Endoscopic Balloon Dilatation in the Treatment of Benign Ureteral Strictures: A Meta-Analysis and Systematic Review.

BACKGROUND AND PURPOSE: Although balloon dilatation is one of the main endoscopic procedures used to treat benign ureteral strictures, its precise efficacy remains controversial. We aimed to identify, combine, and analyze existing published data to ascertain the efficacy of endoscopic balloon dilatation for benign ureteral strictures.

METHODS: In December 2018, a literature search was performed using Medline, Embase, and Web of Science databases. We included reports in which the study population consisted of patients who underwent endoscopic balloon dilatation for the treatment of benign ureteral strictures. Technical, short-term, and long-term success rates (expressed as mean ± standard error) were adopted as the outcome measures.

RESULTS: Using our search strategy, a total of 19 studies (all series reports) were included for analysis. Using a random-effects model, the pooled technical success rate of endoscopic balloon dilatation for benign ureteral strictures was found to be 89% ± 4%. Furthermore, the short-term success rate (i.e., 3 months after surgery) was 60% ± 10%, and the long-term success rate (i.e., 6-12 months after surgery) was 54% ± 14%. In the subgroup analysis, the success rate of endoscopic balloon dilatation for ≤2-cm benign ureteral strictures was significantly higher than that for >2-cm ones (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.05-0.35). In addition, the success rate in cases with strictures of onset timing ≤3 months was relatively higher than that in cases with strictures of onset timing >3 months (OR: 0.46; 95% CI: 0.15-1.43).

CONCLUSION: Our study indicates that endoscopic balloon dilatation has a high success rate in the treatment of benign ureteral strictures with length ≤2 cm and onset timing ≤3 months. However, there is still no consensus on balloon type, dilatation pressure, expansion number, postoperative ureteral stent type, and stent retention time for the balloon dilatation technique.