title: Histopathological correlations to ureteral lesions visualized during ureteroscopy.
abstract: OBJECTIVE
  To correlate ureteral lesions visualized during ureteroscopy with histopathological findings.
  
  
  METHODS
  Ureteral access sheaths (UAS) sized 13/15 Fr. were inserted bilaterally in 22 laboratory pigs. During retraction of the UAS with a semirigid ureteroscope inside, ureteral lesions were evaluated and registered using the Post-ureteroscopic lesion scale (PULS). Ureters were excised in vivo between the uretero-pelvic junction and the uretero-vesical junction. Embedded in paraffin, 4-µm thick sections were step sectioned at 250-300 µm intervals and haematoxylin and eosin (HE) stained. Histopathological scoring of ureteral wall lesions was subsequently performed according to PULS.
  
  
  RESULTS
  In 72.1% of ureters, the highest histopathological score was at least 1 grade higher than the highest endoscopic PULS score. For 12 (27.9%) lesions, the difference was 2 scores higher, and for 1 (2.3%), it was 3 scores higher. The histopathological PULS grade was higher than the endoscopical PULS grade at all minimum, quartile, and maximum scores. There was a significant difference in the distribution of highest lesional scores between the endoscopic and histopathological PULS (p = 0.002). The calculated mean of the highest scores was 1.49 for endoscopic PULS and 2.51 for histopathological PULS (p < 0.0001).
  
  
  CONCLUSIONS
  Histopathological evaluation of ureteral wall lesions after UAS placement revealed a significantly higher degree of severity than observed endoscopically. Thus, endoscopy underestimated the histopathological extent of the lesion in the majority of cases.
authors.affiliation: Department of Urology, Urological Research Centre, Lillebaelt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark.|Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark.
authors.forename: Søren Kissow
authors.initials: SK
authors.lastname: Lildal
authors.affiliation: Department of Clinical Pathology, Lillebaelt Hospital, Vejle, Denmark.|Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark.
authors.forename: Flemming Brandt
authors.initials: FB
authors.lastname: Sørensen
authors.affiliation: Department of Urology, Urological Research Centre, Lillebaelt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark.|Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark.
authors.forename: Kim Hovgaard
authors.initials: KH
authors.lastname: Andreassen
authors.affiliation: Department of Urology, Urological Research Centre, Lillebaelt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark.
authors.forename: Frederikke Eichner
authors.initials: FE
authors.lastname: Christiansen
authors.affiliation: Department of Urology, Urological Research Centre, Lillebaelt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark.
authors.forename: Helene
authors.initials: H
authors.lastname: Jung
authors.affiliation: Department of Urology, Urological Research Centre, Lillebaelt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark.|Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark.
authors.forename: Malene Roland
authors.initials: MR
authors.lastname: Pedersen
authors.affiliation: Department of Urology, Urological Research Centre, Lillebaelt Hospital, Kabbeltoft 25, 7100, Vejle, Denmark. palle.joern.osther@rsyd.dk.|Institute of Regional Health Research, University of Southern Denmark, Vejle, Denmark. palle.joern.osther@rsyd.dk.
authors.forename: Palle Jörn Sloth
authors.initials: PJS
authors.lastname: Osther
mesh_terms: D000818:Animals; D061827:Dimensional Measurement Accuracy; D012107:Research Design; D012720:Severity of Illness Index; D013552:Swine; D014513:Ureter / Q000000981:diagnostic imaging / Q000473:pathology; D014515:Ureteral Diseases / Q000175:diagnosis*; D020709:Ureteroscopes; D018666:Ureteroscopy / Q000295:instrumentation / Q000379:methods
keywords: Complications; Histopathology; Post-ureteroscopic lesion scale; Ureteral access sheath; Ureteral lesions; Ureteroscopy