Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Oct;35(10):1489-1496.
doi: 10.1007/s00345-017-2035-3. Epub 2017 Apr 12.

Histopathological correlations to ureteral lesions visualized during ureteroscopy

Søren Kissow Lildal  1   2 , Flemming Brandt Sørensen  3   2 , Kim Hovgaard Andreassen  1   2 , Frederikke Eichner Christiansen  1 , Helene Jung  1 , Malene Roland Pedersen  1   2 , Palle Jörn Sloth Osther  4   5
Affiliations

Histopathological correlations to ureteral lesions visualized during ureteroscopy

Søren Kissow Lildal et al. World J Urol. 2017 Oct.

Abstract

Purpose: To correlate ureteral lesions visualized during ureteroscopy with histopathological findings.

Materials and 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).

Conclusion: 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.

Keywords: Complications; Histopathology; Post-ureteroscopic lesion scale; Ureteral access sheath; Ureteral lesions; Ureteroscopy.

PubMed Disclaimer

Conflict of interest statement

Funding

The Japanese-Swedish Research Foundation and the Research Foundation of Lillebaelt Hospital supported the study, but had no influence on study design, performance, analysis of data and publication.

Conflict of interest

K.H. Andreassen has received speaker honoraria from Boston Scientific. P.J.S. Osther is member of advisory boards of Olympus, Boston Scientific, and Coloplast. P.J.S. Osther has received speaker honoraria from Olympus, Cook Medical, Boston Scientific, Karl Storz Endoskope, and Coloplast.

Human and animal rights statement

The research did not involve human participants. The animal studies complied with national ethical standards, and the protocols were approved by The National Animal Experiments Inspectorate (Copenhagen, Denmark) (Animal approved project number 2014-15-2934-01015).

Informed consent

N.A. (the study did not involve human participants).

Figures

Fig. 1
Fig. 1
Examples of Endoscopic PULS grade 1, 2, and 3 lesions as visualized during endoscopic video recordings (see Table 1)
Fig. 2
Fig. 2
After fixation, the ureters were cut at right angle to the tubular organ into pieces of equal length. Each of these pieces were then further cut into 3 pieces, and each triplet was placed in one tissue container, routinely processed, and embedded in paraffin. Four-µm thick sections were step sectioned at 250–300 µm intervals, producing step sections from ≥10 levels. Thus 240 histologic sections (120–210 for the 6 shorter ureters) were available from each ureter, covering the whole length of the organ
Fig. 3
Fig. 3
Examples of histopathological PULS grade 0–4 lesions (see Table 1)
See this image and copyright information in PMC

References

    1. Traxer O, Thomas A. Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery. J Urol Elsevier Inc. 2013;189(2):580–584. - PubMed
    1. Guzelburc V, Guven S, Boz MY, Erkurt B, Soytas M, Altay B, et al. Intraoperative evaluation of ureteral access sheath-related injuries using post-ureteroscopic lesion scale. J Laparoendosc Adv Surg Tech A. 2016;26(1):23–26. doi: 10.1089/lap.2015.0294. - DOI - PubMed
    1. Dinlenc CZ, Liatsikos EN, Smith AD. Ureteral ischemia model: an explanation of ureteral dysfunction after chronic obstruction. J Endourol. 2002;16(1):47–50. doi: 10.1089/089277902753483727. - DOI - PubMed
    1. Lallas CD, Auge BK, Raj GV, Santa-Cruz R, Madden JF, Preminger GM. Laser doppler flowmetric determination of ureteral blood flow after ureteral access sheath placement. J Endourol. 2002;16(8):583–590. doi: 10.1089/089277902320913288. - DOI - PubMed
    1. Lildal SK, Nørregaard R, Andreassen KH, Christiansen FE, Jung H, Pedersen MR, et al. Ureteral access sheath influence on the ureteral wall evaluated by cyclooxygenase-2 and tumour necrosis factor-α in a porcine model. J Endourol. 2017;31(3):307–313. doi: 10.1089/end.2016.0773. - DOI - PMC - PubMed