Post-Ureteroscopic Lesion Scale to determine ureteral wall damage, not so easy to employ

R. Polo , À. Canós-Nebot , J.P. Caballero-Romeu , P. Caballero , J.A. Galán-Llopis , F. Soria , J.E. de la Cruz-Conty , J. Tuells
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Abstract

Objective

To analyze the level of agreement of the Post-Ureteroscopy Lesion Scale (PULS) and the consequences on its application in clinical practice with more reliable statistical data than the one used in the original work.

Methods

14 URS and 14 micro-URS were performed in 14 female porcine model. All the procedures were video recorded and an anatomopathological analysis was performed in each ureter. Sixteen urologists (9 endourologists and 7 general urologists) and 4 residents evaluated the ureteral lesions according to the PULS, with degrees 0, 1 and ≥2. The agreement was calculated with percentages, Kendall’s W coefficient and the indicators Fleiss’ Kappa and Krippendorff’s Alpha, while the inter-rater agreement was calculated with Spearman’s correlation and Cohen’s Kappa.

Results

The percent of agreement was 11.1%. The coefficients were likewise classified as low or very low, with the greatest agreement found among the inexperienced. Also, 50% of the raters did not agree with the rest.

Conclusions

The low inter-rater agreement, the specificity of the PULS and the clinical-pathological correlation suggests that this scale is not simple, and probably has a long learning curve.

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输尿管镜后病变量表用于确定输尿管壁损伤,不那么容易使用。
目的:分析输尿管镜后病变量表(PULS)的一致性水平及其在临床实践中的应用效果,与原始工作中使用的统计数据相比,具有更可靠的统计数据。方法:在14只雌性猪模型上进行14次URS和14次微URS。所有的手术都进行了录像,并对每个输尿管进行了解剖病理学分析。16名泌尿科医生(9名腔内泌尿科医生和7名普通泌尿科医生)和4名住院医师根据PULS评估输尿管病变,其程度为0、1和≥2。一致性用百分比、Kendall的W系数和指标Fleiss的Kappa和Krippendorff的Alpha来计算,而评分者之间的一致性用Spearman的相关性和Cohen的Kappa来计算。结果:一致性的百分比为11.1%。这些系数同样分为低或非常低,在缺乏经验的人中发现最大的一致性。此外,50%的评分者不同意其他评分者的观点。结论:评分者之间的低一致性、PULS的特异性和临床病理相关性表明,该量表并不简单,可能有很长的学习曲线。
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