As the prevalence of urolithiasis increases and ureteroscopy (URS) is used more frequently, the risks of uncommon complications such as ureteral stricture may become more notable. Our objective is to assess the rate and associated risk factors of ureteral stricture formation in patients undergoing URS.
Utilizing the IBM® MarketScan® research database, we evaluated data from 2008-2019 and compared ureteral stricture rates and their management following URS to subjects who had shock wave lithotripsy (SWL). SWL was used as a comparison group to represent the rate of stricture from stone disease alone. A third group of those having both SWL and URS was included. Patients and secondary procedures were identified using CPT, ICD-9, and ICD-10 codes.
329,776 patients received URS, SWL or SWL+URS between 2008 and 2019. 2.9% of patients after URS, 1.5% after SWL and 2.6% after SWL+URS developed a stricture. In the multivariable model, rates of stricture were 1.7 fold higher after URS vs SWL (OR:1.71, 95% CI 1.62-1.81). Preoperative hydronephrosis, age, prior stones/intervention and concurrent kidney and ureteral stones were associated with increased risk of stricture. Of those with strictures incurred after URS, 35% required drainage, 21% had endoscopic intervention, 4.8% required reconstructive surgery, and 1.7% underwent nephrectomy.
Ureteral stricture rate after URS of nearly 3% was higher than expected and approximately twice the rate attributable to stone disease alone. Factors associated with the stone as well as instrumentation were found to be risk factors. The morbidity of stricture disease following URS was significant.
The Journal of urology. 2022 Aug 19 [Epub ahead of print]
Peter L Sunaryo, Philip C May, Sarah K Holt, Matthew D Sorensen, Robert M Sweet, Jonathan D Harper
Department of Urology, Northwest Permanente, Portland, Oregon., Evergreen Health, Kirkland, Washington., Department of Urology, University of Washington, Seattle, Washington.