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Meta-Analysis
. 2024 Apr 13;42(1):234.
doi: 10.1007/s00345-024-04933-2.

Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis

S Moretto  1   2 , A Saita  3 , C M Scoffone  4 , M Talso  5 , B K Somani  6 , O Traxer  7 , O Angerri  8 , T Knoll  9 , E Liatsikos  10 , T R W Herrmann  11   12   13 , Ø Ulvik  14 , A Skolarikos  15 , C M Cracco  4 , E X Keller  16 , M Paciotti  3 , A Piccolini  17   3 , A Uleri  17   3 , T Tailly  18 , L Carmignani  19 , A Pietropaolo  6 , M Corrales  7 , G Lughezzani  17   3 , M Lazzeri  3 , V Fasulo  17   3 , V De Coninck  20 , P Arena  17   3 , U Nagele  21 , S Ferretti  22 , P Kronenberg  23 , D Perez-Fentes  24 , P J Osther  25 , I K Goumas  26 , P Acquati  27 , L Ajayi  28 , P Diana  8 , P Casale  3 , N M Buffi  17   3
Affiliations
Meta-Analysis

Ureteral stricture rate after endoscopic treatments for urolithiasis and related risk factors: systematic review and meta-analysis

S Moretto et al. World J Urol. .

Abstract

Purpose: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors.

Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design).

Results: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively.

Conclusions: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.

Keywords: Endoscopic surgery; Iatrogenic ureteral injury; Risk factors; Stone disease; Stone treatment; Ureteral stricture.

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References

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