Open vs Endoscopic Management of Benign Ureteroenteric Anastomotic Strictures: A Systematic Review and Meta-Analysis

Benign ureteroenteric anastomotic strictures (UES) are a common late complication after urinary diversion following radical cystectomy. While open revision is considered definitive, endoscopic approaches are increasingly used because of lower invasiveness. This study compares outcomes of open vs endoscopic and laser vs nonlaser endoscopic techniques for benign UES.

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant search of PubMed, EMBASE, and Scopus was conducted from inception through November 2024 and updated in October 2025. Studies including adults with benign UES after urinary diversion undergoing first-time open, robotic, laparoscopic, or endoscopic intervention were eligible. Definitions of treatment success varied among included studies and generally reflected radiographic patency, symptom resolution, or avoidance of further intervention. Random-effects meta-analyses using generalized linear mixed models pooled success and complication rates. Comparative analyses were limited to double-arm cohorts. Endoscopic techniques were stratified as laser-based or nonlaser, with subgroup analysis by stricture length.

A total of 31 studies (858 patients) met the inclusion criteria, including seven comparative cohorts (368 renal units). Open reconstruction demonstrated higher primary patency than endoscopic management (risk ratio [RR] 2.31, 95% confidence interval [CI]: 1.54-3.47, ARD: 53.16%, 95% CI: 44.57-61.74). Major complication rates were similar (RR 1.40, 95% CI: 0.49-4.01, ARD: 0.95, 95% CI:-5.30 to 7.20), while minor complications were more frequent after open revision (RR 2.56, 95% CI: 1.45-4.51, ARD:10.31, 95% CI: 3.23-17.39). Among endoscopic series, pooled success was 58% for both laser and nonlaser techniques, with low complication rates overall. Laser techniques showed greater success for strictures <1 cm.

Open revision appears to provide higher primary patency, although with greater minor morbidity. Endoscopic management offers a less invasive alternative with moderate success, and laser techniques may benefit selected patients with short strictures. These findings should be interpreted cautiously because of substantial heterogeneity across studies.