Prevention and management of difficult ureteroscope withdrawal caused by ureteroscopic impaction: a narrative review.

Background and objective: Among the complications of ureteroscopic lithotripsy, withdrawal difficulties due to ureteroscopic impaction have not been well studied. Most of the existing literature is limited to single-center retrospective analysis or small-sample case reports. The purpose of this article is to elucidate the causes of intraoperative ureteroscopic impaction, summarize relevant research evidence, and propose effective prevention and management strategies.

Methods: Through a systematic search of PubMed and Web of Science spanning from 1999 to 2024, English and Chinese literature containing keywords such as "ureteroscopy", "difficult ureteroscope withdrawal", "ureteroscopic impaction", and "ureteral injury" were included. The search covered retrospective studies, case reports, and experimental studies.

Key content and findings: This review identified that the primary causes of ureteroscopic impaction encompass operator-related factors, instrumental characteristics, ureteral anatomical strictures, pathological strictures, and ureteral spasms. Preventive strategies involve comprehensive preoperative assessment, appropriate ureteroscopy selection, and meticulous procedural technique. Regarding management, mild cases may resolve spontaneously with observation, whereas severe impaction necessitates employment of specialized exit techniques.

Conclusions: This review offers clinicians comprehensive strategies for preventing and managing ureteroscopic impaction, which can help reduce surgical risks and improve patient outcomes. Further multicenter, prospective studies are necessary to optimize relevant technologies and methods in the future.