Iatrogenic ureteric injuries after abdominal surgery: a systematic review and meta‐regression from the European Association of Urology Endourology Section

OBJECTIVE: To systematically evaluate management strategies and associated outcomes of iatrogenic ureteric injuries, focusing on clinical success, renal unit loss, and the need for subsequent endoscopic or reconstructive procedures. PATIENTS AND METHODS: A pre-registered protocol (CRD420251184018) guided a comprehensive search of PubMed and EMBASE databases. Observational studies reporting outcomes of ≥20 patients treated for iatrogenic ureteric injury with complete data on follow-up were included. Risk of bias was assessed using Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I). Random-effects meta-analysis with PLOGIT transformation was applied, stratifying results by treatment type and timing. Meta-regression examined the association of treatment modality with outcomes adjusting for the timing of reconstruction. RESULTS: = 76.0% due to different follow-up protocols, success outcomes, type and timing of management. Studies dominated by reconstructive procedures (15 studies) had higher success (91%, 95% CI 84-95%), than those primarily using endoscopic techniques (six studies; 66%, 95% CI 58-73%). Renal unit loss occurred in 2.3% (95% CI 1.5-3.6%). No differences in loss of renal unit were found. Additional endoscopic interventions were required in 3% (95% CI 2-4%) and further reconstructive surgery in 5% (95% CI 3-9%). Meta-regression showed endoscopic index management was associated with lower odds of success (odds ratio [OR] 0.14, 95% CI 0.05-0.40) and higher need for further reconstruction (OR 5.64, 95% CI 1.61-19.8). CONCLUSIONS: Across retrospective and heterogeneous studies, reconstructive-dominant management of iatrogenic ureteric injuries was associated with higher clinical success compared with endoscopic-dominant approaches, while renal unit loss remained uncommon. Endoscopic management was feasible in selected cases but was more frequently followed by additional endoscopic or reconstructive interventions.