The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate a patient with ureteral complications following radiation and chemotherapy.
Subjective measures:
(1) pain
Objective measures:
(1) obstruction
(2) renal function (proteinuria)
Management measures:
(1) pain
(2) obstruction
Analytic studies:
(1) intravenous pyelogram: for assessment of ureter integrity
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
Items |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
obstruction |
ureteral narrowing without hydro-nephrosis |
ureteral narrowing with hydro-nephrosis |
unilateral obstruction |
bilateral obstruction |
|
proteinuria |
1+ |
2+ |
(3 to) 4+ |
NA (see note) |
|
management of pain |
occasional non-narcotic |
regular non-narcotic |
regular narcotic |
surgical intervention |
|
management of obstruction |
NA |
NA |
unilateral stent or nephrostomy |
bilateral nephrostomy or diversion |
where:
• I am not sure why renal function is included with the ureter, while hematuria is not; one possible explanation is that severe proteinuria may have an increased rate of obstruction. Also there is no entry in the table on page 1076 for 3+ proteinuria. I included this with 4+ in grade 3; alternatively 4+ proteinuria could be moved to grade 4.
total score =
= SUM(points for all 5 items)
LENT score =
= (total score) / 5
Interpretation:
• maximum total score: 19
• minimum LENT score: 0
• maximum LENT score: 3.8
Specialty: Hematology Oncology, Nephrology
