Ureteral wall thickness predicts stone impaction, outcomes

Thin measurements of ureteral wall thickness on noncontrast computed tomography are suggestive of a lack of stone impaction and successful management outcomes, a study has shown.

In April 2022, the authors searched the databases of PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library, Proquest Dissertations & Theses Global, and SCOPUS for all adult, human, and English studies examining ureteral wall thickness. They then carried out a systematic review and meta-analysis using a random effects model.

Risk of bias was assessed using the Methodological Index for Nonrandomized Studies score. In addition, the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used in completing this study.

Fourteen studies, including a total of 2,987 patients, met the eligibility criteria for the quantitative analysis, while 34 made it to the qualitative review.

Pooled data suggested the association of a thinner ureteral wall thickness with more favourable subgroup stone outcomes. A thinner ureteral wall thickness predicted a lack of stone impaction and correlated with better rates of spontaneous stone passage, successful retrograde guidewire and stent placement, and improved shock wave lithotripsy outcomes.

Notably, eligible studies were lacking a standardized ureteral wall thickness measurement protocol.

“Variability in measurement methods confirms that a standardized ureteral wall thickness protocol is needed, and the clinical utility of ureteral wall thickness is yet to be determined,” the authors said.