Department of Biomedical Sciences, Humanitas University, Milan, Italy.
Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy.
World J Urol. 2024 Apr 13;42(1):234. doi: 10.1007/s00345-024-04933-2.
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.
我们旨在准确确定尿石症治疗后输尿管狭窄（US）的发生率及其相关危险因素。
我们按照 PRISMA 指南进行了系统评价和荟萃分析，使用了从成立到 2023 年 11 月的数据库。如果研究包括≥18 岁的尿路结石（患者）患者，这些患者接受了内镜治疗（干预），包括输尿管镜检查（URS）、经皮肾镜取石术（PCNL）或体外冲击波碎石术（SWL）（比较），以评估前瞻性和回顾性研究中 US（结果）的发生率（研究设计），则认为该研究符合分析标准。
共有 43 项研究纳入分析。SWL 后 US 的总体发生率为 1.3%，PCNL 后为 2.1%。URS 后 US 的总体发生率为 1.9%，但考虑到最近五年的研究，该比例上升至 2.7%，如果结石嵌顿，该比例则上升至 4.9%。此外，如果随访时间少于或超过 6 个月，US 的发生率也会有所不同。输尿管上段结石、术前肾积水、术中输尿管穿孔和嵌顿结石的患者，在接受内镜干预后发生 US 的风险更高，优势比分别为 1.6（P=0.05）、2.6（P=0.009）、7.1（P<0.001）和 7.47（P=0.003）。
总体 US 发生率为 0.3%至 4.9%，近年来呈上升趋势。它受到治疗类型、结石位置和嵌顿、术前肾积水和术中穿孔的影响。未来标准化的报告和前瞻性的、更广泛的随访研究可能有助于更好地了解与结石治疗相关的 US 风险。
