TRANSCRIPT VIDEO ID 4248 I WCET 2024 - UroToday - PULS3
Despite the low occurrence of strictures, little is known about the association between ureteral stricture formation and graded ureteral injury severity. We sought to determine the risk of ureteral stricture formation following ureteroscopy based on the Post-Ureteroscopic Lesion Scale (PULS) for each separate level of injury.
At our institution, between 2018 and 2022, 684 patients who underwent flexible ureteroscopy were entered into our data registry. Among these patients, 550 had a PULS score recorded and follow-up imaging. To define ureteral stricture formation, all patients underwent post-operative imaging at three to six months. A penalized logistic regression model was utilized to assess different factors that might increase the likelihood of developing a ureteral stricture.
De-novo stricture rates were 0% for PULS 0, 0.48% for PULS 1, and 1.1% for a superficial urothelial tear, PULS 2. Notably, for PULS 3, a transmural injury with visualization of fat, the stricture rate rose to 13%. Given the stricture rate jumps 13-fold for a PULS 2 injury and 40-fold for a PULS 3 injury, we propose a new binary scoring system in which patients are divided into one of two categories for ureteral stricture prognostication.
Category one will assess cases with no urothelial disruption, UCI 0, equivalent to PULS 0 and 1, versus those with superficial urothelial disruption, UCI 1, equivalent to PULS 2. Category two will assess superficial urothelial disruption, UCI 1, against more severe disruptions involving the presence of fat, UCI 2, equivalent to PULS 3 or higher.
In conclusion, stricture rates surge when the integrity of the ureteral wall is subject to a partial or transmural injury. A binary grading system based first on the absence or presence of ureteral splitting, and second, the depth of ureteral injury, provides for stricture prognostication and post-operative management of the injured ureter. Thank you for your time.