title: Evaluating Ureteral Wall Injuries with Endoscopic Grading System and Analysis of the Predisposing Factors.
abstract: OBJECTIVE
  To analyze the predictive factors for intraoperative ureteral wall injury due to semirigid ureteroscopy (URS) used in the treatment of ureteral calculi.
  
  
  METHODS
  The data of 437 patients who had URS due to ureteral stones were prospectively analyzed. The ureteral wall injuries that occurred during URS were reviewed endoscopically at the end of surgery and divided into two groups as low grade (grades 0 and 1) and high grade (grades 2, 3, and 4) according to classification of ureteral wall injuries. Those two groups were compared for patient and stone characteristics and perioperative findings.
  
  
  RESULTS
  Ureteral wall injury was seen in 133 (30.4%) patients after surgery. According to the endoscopic classification of the lesions after URS, grades 0, 1, 2, and 3 injury were seen in 69.5%, 16.4%, 11.2%, and 2.7% of the patients, respectively. There were no grade 4 injuries in our series. Two groups showed statistically significant differences for the location (prox- vs distal and mid-ureter) and size of the stone (9.9 mm vs 14.03 mm), presence of preoperatively urinary tract infection (UTI) (12% vs 50.8%), needed balloon dilatation (9.8% vs 36.1%), duration of surgery (33.6 min vs 43.3 min), and surgical success rate (90% vs 76%) (p = 0.01, for all). Stone size, location, duration of surgery, and presence of preoperative infection were determined as independent prognostic factors for mucosal injury.
  
  
  CONCLUSIONS
  The ureteral wall injury grading system may be used for standardized reporting of ureteral lesions after ureteroscopy. Big, proximal ureteral stone, longer operation time, and presence of UTI are the risk factors for ureteral wall injury during URS.
authors: 1 Department of Urology, Yenimahalle Training and Research Hospital , Ankara, Turkey .
authors: Tolga
authors: T
authors: Karakan
authors: 2 Department of Urology, Ankara Training and Research Hospital , Ankara, Turkey .
authors: Muhammet Fatih
authors: MF
authors: Kilinc
authors: 2 Department of Urology, Ankara Training and Research Hospital , Ankara, Turkey .
authors: Arif
authors: A
authors: Demirbas
authors: 2 Department of Urology, Ankara Training and Research Hospital , Ankara, Turkey .
authors: Ahmet Metin
authors: AM
authors: Hascicek
authors: 2 Department of Urology, Ankara Training and Research Hospital , Ankara, Turkey .
authors: Omer Gokhan
authors: OG
authors: Doluoglu
authors: 3 Department of Urology, Adıyaman University , Faculty of Medicine, Adiyaman, Turkey .
authors: Mehmet Ozgur
authors: MO
authors: Yucel
authors: 4 Department of Urology, Canakkale 18 Mart University , Faculty of Medicine, Canakkale, Turkey .
authors: Berkan
authors: B
authors: Resorlu
mesh_terms: D000328:Adult; D015897:Comorbidity; D004106:Dilatation / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000293:injuries; D015999:Multivariate Analysis; D061646:Operative Time; D011446:Prospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D014513:Ureter / Q000293:injuries*; D014514:Ureteral Calculi / Q000453:epidemiology / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000453:epidemiology