Open vs Endoscopic Management of Benign Ureteroenteric Anastomotic Strictures: A Systematic Review and Meta-Analysis.
Pritish Kendrekar, Ansh Bhatia, Hasim Bakbak et al.
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In 30 seconds
This systematic review and meta-analysis compared open reconstruction with endoscopic treatment for benign ureteroenteric anastomotic strictures after urinary diversion in adults. Across 31 studies involving 858 patients, including seven comparative cohorts, open revision had higher primary patency than endoscopic management (RR 2.31, 95% CI: 1.54-3.47; ARD: 53.16%, 95% CI: 44.57-61.74). Major complication rates were similar, but minor complications were more frequent after open revision. Pooled endoscopic success was 58% for both laser and nonlaser techniques; laser approaches showed greater success for strictures <1 cm.
Key findings
- Open reconstruction had higher primary patency than endoscopic management (RR 2.31, 95% CI: 1.54-3.47).
- Major complication rates were similar, while minor complications were more frequent after open revision (RR 2.56, 95% CI: 1.45-4.51).
- Pooled success was 58% for both laser and nonlaser endoscopic techniques; laser techniques performed better for strictures <1 cm.
Why it matters
The findings clarify the trade-off between greater primary patency with open revision and the lower invasiveness of endoscopic treatment. They also suggest that stricture length may help distinguish patients who could benefit from laser-based endoscopic management. Because outcomes varied across studies, these pooled estimates should inform discussion of options rather than be treated as definitive comparative predictions.
What to keep in mind
Substantial heterogeneity across studies, and definitions of treatment success varied. Comparative analyses were limited to seven double-arm cohorts.