damage in Ureteroscopic stone Treatment: Results of the German Prospective Multicentre Benchmarks of Ureterorenoscopic Stone Treatment-Results in Terms of Complications, Quality of Life, and Stone-Free Rates Project

Risk Factors for Ureteral Damage in Ureteroscopic stone Treatment: Results of the German Prospective Multicentre Benchmarks of Ureterorenoscopic Stone Treatment-Results in Terms of Complications, Quality of Life, and Stone-Free Rates Project

Pharmacological Relaxation of the Ureter When Using Ureteral Access Sheaths during Ureterorenoscopy: A Randomized Feasibility Study in a Porcine Model

Is Prolonged Operation Time a Predictor for the Occurrence of Complications in Ureteroscopy?

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