Incidence and context-specific risk patterns of ureteral avulsion and perforation during ureteroscopy: EAU endourology systematic review and meta-analysis.
UrolithiasisSep 24, 2026 (epub)
Ali Talyshinskii, Nariman Gadzhiev, Vigen Malkhasyan et al.
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In 30 seconds
This systematic review and meta-analysis evaluated the incidence of ureteral perforation and avulsion during ureteroscopy (URS) for ureteral stones, analyzing 15 studies with 20,635 procedures. The pooled incidence of ureteral perforation was found to be 1.89% (95% CI 1.11-3.19%), while ureteral avulsion occurred at a rate of 0.32%. The study highlights the increased risk associated with impacted stones.
Key findings
- The pooled incidence of ureteral perforation during URS was 1.89% (95% CI 1.11-3.19%).
- Incidence of perforation was significantly higher at 13.71% in studies restricted to impacted stones.
- The pooled incidence of ureteral avulsion was 0.32% across the analyzed studies.
- A higher male proportion was associated with increased odds of perforation (OR 2.03 per 10% increase).
Why it matters
Understanding the incidence and risk factors for ureteral perforation and avulsion during URS is crucial for clinicians to implement risk-stratified approaches and improve patient safety during procedures.