Predictors of Ureteral Strictures after Retrograde Ureteroscopic Treatment of Impacted Ureteral Stones: A Systematic Literature Review

TONYALI Ş., Yilmaz M., Tzelves L., Emiliani E., De Coninck V., Keller E. X., ...More

Journal of Clinical Medicine, vol.12, no.10, 2023 (SCI-Expanded) identifier identifier

  • Publication Type: Article / Review
  • Volume: 12 Issue: 10
  • Publication Date: 2023
  • Doi Number: 10.3390/jcm12103603
  • Journal Name: Journal of Clinical Medicine
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, EMBASE, Directory of Open Access Journals
  • Keywords: impacted stone, stricture, ureteral perforation, ureteroscopy
  • Istanbul University Affiliated: Yes


Background: 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. Methods: 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. Results: 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. Conclusion: Ureteral perforation during surgery might be considered the main risk factor for ureteral stricture formation following retrograde ureteroscopic stone removal for impacted ureteral stones.