Abstract：
OBJECTIVE: We aimed to accurately determine ureteral stricture (US) rates following urolithiasis treatments and their related risk factors.
METHODS: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design).
RESULTS: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years\' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively.
CONCLUSIONS: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
METHODS: We conducted a systematic review and meta-analysis following the PRISMA guidelines using databases from inception to November 2023. Studies were deemed eligible for analysis if they included ≥ 18 years old patients with urinary lithiasis (Patients) who were subjected to endoscopic treatment (Intervention) with ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), or shock wave lithotripsy (SWL) (Comparator) to assess the incidence of US (Outcome) in prospective and retrospective studies (Study design).
RESULTS: A total of 43 studies were included. The pooled US rate was 1.3% post-SWL and 2.1% post-PCNL. The pooled rate of US post-URS was 1.9% but raised to 2.7% considering the last five years\' studies and 4.9% if the stone was impacted. Moreover, the pooled US rate differed if follow-ups were under or over six months. Patients with proximal ureteral stone, preoperative hydronephrosis, intraoperative ureteral perforation, and impacted stones showed higher US risk post-endoscopic intervention with odds ratio of 1.6 (P = 0.05), 2.6 (P = 0.009), 7.1 (P < 0.001), and 7.47 (P = 0.003), respectively.
CONCLUSIONS: The overall US rate ranges from 0.3 to 4.9%, with an increasing trend in the last few years. It is influenced by type of treatment, stone location and impaction, preoperative hydronephrosis and intraoperative perforation. Future standardized reporting and prospective and more extended follow-up studies might contribute to a better understanding of US risks related to calculi treatment.
摘要：
目的：我们旨在准确确定尿石症治疗后输尿管狭窄（US）的发生率及其相关危险因素。
方法：我们根据PRISMA指南使用数据库从开始到2023年11月进行了系统评价和荟萃分析。如果研究包括≥18岁的尿路结石患者（患者），接受输尿管镜检查（URS）的内镜治疗（干预），则认为这些研究符合分析条件。经皮肾镜取石术(PCNL),或冲击波碎石术（SWL）（比较），以评估前瞻性和回顾性研究（研究设计）中US（结果）的发生率。
结果：共纳入43项研究。合并的US率为SWL后1.3%和PCNL后2.1%。美国后URS的合并率为1.9％，但考虑到过去五年的研究，该比率提高到2.7％，如果石头受到影响，则为4.9％。此外，如果随访时间低于或超过6个月,则合并的美国比率不同.输尿管近端结石患者，术前肾积水,术中输尿管穿孔，和嵌顿性结石显示较高的美国风险内镜干预后的比值比为1.6（P=0.05），2.6（P=0.009），7.1（P<0.001），和7.47（P=0.003），分别。
结论：美国的总体比率为0.3％至4.9％，在过去的几年中呈增长趋势。它受治疗类型的影响，石头的位置和撞击，术前肾积水及术中穿孔。未来的标准化报告以及前瞻性和更广泛的随访研究可能有助于更好地了解与结石治疗相关的美国风险。
方法：我们根据PRISMA指南使用数据库从开始到2023年11月进行了系统评价和荟萃分析。如果研究包括≥18岁的尿路结石患者（患者），接受输尿管镜检查（URS）的内镜治疗（干预），则认为这些研究符合分析条件。经皮肾镜取石术(PCNL),或冲击波碎石术（SWL）（比较），以评估前瞻性和回顾性研究（研究设计）中US（结果）的发生率。
结果：共纳入43项研究。合并的US率为SWL后1.3%和PCNL后2.1%。美国后URS的合并率为1.9％，但考虑到过去五年的研究，该比率提高到2.7％，如果石头受到影响，则为4.9％。此外，如果随访时间低于或超过6个月,则合并的美国比率不同.输尿管近端结石患者，术前肾积水,术中输尿管穿孔，和嵌顿性结石显示较高的美国风险内镜干预后的比值比为1.6（P=0.05），2.6（P=0.009），7.1（P<0.001），和7.47（P=0.003），分别。
结论：美国的总体比率为0.3％至4.9％，在过去的几年中呈增长趋势。它受治疗类型的影响，石头的位置和撞击，术前肾积水及术中穿孔。未来的标准化报告以及前瞻性和更广泛的随访研究可能有助于更好地了解与结石治疗相关的美国风险。
