Keyword: GRADE
2 results found.
Perspective Article
Journal of Urology and Andrology Research, 1(1), 2026, juar005
ABSTRACT:
Background: Ureteral stricture is an uncommon but disproportionately morbid late complication of endourological stone surgery, presenting weeks to years after an ostensibly successful procedure and capable of producing silent, progressive renal damage if surveillance is inadequate.
Objective: To synthesize contemporary evidence on the incidence, pathophysiology, risk factors, prevention, surveillance, and management of ureteral strictures after ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and shock-wave lithotripsy (SWL), focusing on impacted ureteral stones and ureteral access sheath (UAS)-related injury as two consistently implicated and potentially modifiable contributors.
Evidence Acquisition: This narrative review was informed by a structured literature search of PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library, supplemented by reference-list screening and forward citation tracking. The core search window was January 2015 through December 2025, with earlier landmark studies retained when foundational and targeted citation updating performed during manuscript revision. Because the work is a narrative review rather than a systematic review, no de novo meta-analysis or formal study-level risk-of-bias scoring was undertaken. Database-specific search strategies are provided in Supplementary Appendix S1.
Evidence Synthesis: Pooled stricture rates are 1.9% after URS (4.9% with impacted stones), 2.1% after PCNL, and 1.3% after SWL; UAS-related injury requiring prolonged stenting occurs in 1.8% of RIRS cases in the largest registry, while any-grade endoscopic UAS wall injury reaches 46.5%. Ureteral perforation at the site of an impacted stone is the most consistently reported risk factor. Pathophysiologically, macrophage- and fibroblast-derived TGF-β1 contributes to a myofibroblast–collagen cascade triggered by ischemia, chronic obstruction, and infection. Prevention evidence supports pre-stenting in selected difficult ureters, sheath-size matching, controlled laser energy, and drainage of a substantially traumatized ureter. Postoperative surveillance remains unstandardized. Endoscopic management can achieve high early technical success, but durability decreases over time in anatomically complex strictures, whereas reconstructive surgery offers more durable treatment at the cost of greater invasiveness.
Conclusions: Post-endourological ureteral stricture is uncommon but clinically important. The highest-risk setting is an impacted or proximal stone complicated by perforation or high-grade ureteral injury. Prevention, documentation of intraoperative injury, selective early imaging in high-risk patients, and anatomy-based treatment selection are the most practical strategies supported by the current evidence.
Objective: To synthesize contemporary evidence on the incidence, pathophysiology, risk factors, prevention, surveillance, and management of ureteral strictures after ureteroscopy (URS), retrograde intrarenal surgery (RIRS), percutaneous nephrolithotomy (PCNL), and shock-wave lithotripsy (SWL), focusing on impacted ureteral stones and ureteral access sheath (UAS)-related injury as two consistently implicated and potentially modifiable contributors.
Evidence Acquisition: This narrative review was informed by a structured literature search of PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library, supplemented by reference-list screening and forward citation tracking. The core search window was January 2015 through December 2025, with earlier landmark studies retained when foundational and targeted citation updating performed during manuscript revision. Because the work is a narrative review rather than a systematic review, no de novo meta-analysis or formal study-level risk-of-bias scoring was undertaken. Database-specific search strategies are provided in Supplementary Appendix S1.
Evidence Synthesis: Pooled stricture rates are 1.9% after URS (4.9% with impacted stones), 2.1% after PCNL, and 1.3% after SWL; UAS-related injury requiring prolonged stenting occurs in 1.8% of RIRS cases in the largest registry, while any-grade endoscopic UAS wall injury reaches 46.5%. Ureteral perforation at the site of an impacted stone is the most consistently reported risk factor. Pathophysiologically, macrophage- and fibroblast-derived TGF-β1 contributes to a myofibroblast–collagen cascade triggered by ischemia, chronic obstruction, and infection. Prevention evidence supports pre-stenting in selected difficult ureters, sheath-size matching, controlled laser energy, and drainage of a substantially traumatized ureter. Postoperative surveillance remains unstandardized. Endoscopic management can achieve high early technical success, but durability decreases over time in anatomically complex strictures, whereas reconstructive surgery offers more durable treatment at the cost of greater invasiveness.
