Proposal and validation of a ureteral stricture classification system

You have accessJournal of UrologyCME1 Apr 2023MP42-02 PROPOSAL AND VALIDATION OF A URETERAL STRICTURE CLASSIFICATION SYSTEM Eric Cho, Lee Zhao, Michael Witthaus, Ameen Chaudry, Nejd Alsikafi, Benjamin Breyer, Joshua Broghammer, Sean Elliott, Bradley Erickson, Shawn Grove, Jeremy Myers, Andrew Peterson, Keith Rourke, Thomas Smith, Alex Vanni, Bryan Voelzke, and Jill Buckley Eric ChoEric Cho More articles by this author , Lee ZhaoLee Zhao More articles by this author , Michael WitthausMichael Witthaus More articles by this author , Ameen ChaudryAmeen Chaudry More articles by this author , Nejd AlsikafiNejd Alsikafi More articles by this author , Benjamin BreyerBenjamin Breyer More articles by this author , Joshua BroghammerJoshua Broghammer More articles by this author , Sean ElliottSean Elliott More articles by this author , Bradley EricksonBradley Erickson More articles by this author , Shawn GroveShawn Grove More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Andrew PetersonAndrew Peterson More articles by this author , Keith RourkeKeith Rourke More articles by this author , Thomas SmithThomas Smith More articles by this author , Alex VanniAlex Vanni More articles by this author , Bryan VoelzkeBryan Voelzke More articles by this author , and Jill BuckleyJill Buckley More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003280.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The surgical management of ureteral stricture disease is contingent upon multiple factors such as stricture length, location, and etiology. Ureteral strictures are conventionally characterized descriptively. Unlike urethral stricture disease, there is currently no widely adopted classification system. Herein, we aim to propose a ureteral stricture classification system for the purpose of creating a standard nomenclature with the goal of validating classification with reconstructive surgical techniques. METHODS: Consensus was obtained from 14 reconstructive urologists. All reviewers had completed a Society of Genitourinary Reconstructive Surgeons (GURS) fellowship and were in clinical practice. Consensus was formulated regarding three primary elements: length of ureteral stricture (L); stricture segment (S); and modifiers (M). These constituted the cLSM classification system (Table 1). Each reviewer was presented with an image(s) of fluoroscopic studies for 24 various ureteral strictures with no additional clinical history and were tasked with assigning a cLSM grade for each individual clinical vignette. These results were tabulated and interrater reliability was determined by a Fleiss Kappa analysis. Etiology of stricture was included in the final version of the cLSM classification system but was not designed to be included in this analysis (Table 1). RESULTS: Of the 24 ureteral strictures, 11 (45.8%) were proximal, 10 (41.7%) were distal, 2 (8.3%) were mid-ureter and 1 (4.2%) was of overlapping sites. Distal ureteral injuries were assessed with only an antegrade pyelogram hindering a precise length measurement. There was substantial agreement across experts demonstrated by an overall Fleiss Kappa score of 0.677 (0.667 – 0.686) for the 24 clinical vignettes for ureteral length, segment and modifiers. CONCLUSIONS: The cLSM ureteral classification system shows a strong interrater reliability by experienced reconstructive urologists. Consistent nomenclature and application of the classification system will standardize discussion of types of ureteral injuries as well as allow for assessment of outcomes. The final ureteral classification system will include etiology (cLSE) to further characterize ureteral injuries and compare reconstructive operative techniques. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e566 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eric Cho More articles by this author Lee Zhao More articles by this author Michael Witthaus More articles by this author Ameen Chaudry More articles by this author Nejd Alsikafi More articles by this author Benjamin Breyer More articles by this author Joshua Broghammer More articles by this author Sean Elliott More articles by this author Bradley Erickson More articles by this author Shawn Grove More articles by this author Jeremy Myers More articles by this author Andrew Peterson More articles by this author Keith Rourke More articles by this author Thomas Smith More articles by this author Alex Vanni More articles by this author Bryan Voelzke More articles by this author Jill Buckley More articles by this author Expand All Advertisement PDF downloadLoading ...