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

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.