Conclusions: Post-endourological ureteral stricture is uncommon but clinically important. The highest-risk setting is an impacted or proximal stone complicated by perforation or high-grade ureteral injury. Prevention, documentation of intraoperative injury, selective early imaging in high-risk patients, and anatomy-based treatment selection are the most practical strategies supported by the current evidence.
Perspective Article
Journal of Urology and Andrology Research, 1(1), 2026, juar004
ABSTRACT:
Primary objective: To systematically evaluate and synthesize current clinical evidence on the impact of prostatic artery embolization (PAE) on erectile and ejaculatory function in men treated for benign prostatic hyperplasia (BPH).
Secondary objectives: To summarize, where reported, changes in prostate volume, PSA, IPSS/QoL, procedure-related adverse events, and cost-effectiveness data. These are presented separately from, and do not substitute for, the primary sexual-function analysis.
Materials and methods: A systematic review was conducted in accordance with the PRISMA 2020 statement. Four databases (PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus) were searched to June 2026. Eligible studies were RCTs and prospective cohort studies reporting IIEF-5 and/or MSHQ-EjD outcomes with a minimum 3-month follow-up. Risk of bias was assessed with RoB 2 (randomized trials), ROBINS-I (non-randomized comparative studies), and the Newcastle–Ottawa Scale (single-arm cohorts). Certainty of evidence was evaluated using the GRADE approach. The protocol was not prospectively registered in PROSPERO (acknowledged as a limitation). Given clinical and methodological heterogeneity across studies, a quantitative meta-analysis was not performed; a narrative synthesis is presented.
Results: PAE was associated with a markedly lower rate of retrograde ejaculation (0–5%) than TURP or laser enucleation (56–85%), and with a stable-to-modestly-improved IIEF-5 score (+1.5 to +2.5 points at 12 months), attributed largely to LUTS relief and discontinuation of alpha-blockers/5-ARIs rather than a direct vascular effect on erectile tissue.
Conclusion: Current evidence supports PAE as an organ-preserving option with a superior sexual-function profile relative to TURP/HoLEP for sexually active men with BPH who prioritize preservation of antegrade ejaculation, though the certainty of this evidence is limited by open-label trial designs, non-validated outcome measures in several studies, and the absence of prospective registration.
Secondary objectives: To summarize, where reported, changes in prostate volume, PSA, IPSS/QoL, procedure-related adverse events, and cost-effectiveness data. These are presented separately from, and do not substitute for, the primary sexual-function analysis.
Materials and methods: A systematic review was conducted in accordance with the PRISMA 2020 statement. Four databases (PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus) were searched to June 2026. Eligible studies were RCTs and prospective cohort studies reporting IIEF-5 and/or MSHQ-EjD outcomes with a minimum 3-month follow-up. Risk of bias was assessed with RoB 2 (randomized trials), ROBINS-I (non-randomized comparative studies), and the Newcastle–Ottawa Scale (single-arm cohorts). Certainty of evidence was evaluated using the GRADE approach. The protocol was not prospectively registered in PROSPERO (acknowledged as a limitation). Given clinical and methodological heterogeneity across studies, a quantitative meta-analysis was not performed; a narrative synthesis is presented.
Results: PAE was associated with a markedly lower rate of retrograde ejaculation (0–5%) than TURP or laser enucleation (56–85%), and with a stable-to-modestly-improved IIEF-5 score (+1.5 to +2.5 points at 12 months), attributed largely to LUTS relief and discontinuation of alpha-blockers/5-ARIs rather than a direct vascular effect on erectile tissue.
Conclusion: Current evidence supports PAE as an organ-preserving option with a superior sexual-function profile relative to TURP/HoLEP for sexually active men with BPH who prioritize preservation of antegrade ejaculation, though the certainty of this evidence is limited by open-label trial designs, non-validated outcome measures in several studies, and the absence of prospective registration.