Ureteral Stricture Risk After Ureteroscopy: The PULS Score "Presentation" - Amir Lavasani
August 14, 2024
At the World Congress of Endourology and Uro-Technology, Amir Lavasani presents a study on ureteral stricture formation following ureteroscopy, analyzing 550 cases from 2018 to 2022. The research examines the relationship between stricture formation and injury severity using the Post-Ureteroscopic Lesion Scale (PULS). The study concludes that stricture rates significantly increase with partial or transmural ureteral injuries, emphasizing the importance of this binary grading system for post-operative management of injured ureters.
Biographies:
Seyed Amiryaghoub M. Lavasani, Department of Urology, University of California, Irvine, CA
Biographies:
Seyed Amiryaghoub M. Lavasani, Department of Urology, University of California, Irvine, CA
Read the Full Video Transcript
Seyed Amir Yaghoub M. Lavasani: Dear viewers, my name is Amir Lavasani, and I'm a research specialist with the Department of Urology at the University of California, Irvine. I'm proud to present the following study titled Incidence of Ureteral Strictures Following Ureteral Access Sheath Passage: An In-depth Study of 550 Contemporary Cases.
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.
Seyed Amir Yaghoub M. Lavasani: Dear viewers, my name is Amir Lavasani, and I'm a research specialist with the Department of Urology at the University of California, Irvine. I'm proud to present the following study titled Incidence of Ureteral Strictures Following Ureteral Access Sheath Passage: An In-depth Study of 550 Contemporary Cases.
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.