INTRODUCTION: Urolithiasis prevalence and ureteroscopic lithotripsy utilization have increased ureteral strictures' visibility. It is imperative to summarize the global epidemiological trends and investigate risk factors associated with lithotripsy itself. EVIDENCE ACQUISITION: A systematic review of English literature was conducted to assess the incidence of ureteral strictures following lithotripsy across all age groups. Comprehensive analyses, including meta-regression, network meta-analysis, and Joinpoint regression, were used to investigate subgroup incidence. Machine learning algorithms identified influencing factors related to lithotripsy. EVIDENCE SYNTHESIS: This study included 43 studies, estimating an overall ureteral stricture (US) occurrence rate of 1.7% and 2.9% over the past decade, indicating an upward trend. Subgroup analysis showed the lowest postoperative stenosis incidence of 1.4% for flexible combined with semi-rigid ureteroscopy. Laser lithotripsy had a higher incidence (2.4%) than pneumatic lithotripsy (1.7%), with an odds ratio (OR) of 4.61 (95% CI: 2.0-10.6). Middle and proximal segment strictures had higher ORs compared to the distal segment (2.2, 95% CI: 1.1-4.1; 2.0, 95% CI: 1.1-3.5, respectively). Machine learning models indicated that operation time is a significant predictor of postoperative stenosis. Joinpoint regression identified a change point at 45 minutes of surgical time (MPC=2.18, P<0.05), with increased stenosis incidence thereafter. CONCLUSIONS: The prevalence of US post-lithotripsy is increasing. Different endoscope types, lithotripsy methods, and locations show distinct incidence rates. Patients with urinary lithotripsy lasting longer than 45 minutes should be actively evaluated for potential stenosis.
Tan et al. (2025) studied this question.