[Ureterorenoscopy]

Evaluation of Inflammatory Parameters Following Extracorporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopy for the Treatment of Proximal Ureteral Stones

Introduction Inflammation can arise as a consequence of both extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) treatments. Alterations in inflammatory parameters may serve as indicators of kidney injuries and the ensuing inflammation. This study aims to investigate the effects of ESWL and URS procedures on inflammatory parameters for proximal ureteral stone treatment. Materials and methods A prospective interventional study comprised 120 patients with confirmed stones measuring less than 10 mm in the upper half of the proximal ureter. These patients were randomly assigned to either the ESWL or URS treatment groups. Laboratory analyses encompassed interleukin-6 (IL-6), leukocyte count, fibrinogen levels, and erythrocyte sedimentation rate (ESR), which were assessed prior to the intervention, on the first postoperative day, and six months later. IL-6 levels in the serum were determined using a chemiluminescence immunoassay (CLIA). Results There was no significant difference in IL-6 levels between pre-intervention and the first post-intervention day in patients treated with ESWL (1.8 (1.4-2.59) pg/mL vs. 2.33 (1.22-3.19) pg/mL). However, for patients treated with URS, the pre-intervention IL-6 value was 2.9 (1.9-3.34) pg/mL, and it increased significantly to 7.1 (3.85-28.07) pg/mL on the first post-intervention day (p<0.001). On the first post-intervention day, levels of IL-6, CRP, leukocyte count, and ESR were significantly higher in patients treated with URS compared to ESWL (p<0.001; p<0.001; p=0.03; p=0.03, respectively). Conclusion Our research findings suggest that monitoring IL-6 levels can offer valuable insights into the degree of inflammation and tissue damage during and following observed procedures, particularly among patients undergoing URS, even within the initial days post-procedure.

[Interrater reliability and clinical impact of the Post-Ureteroscopic Lesion Scale (PULS) grading system for ureteral lesions after ureteroscopy : Results of the German prospective multicenter BUSTER project]

BACKGROUND

The Post-ureteroscopic Lesion Scale (PULS) was designed as a standardized classification system for ureteral lesions after uretero(reno)scopy (URS). This study evaluates its routine use and a possible clinical impact based on a representative patient cohort.

MATERIALS AND METHODS

Data of 307 patients in 14 German centers within the BUSTER project were used to test 3 hypotheses (H): PULS score shows a high interrater reliability (IRR) after independent assessment by urologic surgeon and assistance personnel (H1); PULS score is correlated with the frequency of postoperative complications during hospital stay (H2); post-URS stenting of the ureter is associated with higher PULS scores (H3).

RESULTS

Median age of patients was 54.4 years (interquartile range [IQR] 44.4-65.8; 65.5% male). Median diameter of index stones was 6 mm (IQR 4-8) with 117 (38.4%) pyelo-caliceal and 188 (61.6%) ureteral stones. Overall, 70 and 82.4% of patients had pre-stenting and post-URS stenting, respectively. Stone-free status was achieved in 68.7% after one URS procedure with a complication rate of 10.8% (mostly grade 1-2 according to Clavien-Dindo). PULS scores 0, 1, 2 and 3 were assessed in 40%, 52.1%, 6.9% and 1% of patients, respectively, when estimated by urologic surgeons. PULS score showed a high IRR between the urologic surgeon and assistance personnel (κ = 0.883, p < 0.001), but was not significantly correlated with complications (ρ = 0.09, p = 0.881). In contrast, a significant positive correlation was found between PULS score and post-URS stenting (ρ = 0.287, p < 0.001). A PULS score of 1 multiplied the likelihood of post-URS stenting by 3.24 (95% confidence interval 1.43-7.34; p = 0.005) as opposed to PULS score 0.

CONCLUSIONS

Removal of upper urinary tract stones using URS is safe and efficacious. Real-world data provided by this study confirm a high IRR of the PULS score and its clinical impact on the indication for post-URS stenting. A future prospective randomized trial should evaluate a possible standardization of post-URS stenting based on PULS score assessment.

["We're going to place a ureteral stent …" : Development and use of the terms stent and splint by German-speaking urologists]

The use of eponyms has a long history in medicine. But it is a rare case that a term not associated with a procedure or an anatomical description has come into use. The terms "stent" and "splint" in German and English used as a verb and a noun are a typical example. The coronary stent was named after Charles Thomas Stent (1807-1885). Charles Theodore Dotter (1920-1985) was the one who introduced the eponym into the literature of angiography in 1983. The change in urology occurred after an article of Willard Goodwin especially in the English literature but did not come into constant use in the German language.