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The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability

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Abstract

Purpose

The Post-Ureteroscopic Lesion Scale (PULS) offers a simple grading system for the description of ureteral lesions after ureteroscopy. In this article, we present the results of a video-based multicenter evaluation of the inter-rater reliability of clinically important PULS grades 0–3.

Methods

Video sequences at the end of ureteroscopy (final passage) were recorded for 100 consecutive patients at a single institution and assessed by experienced urologists (n = 20) and senior residents (n = 17) at 19 international centers. The cohort included only patients with lesions grades 0–3 (with grades 2 and 3 subsumed as 2 + since distinction is defined by an extravasation of contrast medium in fluoroscopy). The gradings were evaluated for inter-rater reliability and in terms of simplicity, validity, comprehensibility, reproducibility, and usefulness.

Results

Overall, inter-rater reliability was high (Kendall’s W = 0.69, p < 0.001) and was comparable between specialists (Kendall’s W = 0.69, p < 0.001) and residents (Kendall’s W = 0.71, p < 0.001). The matched ratings showed grade 0 in 43.0 % of patients and grades 1 or 2 + in 44.0 and 13.0 % of patients, respectively. Results of the questionnaires indicated a high degree of acceptance, with an overall rating of 1.76 (1.64–1.93 for different items, scale 1–6).

Conclusions

Inter-rater reliability of the endoscopically assessable PULS was high among urologists with different levels of experience in different countries worldwide. The validated PULS system may be used for standardized reporting of ureteral lesions/injuries after ureteroscopy. In addition, PULS will enable more selective standardization of indications for postoperative DJ stenting based on the randomized controlled trials.

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Abbreviations

PULS:

Post-Ureteroscopic Lesion Scale

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Acknowledgments

We would like to acknowledge and extend our heartfelt gratitude to the other members of the PULS working group for contributing substantially to this work: Alessio Anghileri (Ospedale Manzoni Lecco, Department of Urology, Lecco, Italy), Jawad Feghali (Lenox Hill Hospital, Department of Urology, New York, USA), Ioannis Georgiopoulos (University of Patras Medical School, Department of Urology, Patras, Greece), Katharina Hauner (Technische Universität München, Klinikum rechts der Isar, Department of Urology, Munich, Germany), John Henderson (University of Oxford, The Churchill Hospital, Nuffield Department of Surgical Sciences, Department of Urology, Oxford, United Kingdom), Manuela Hiess (St. John of God Hospital, Teaching Hospital of the Medical University of Vienna, Department of Urology, Vienna, Austria), Imran Khan Jalbani (AGA Khan University Hospital, Department of Surgery and Urology, Karachi, Pakistan), Katharina Kaftan (University Hospital Rostock, Department of Urology, Rostock, Germany), Florian Kurtz (Technische Universität München, Klinikum rechts der Isar, Department of Urology, Munich, Germany), Julien Letendre (Tenon University Hospital, Department of Urology, Paris, France), Søren Kissow Lildal (University of Southern Denmark, Department of Urology, Hospital Littlebelt, Fredericia, Denmark), Gabriele Lotter (University of Regensburg, Caritas-Hospital St. Josef, Regensburg, Germany), António Garcias Soares (Universidade Católica Portuguesa, Department of Urology, Lisboa, Portugal), Stephanie Tatzel (Western University, St Joseph’s Hospital, Department of Urology, London, Ontario, Canada), Antonopoulos Theodosios (Siloah St. Trudpert Hospital, Department of Urology, Pforzheim, Germany), Christian Tiburtius (Asklepios Klinik Barmbek, Department of Urology, Hamburg, Germany).

