The Post-Ureteroscopic Lesion Scale (PULS) is a validated, standardised scale that classifies iatrogenic ureteral lesions during ureteroscopy (URS).
To determine risk factors for the various PULS-grades caused by URS.
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.
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).
Intracorporal lithotripsy is associated with a significant increase in damage to the ureter; further research is needed to determine its long-term effects.
Urologia internationalis. 2018 Nov 27 [Epub ahead of print]
Steffen Lebentrau, Philippe-Fabian Müller, Arkadiusz Miernik, Martin Schönthaler, Christian Gilfrich, Julia Peter, Martin Schostak, Matthias May, BUSTER study group
Department of Urology and Pediatric Urology, Ruppiner Kliniken, University hospital, Brandenburg Medical School, Neuruppin, ., Department of Urology, Faculty of Medicine, University of Freiburg, Medical Centre, Freiburg, Germany., Department of Urology, St. Elisabeth Hospital, Straubing, Germany., Department of Urology and Pediatric Urology, Magdeburg University Medical Centre, Magdeburg, Germany.