Tonyali Senol, Yilmaz Mehmet, Tzelves Lazaros, Emiliani Esteban, De Coninck Vincent, Keller Etienne Xavier, Miernik Arkadiusz
Department of Urology, Istanbul Faculty of Medicine, Istanbul University, 34452 Istanbul, Turkey.
Department of Urology, Faculty of Medicine, Medical Center, University of Freiburg, 79106 Freiburg, Germany.
J Clin Med. 2023 May 22;12(10):3603. doi: 10.3390/jcm12103603.
The stricture-formation rate following ureteroscopy ranges from 0.5 to 5% and might amount to 24% in patients with impacted ureteral stones. The pathogenesis of ureteral stricture formation is not yet fully understood. It is likely that the patient and stone characteristics, as well as intervention factors, play a role in this process. In this systematic review, we aimed to determine the potential factors responsible for ureteral stricture formation in patients having impacted ureteral stones.
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria, we conducted systematic online research through PubMed and Web of Science without a time restriction, applying the keywords "ureteral stone", "ureteral calculus", "impacted stone", "ureteral stenosis", "ureteroscopic lithotripsy", "impacted calculus", and "ureteral strictures" singly or in combination.
After eliminating non-eligible studies, we identified five articles on ureteral stricture formation following treatment of impacted ureteral stones. Ureteral perforation and/or mucosal damage appeared as key predictors of ureteral stricture following retrograde ureteroscopy (URS) for impacted ureteral stones. Besides ureteral perforation stone size, embedded stone fragments into the ureter during lithotripsy, failed URS, degree of hydronephrosis, nephrostomy tube or double-J stent (DJS)/ureter catheter insertion were also suggested factors leading to ureteral strictures.
Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones.
输尿管镜检查后狭窄形成率为0.5%至5%，在输尿管结石嵌顿患者中可能高达24%。输尿管狭窄形成的发病机制尚未完全明确。患者和结石特征以及干预因素可能在此过程中起作用。在本系统评价中，我们旨在确定输尿管结石嵌顿患者输尿管狭窄形成的潜在因素。
按照系统评价和Meta分析的首选报告项目（PRISMA）标准，我们通过PubMed和Web of Science进行无时间限制的系统在线研究，单独或组合应用关键词“输尿管结石”“输尿管 calculus”“嵌顿结石”“输尿管狭窄”“输尿管镜碎石术”“嵌顿 calculus”和“输尿管狭窄”。
在排除不合格研究后，我们确定了5篇关于输尿管结石嵌顿治疗后输尿管狭窄形成的文章。输尿管穿孔和/或黏膜损伤是逆行输尿管镜检查（URS）治疗输尿管结石嵌顿后输尿管狭窄的关键预测因素。除输尿管穿孔外，结石大小、碎石术中输尿管内残留结石碎片、URS失败、肾积水程度、肾造瘘管或双J支架（DJS）/输尿管导管插入也被认为是导致输尿管狭窄的因素。
手术期间输尿管穿孔可能被认为是逆行输尿管镜取石治疗输尿管结石嵌顿后输尿管狭窄形成的主要危险因素。
