We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors.
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).
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.
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.
World journal of urology. 2024 Apr 13*** epublish ***
S Moretto, A Saita, C M Scoffone, M Talso, B K Somani, O Traxer, O Angerri, T Knoll, E Liatsikos, T R W Herrmann, Ø Ulvik, A Skolarikos, C M Cracco, E X Keller, M Paciotti, A Piccolini, A Uleri, T Tailly, L Carmignani, A Pietropaolo, M Corrales, G Lughezzani, M Lazzeri, V Fasulo, V De Coninck, P Arena, U Nagele, S Ferretti, P Kronenberg, D Perez-Fentes, P J Osther, I K Goumas, P Acquati, L Ajayi, P Diana, P Casale, N M Buffi
Department of Biomedical Sciences, Humanitas University, Milan, Italy. ., Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy., Department of Urology, Cottolengo Hospital, Turin, Italy., Department of Urology, Luigi Sacco University Hospital, Milan, Italy., Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK., Department of Urology, Sorbonne Université, Paris, France., Department of Urology, Fundació Puigvert Univ. Autonoma de Barcelona, Barcelona, Spain., Department of Urology, Sindelfingen Medical Center, University of Tübingen, Tübingen, Germany., Department of Urology, University Hospital of Patras, Patras, Greece., Department of Urology, Spital Thurgau AG, Frauenfeld, Switzerland., Department of Urology, Haukeland University Hospital, Bergen, Norway., Second Department of Urology, Sismanoglio Hospital, National and Kapodistrian University of Athen, Athens, Greece., Department of Urology, University Hospital Zurich, Zurich, Switzerland., Department of Biomedical Sciences, Humanitas University, Milan, Italy., Department of Urology, University Hospital Ghent, Ghent, Belgium., Department of Urology, University of Milan, Milan, Italy., Department of Urology, AZ Klina, Brasschaat, Belgium., Department of Urology, General Hospital Hall in Tirol, Hall in Tirol, Austria., Department of Urology, Azienda Ospedaliero-Universitaria di Modena, Baggiovara, Italy., Department of Urology, Hospital CUF Descobertas, Lisbon, Portugal., Department of Urology, University Hospital Complex of Santiago de Compostela, Santiago, Spain., Department of Urology, Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark., Department of Urology, Istituto Clinico Beato Matteo, Vigevano, Italy., Department of Urology, IRCCS Policlinico San Donato, Milan, Italy., Department of Urology, Royal Free London NHS Foundation Trust, London, UK.