Etiological distribution of benign ureteral stricture in 2532 adults: a cross-sectional analysis in a tertiary center

Purpose: To present the etiological distribution of benign ureteral stricture (BUS) in a high-volume outpatient clinic of a tertiary center. Methods and patients: A total of 2532 consecutive patients diagnosed with BUS were involved. The diagnosis and determination of etiology for BUS were based on a comprehensive evaluation of symptoms, medical history and imaging findings. Results: 1307 female (51.62%) patients and 1225 male patients (48.38%) with BUS were included, with a median age of 39 years. The etiological distribution included 1130 patients (44.67%) with congenital malformations, 769 patients (30.33%) with iatrogenic injuries causes, 418 patients (16.51%) with acquired non-iatrogenic causes and 215 patients (8.49%) with unknown causes. Ureteropelvic junction obstruction (UPJO) (25.2%), urological procedures (17%), and radiotherapy (7.3%) were the most common causes of BUS. Male patients exhibited a higher prevalence of congenital malformations (49.8% vs 39.86%, P < 0.001) and a lower incidence of iatrogenic injuries (25.14% vs 35.2%, P < 0.001) compared to female patients. Congenital malformations were more common in patients < 40 years old, while iatrogenic injuries were predominant in individuals ≥ 41 years old. Patients with a history of intervention had a higher proportion of congenital malformations ( P < 0.001) and a lower proportion of iatrogenic injuries ( P < 0.001) and acquired factors ( P < 0.001). Conclusion: The etiology of BUS in adults was characterized by its complexity and diversity. UPJO, urologic procedure and radiotherapy were sequentially the top three causes of BUS. Age and gender significantly affected the distribution of etiologies of BUS.