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Histopathological correlations to ureteral lesions visualized during ureteroscopy
Søren Kissow Lildal1,2, Flemming Brandt Sørensen3,2, Kim Hovgaard Andreassen1,2
1Department of Urology, Urological Research Centre, Lillebaelt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark.
World Journal of Urology
|April 14, 2017
Summary
Ureteroscopy often underestimates ureteral injury severity. Histopathological analysis revealed significantly worse lesions than seen during endoscopy, highlighting the need for thorough evaluation after ureteral access sheath use.
Area of Science:
- Urology
- Surgical Pathology
- Medical Device Evaluation
Background:
- Ureteral access sheaths (UAS) are commonly used during ureteroscopy.
- Assessing ureteral injury post-ureteroscopy is crucial for patient outcomes.
- The Post-ureteroscopic Lesion Scale (PULS) is used to grade ureteral lesions.
Purpose of the Study:
- To correlate ureteral lesions visualized during ureteroscopy with histopathological findings.
- To determine if endoscopic assessment accurately reflects ureteral injury severity.
Main Methods:
- Ureteral access sheaths (13/15 Fr.) were inserted bilaterally in 22 pigs.
- Ureteral lesions were evaluated endoscopically using the Post-ureteroscopic Lesion Scale (PULS).
- Ureters were excised, sectioned, and histopathologically scored using PULS.
Main Results:
- Histopathological scores were significantly higher than endoscopic scores in most ureters (72.1% showed at least a 1-grade difference).
- Differences ranged from 1 to 3 grades higher in histopathological assessment.
- Mean endoscopic PULS score was 1.49, while mean histopathological PULS score was 2.51 (p < 0.0001).
Conclusions:
- Endoscopic evaluation significantly underestimates the severity of ureteral wall lesions after UAS placement.
- Histopathological analysis reveals a greater extent of injury than observed endoscopically.
- This suggests current endoscopic grading may not fully capture ureteral trauma.