M May1, M Schönthaler2, C Gilfrich3, I Wolff4, J Peter3, A Miernik2, H-M Fritsche5,6, M Burger5, M Schostak7, S Lebentrau8. 1. Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland. matthias.may@klinikum-straubing.de. 2. Urologische Kliniken, Universitätsklinikum Freiburg, Freiburg, Deutschland. 3. Urologische Kliniken, St. Elisabeth-Klinikum Straubing, St.-Elisabeth-Str. 23, 94315, Straubing, Deutschland. 4. Urologische Kliniken, Carl-Thiem-Klinikum Cottbus, Cottbus, Deutschland. 5. Urologische Kliniken, Universitätsklinikum Regensburg, Caritas-Krankenhaus St. Josef, Regensburg, Deutschland. 6. Urologische Abteilung der Chirurgischen Klinik München-Bogenhausen, München, Deutschland. 7. Urologische Kliniken, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland. 8. Urologische Kliniken, Ruppiner Kliniken GmbH, Hochschulklinikum der MHB, Neuruppin, Deutschland.
Abstract
BACKGROUND: The Post-ureteroscopic Lesion Scale (PULS) was designed as a standardized classification system for ureteral lesions after uretero(reno)scopy (URS). This study evaluates its routine use and a possible clinical impact based on a representative patient cohort. MATERIALS AND METHODS: Data of 307 patients in 14 German centers within the BUSTER project were used to test 3 hypotheses (H): PULS score shows a high interrater reliability (IRR) after independent assessment by urologic surgeon and assistance personnel (H1); PULS score is correlated with the frequency of postoperative complications during hospital stay (H2); post-URS stenting of the ureter is associated with higher PULS scores (H3). RESULTS: Median age of patients was 54.4 years (interquartile range [IQR] 44.4-65.8; 65.5% male). Median diameter of index stones was 6 mm (IQR 4-8) with 117 (38.4%) pyelo-caliceal and 188 (61.6%) ureteral stones. Overall, 70 and 82.4% of patients had pre-stenting and post-URS stenting, respectively. Stone-free status was achieved in 68.7% after one URS procedure with a complication rate of 10.8% (mostly grade 1-2 according to Clavien-Dindo). PULS scores 0, 1, 2 and 3 were assessed in 40%, 52.1%, 6.9% and 1% of patients, respectively, when estimated by urologic surgeons. PULS score showed a high IRR between the urologic surgeon and assistance personnel (κ = 0.883, p < 0.001), but was not significantly correlated with complications (ρ = 0.09, p = 0.881). In contrast, a significant positive correlation was found between PULS score and post-URS stenting (ρ = 0.287, p < 0.001). A PULS score of 1 multiplied the likelihood of post-URS stenting by 3.24 (95% confidence interval 1.43-7.34; p = 0.005) as opposed to PULS score 0. CONCLUSIONS: Removal of upper urinary tract stones using URS is safe and efficacious. Real-world data provided by this study confirm a high IRR of the PULS score and its clinical impact on the indication for post-URS stenting. A future prospective randomized trial should evaluate a possible standardization of post-URS stenting based on PULS score assessment.
BACKGROUND: The Post-ureteroscopic Lesion Scale (PULS) was designed as a standardized classification system for ureteral lesions after uretero(reno)scopy (URS). This study evaluates its routine use and a possible clinical impact based on a representative patient cohort. MATERIALS AND METHODS: Data of 307 patients in 14 German centers within the BUSTER project were used to test 3 hypotheses (H): PULS score shows a high interrater reliability (IRR) after independent assessment by urologic surgeon and assistance personnel (H1); PULS score is correlated with the frequency of postoperative complications during hospital stay (H2); post-URS stenting of the ureter is associated with higher PULS scores (H3). RESULTS: Median age of patients was 54.4 years (interquartile range [IQR] 44.4-65.8; 65.5% male). Median diameter of index stones was 6 mm (IQR 4-8) with 117 (38.4%) pyelo-caliceal and 188 (61.6%) ureteral stones. Overall, 70 and 82.4% of patients had pre-stenting and post-URS stenting, respectively. Stone-free status was achieved in 68.7% after one URS procedure with a complication rate of 10.8% (mostly grade 1-2 according to Clavien-Dindo). PULS scores 0, 1, 2 and 3 were assessed in 40%, 52.1%, 6.9% and 1% of patients, respectively, when estimated by urologic surgeons. PULS score showed a high IRR between the urologic surgeon and assistance personnel (κ = 0.883, p < 0.001), but was not significantly correlated with complications (ρ = 0.09, p = 0.881). In contrast, a significant positive correlation was found between PULS score and post-URS stenting (ρ = 0.287, p < 0.001). A PULS score of 1 multiplied the likelihood of post-URS stenting by 3.24 (95% confidence interval 1.43-7.34; p = 0.005) as opposed to PULS score 0. CONCLUSIONS: Removal of upper urinary tract stones using URS is safe and efficacious. Real-world data provided by this study confirm a high IRR of the PULS score and its clinical impact on the indication for post-URS stenting. A future prospective randomized trial should evaluate a possible standardization of post-URS stenting based on PULS score assessment.
Authors: Martin Schoenthaler; Noor Buchholz; Erik Farin; Hammad Ather; Christian Bach; Thorsten Bach; John D Denstedt; Hans-Martin Fritsche; Michael Grasso; Oliver W Hakenberg; Ralf Herwig; Thomas Knoll; Franklin Emmanuel Kuehhas; Evangelos Liatsikos; Peter Liske; Michael Marberger; Palle J S Osther; José Manuel Reis Santos; Kemal Sarica; Christian Seitz; Michael Straub; Olivier Traxer; Alberto Trinchieri; Ben Turney; Arkadiusz Miernik Journal: World J Urol Date: 2013-10-18 Impact factor: 4.226
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Authors: Athanasios E Dellis; Athanasios G Papatsoris; Francis X Keeley; Aristotelis Bamias; Charalambos Deliveliotis; Andreas A Skolarikos Journal: J Endourol Date: 2016-11-29 Impact factor: 2.942
Authors: Martin Schoenthaler; Konrad Wilhelm; Franklin E Kuehhas; Erik Farin; Christian Bach; Noor Buchholz; Arkadiusz Miernik Journal: J Endourol Date: 2012-08-27 Impact factor: 2.942
Authors: Dominik Abt; Kristina Dötzer; Patrick Honek; Karolina Müller; Daniel Stephan Engeler; Maximilian Burger; Hans-Peter Schmid; Thomas Knoll; Francesco Sanguedolce; Hrishi B Joshi; Hans-Martin Fritsche Journal: World J Urol Date: 2016-06-23 Impact factor: 4.226