title: Intraoperative Evaluation of Ureteral Access Sheath-Related Injuries Using Post-Ureteroscopic Lesion Scale.
abstract: OBJECTIVE
  In the present study, intraoperative ureteral injuries inflicted during retrograde intrarenal surgery (RIRS) with ureteral access sheath (UAS) use were evaluated using the Post- Ureteroscopic Lesion Scale (PULS).
  
  
  METHODS
  Patients in whom a UAS was used during RIRS and for whom ureter images were video recorded during the procedure were included in the study. PULS grading was performed after UAS removal, and video sequences of all patients were viewed by a junior resident, a senior resident, and four experienced urologists and assessed according to the PULS. Ureteral lesions in distal, middle, proximal, and multiple locations were evaluated and compared according to the PULS scale. The inter-rater reliability of PULS grading among various urologists was also evaluated.
  
  
  RESULTS
  The evaluation comprised 101 patients. In 77 patients, 9.5/11.5 French UAS devices were used, and in 24 patients, 12/14 French UAS devices were used. The stone-free rate, clinical insignificant residual fragments, and final stone-free rate were 41.6%, 53.5%, and 98%, respectively. In 58.4% of the patients, no lesions were present according to PULS grading. No lesions of Grade 3 and above were found; however, there were lesions of Grade 1 and 2 in 38.6% and 2.9% of the patients, respectively. Injuries were found in the proximal ureter only and distal ureter only in 45.23% and 40.47% of the patients, respectively. Multiple injuries occurred in 5.94% of the patients (in 3.96% in the proximal and distal ureter, in 0.99% in the mid- and distal ureter, and in 0,99% in the proximal, mid-, and distal ureter). In the grading performed according to the PULS classification, there was a high accuracy among the residents and specialists.
  
  
  CONCLUSIONS
  The assessment of UAS-induced injuries using standardized intraoperative methods will help to evaluate the procedure more objectively and will guide the postoperative follow-up of patients.
authors.affiliation: Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey .
authors.forename: Vahit
authors.initials: V
authors.lastname: Guzelburc
authors.affiliation: Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey .
authors.forename: Selcuk
authors.initials: S
authors.lastname: Guven
authors.affiliation: Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey .
authors.forename: Mustafa Yucel
authors.initials: MY
authors.lastname: Boz
authors.affiliation: Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey .
authors.forename: Bulent
authors.initials: B
authors.lastname: Erkurt
authors.affiliation: Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey .
authors.forename: Mustafa
authors.initials: M
authors.lastname: Soytas
authors.affiliation: Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey .
authors.forename: Bulent
authors.initials: B
authors.lastname: Altay
authors.affiliation: Department of Urology, Medical Faculty of Istanbul Medipol University , Istanbul, Turkey .
authors.forename: Selami
authors.initials: S
authors.lastname: Albayrak
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007431:Intraoperative Complications / Q000175:diagnosis* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D014513:Ureter / Q000293:injuries* / Q000601:surgery; D018666:Ureteroscopy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014741:Video Recording