Evaluation of ureteral injury using the PULS grading system in patients undergoing semi-rigid and flexible ureteroscopy.

Abstract

Purpose: Ureteroscopy is one of the main diagnostic and treatment approaches for the upper urinary system luminal pathologies today. In recent years complication rates have decreased significantly. Standardizing ureteral damage after ureteroscopic interventions is of great importance for the management of complications. This study aimed to prospectively evaluate ureteral damage and factors affecting it in patients who underwent retrograde intrarenal surgery (RIRS) with ureteral access sheath (UAS), RIRS without UAS, and stone treatment with semi-rigid ureteroscope.

Methods: In this study, we included patients who underwent endoscopic surgery for ureter or kidney stones in our clinic. The ureteral pathologies of 202 patients who underwent RIRS with UAS, RIRS without the use of UAS, and semi-rigid ureteroscopy were prospectively evaluated using the Post-Ureteroscopic Lesion Scale (PULS).

Results: 75.7% of the lesions were PULS grade 1, 15.3% were grade 2. Lesions were most commonly located in the lower ureter during semi-rigid ureteroscopy, in the middle ureter during RIRS without a sheath, and in the upper ureter during RIRS with a sheath (p = 0.003). PULS 1 lesions (55.6%) were more commonly observed in the lower ureter, and PULS 2 lesions (41.9%) were also predominantly located in the lower ureter compared to other parts of the ureter.

Conclusion: It should be kept in mind that ureteral damage may occur after the ureteroscopy procedure. The degree and localization of the ureteral lesion may vary depending on the procedure to be chosen. Evaluating ureteral damage using the PULS scoring system is important for patient management.