Conflict of interest

All authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Urology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany

    Martin Schoenthaler & Arkadiusz Miernik

  2. Endourology and Stone Services, Department of Urology, Bartshealth NHS Trust, The Royal London Hospital, London, E1 1BB, UK

    Noor Buchholz & Christian Bach

  3. Department of Quality Management and Social Medicine, University Medical Centre Freiburg, Breisacher Straße 62, Haus 4, 79106, Freiburg, Germany

    Erik Farin

  4. Department of Surgery and Urology, AGA Khan University Hospital, Stadium Road, PO Box 3500, Karachi, 74800, Pakistan

    Hammad Ather

  5. Urologisches Zentrum Hamburg, Asklepios Klinik Harburg, Eißendorfer Pferdeweg 52, 21075, Hamburg, Germany

    Thorsten Bach

  6. Department of Urology, St Joseph’s Hospital, Western University, 268 Grosvenor St., London, ON, N6A 4V2, Canada

    John D. Denstedt

  7. Department of Urology, Caritas-Hospital St. Josef, University of Regensburg, Postfach 10 06 45, 93006, Regensburg, Germany

    Hans-Martin Fritsche

  8. Department of Urology, Lenox Hill Hospital, 100 East 77th Street, 4 East building, New York, NY, 10075, USA

    Michael Grasso

  9. Department of Urology, University Hospital Rostock, Ernst-Heydemann-Strasse 6, Postfach 100888, 18055, Rostock, Germany

    Oliver W. Hakenberg

  10. Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Ralf Herwig, Franklin Emmanuel Kuehhas & Michael Marberger

  11. Department of Urology, Sindelfingen-Böblingen Medical Center, University of Tübingen, Arthur-Gruberstrasse 70, 71065, Sindelfingen, Germany

    Thomas Knoll

  12. Department of Urology, University of Patras Medical School, 26 500, Rio, Patras, Greece

    Evangelos Liatsikos

  13. Department of Urology, Siloah St. Trudpert Hospital, Wilferdingerstr. 67, 75179, Pforzheim, Germany

    Peter Liske

  14. Department of Urology, Hospital Littlebelt, Fredericia, Urological Research Center (URS), University of Southern Denmark, Dronningensgade 97, 7000, Fredericia, Denmark

    Palle J. S. Osther

  15. Department of Urology, Universidade Católica Portuguesa, Palma de Cima, 1649-023, Lisbon, Portugal

    José Manuel Reis Santos

  16. Department of Urology, Yeditepe University Medical School, Soguksu Mah. Karslilar Sokak, Bogazgoren sitesi, 2. Kisim 1. Blok No:9 Pasabahce, 34800, Istanbul, Turkey

    Kemal Sarica

  17. Department of Urology, Teaching Hospital of the Medical University of Vienna, St. John of God Hospital, Johannes von Gott Platz 1, 1020, Vienna, Austria

    Christian Seitz

  18. Department of Urology, Klinikum rechts der Isar, Technische Universität München, Johannes von Gott Platz 1, 81675, Munich, Germany

    Michael Straub

  19. Department of Urology, Tenon University Hospital, 4 Rue de la Chine, 75970, Paris, France

    Olivier Traxer

  20. Department of Urology, Ospedale Manzoni Lecco, via deii’Eremo 9/11, 23900, Lecco, Italy

    Alberto Trinchieri

  21. Department of Urology, Nuffield Department of Surgical Sciences, The Churchill Hospital, University of Oxford, Oxford, OX3 7LJ, UK

    Ben Turney

Authors
  1. Martin Schoenthaler
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  2. Noor Buchholz
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  3. Erik Farin
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  4. Hammad Ather
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  5. Christian Bach
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  6. Thorsten Bach
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  7. John D. Denstedt
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  8. Hans-Martin Fritsche
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  9. Michael Grasso
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  10. Oliver W. Hakenberg
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  11. Ralf Herwig
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  12. Thomas Knoll
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  13. Franklin Emmanuel Kuehhas
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  14. Evangelos Liatsikos
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  15. Peter Liske
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  16. Michael Marberger
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  17. Palle J. S. Osther
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  18. José Manuel Reis Santos
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  19. Kemal Sarica
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  20. Christian Seitz
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  21. Michael Straub
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  22. Olivier Traxer
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  23. Alberto Trinchieri
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  24. Ben Turney
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  25. Arkadiusz Miernik
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Corresponding author

Correspondence to Arkadiusz Miernik.

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Schoenthaler, M., Buchholz, N., Farin, E. et al. The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability. World J Urol 32, 1033–1040 (2014). https://doi.org/10.1007/s00345-013-1185-1

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  • DOI: https://doi.org/10.1007/s00345-013-1185-1

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