Ureteral stricture after ureteroscopy for stones: A prospective study for the incidence and risk factors

Abstract

Context: A ureteral stricture is a serious complication of ureteroscopy (URS) that was reported in the literature in highly variable rates from 0.2% to 24%. Aims: Our aims are to estimate the incidence and to detect the risk factors of ureteral stricture after URS. Settings and Design: This is a prospective, case-series study. Materials and Methods: During the period from May 2015 to August 2016, 251 adult patients underwent 263 URS for the treatment of 304 ureteral stones. Postoperative regular follow-up was done for 12 months by ultrasound. Computed tomography urography and diuretic renogram were performed for the cases developed hydronephrosis to confirm and detect the level of the stricture. Statistical Analysis: IBM SPSS Statistics for Windows, Version 19.0, Armonk, NY: IBM Corp. used for data analysis. Chi-square and Fisher's exact tests were used to compare between qualitative variables. Mann–Whitney test was used to compare between two quantitative variables in case of nonparametric data. Multiple logistic regression analysis was done to measure the risk factors. P value was considered statistically significant when <0.05. Results: The mean age was 43.5 years (standard deviation [SD]: ±13.6), and the mean body mass index was 28.39 (±3.96). The mean total stone burden was 12.8 mm (SD: ±5.9). Bilateral URS was performed in 12 cases. The mean operative time was 54.8 min (SD: ±22.68). Initial and final stone-free rates were 83.3% and 100%, respectively. The overall complications rate was 28.1%. Stricture occurred in four cases (1.5%). Conclusions: In our experience, the incidence of post-URS ureteral stricture is low. The impacted stone is the most common cause of URS complications and hence stricture formation.

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“…Currently, ureteral strictures are managed in a variety of ways [5]. Endovascular surgery is often the rst choice for clinical physicians because of its minimally invasive nature and rapid associated postoperative recovery [6].…”

A Forgotten Double-J Ureteric Stent as the Core of a Bladder Stone: A Case Report and Literature Review

“…Iatrogenic causes are the most common causes of ureteric strictures, and the previous operation may have contributed to his early stenosis [ 24 , 25 ]. Ureteric strictures can cause urinary stones, infection, and impaired renal function [ 26 ].…”

Preoperative hydronephrosis is a predictive factor of ureteral stenosis after flexible ureteroscopy: a propensity scores matching analysis

“…Logistic regression analysis found that stone impaction was associated with ureteral stricture. There were only 4 cases of Ureteral stricture in the article [ 3 ]. Xeng Inn Fam et al explored the risk factors for ureteral stricture after ureteroscopy in the treatment of impaction calculi.…”

“…Early ureteroscopy studies reported ureteral stricture rates around 0.30%-23.81%, mostly in rigid and semi-rigid ureteroscopy studies [ 2 ]. Some scholars have studied the risk factors of ureteral stenosis, and believe that stone burden, stone impaction and operation time are important factors [ 3 ]. "Stone impaction" has been mentioned in the EAU guideline and many other literatures [ 1 , 4 , 5 ].…”