title: The Post-Ureteroscopic Lesion Scale (PULS): a multicenter video-based evaluation of inter-rater reliability.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Urology, University Medical Center, Hugstetterstr. 55, 79106, Freiburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Schoenthaler
authors.forename: Noor
authors.initials: N
authors.lastname: Buchholz
authors.forename: Erik
authors.initials: E
authors.lastname: Farin
authors.forename: Hammad
authors.initials: H
authors.lastname: Ather
authors.forename: Christian
authors.initials: C
authors.lastname: Bach
authors.forename: Thorsten
authors.initials: T
authors.lastname: Bach
authors.forename: John D
authors.initials: JD
authors.lastname: Denstedt
authors.forename: Hans-Martin
authors.initials: HM
authors.lastname: Fritsche
authors.forename: Michael
authors.initials: M
authors.lastname: Grasso
authors.forename: Oliver W
authors.initials: OW
authors.lastname: Hakenberg
authors.forename: Ralf
authors.initials: R
authors.lastname: Herwig
authors.forename: Thomas
authors.initials: T
authors.lastname: Knoll
authors.forename: Franklin Emmanuel
authors.initials: FE
authors.lastname: Kuehhas
authors.forename: Evangelos
authors.initials: E
authors.lastname: Liatsikos
authors.forename: Peter
authors.initials: P
authors.lastname: Liske
authors.forename: Michael
authors.initials: M
authors.lastname: Marberger
authors.forename: Palle J S
authors.initials: PJ
authors.lastname: Osther
authors.forename: José Manuel Reis
authors.initials: JM
authors.lastname: Santos
authors.forename: Kemal
authors.initials: K
authors.lastname: Sarica
authors.forename: Christian
authors.initials: C
authors.lastname: Seitz
authors.forename: Michael
authors.initials: M
authors.lastname: Straub
authors.forename: Olivier
authors.initials: O
authors.lastname: Traxer
authors.forename: Alberto
authors.initials: A
authors.lastname: Trinchieri
authors.forename: Ben
authors.initials: B
authors.lastname: Turney
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Miernik
mesh_terms: D006801:Humans; D060787:Neoplasm Grading / Q000379:methods*; D015588:Observer Variation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014516:Ureteral Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D018666:Ureteroscopy / Q000379:methods*; D014743:Videotape Recording