Ureteral Wall Thickness (UWT) is an Effective Predictor of Ureteral Stone Impaction and Management Outcomes: A Systematic-Review and Meta-Analysis.

Abstract

Ureteral stone impaction is associated with unfavorable endourologic outcomes, however reliable predictors of stone impaction are limited. We aimed to assess the performance of ureteral wall thickness (UWT) on non-contrast computed tomography as a predictor of ureteral stone impaction and failure rates of spontaneous stone passage, shockwave lithotripsy, and retrograde guidewire and stent passage. This study was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). A search was conducted in April 2022 for all adult, human and English language studies investigating UWT using PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library, Proquest Dissertations and Theses Global and SCOPUS. A systematic review and meta-analysis using random effects model were conducted. Risk of bias was assessed using the MINORS score. Fourteen studies with a pooled population of 2987 patients were included for quantitative analysis and 34 studies were included in our qualitative review. Meta-analysis findings suggest that a thinner UWT is associated with more favorable subgroup stone outcomes. Thinner UWT suggests a lack of stone impaction and was associated with improved rates of spontaneous stone passage, successful retrograde guidewire and stent placement, and improved shockwave lithotripsy outcomes. Studies lack a standardized UWT measurement protocol. UWT is a non-invasive measure that predicts ureteral stone impaction and thin measurements are predictive of successful outcomes. Variability in measurement methods confirms that a standardized UWT protocol is needed, and the clinical utility of UWT is yet to be determined.