Keyword: Impacted Ureteral Stone
1 result 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.
