Şimşek Alper, Duran Mesut Berkan, Aydın Mustafa, Yıldız Hakan, Ordulu Reha, İrkilata Lokman, Kırdağ Mustafa Koray, Öztürk Uğur, Küçük Emrah, Atilla Mustafa Kemal
Department of Urology, Siverek State Hospital, Sanliurfa, Turkey.
Department of Urology, Pamukkale University Hospital, Denizli, Turkey.
World J Urol. 2025 Mar 18;43(1):176. doi: 10.1007/s00345-025-05461-3.
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.
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).
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.
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.
输尿管镜检查是目前上尿路腔道疾病的主要诊断和治疗方法之一。近年来，并发症发生率显著下降。规范输尿管镜干预后的输尿管损伤对于并发症的处理至关重要。本研究旨在前瞻性评估接受输尿管硬镜逆行肾内手术（RIRS）并使用输尿管通路鞘（UAS）、未使用UAS的RIRS以及使用半硬性输尿管镜进行结石治疗的患者的输尿管损伤情况及其影响因素。
在本研究中，我们纳入了在我们诊所接受输尿管或肾结石内镜手术的患者。使用输尿管镜检查后病变量表（PULS）对202例接受带UAS的RIRS、未使用UAS的RIRS以及半硬性输尿管镜检查的患者的输尿管病变进行前瞻性评估。
75.7%的病变为PULS 1级，15.3%为2级。在半硬性输尿管镜检查中，病变最常见于输尿管下段；在未使用鞘的RIRS中，病变最常见于输尿管中段；在使用鞘的RIRS中，病变最常见于输尿管上段（p = 0.003）。与输尿管其他部位相比，PULS 1级病变（55.6%）更常见于输尿管下段，PULS 2级病变（41.9%）也主要位于输尿管下段。
应牢记输尿管镜检查术后可能发生输尿管损伤。输尿管病变的程度和部位可能因所选手术方式而异。使用PULS评分系统评估输尿管损伤对患者管理很重要。
