The role of paclitaxel-coated balloons in treating ureteral or anastomotic strictures: current evidence and future directions from EAU endourology.

BACKGROUND: This review aims to summarize the current literature on the use of paclitaxel-coated balloons (PCB) for the management of ureteral strictures (US), an area where minimally invasive alternatives to reconstructive surgery remains limited. METHODS: A comprehensive search of the literature was conducted through September 2025. Case reports and case series published as full texts were included. The review protocol was prospectively specified and registered on the PROSPERO database (CRD420251126296). Additional references were identified from bibliographies of relevant articles. The review followed PRISMA guidelines, and a flowchart was constructed to illustrate the study selection process. Risk of bias was assessed. RESULTS: Eight studies met the inclusion criteria: four clinical reports/series and four animal studies. Among 58 reported cases, the mean age at intervention was 62 years, with a male-to-female ratio of 34:24. The main etiologies of stricture included ureteroenteric anastomosis (n=25), post-ureteroscopy for urolithiasis treatment (n=19), post-laparoscopic pyeloplasty (n=7), iatrogenic surgical complications (n=5), transplanted kidney (n=1), and post-radiotherapy changes (n=1). The mean stricture length was 27.9 mm. Anatomical distribution comprised upper ureter (n=3), lower ureter (n=8), ureterovesical anastomosis (n=1), ureteroenteric anastomosis (n=25), abdominal ureter (n=11), and pelvic ureter (n=10). Mean follow-up was 20.7 months. Success criteria varied across series but generally included absence or improvement of hydronephrosis at 1–12 months. The overall success rate was 86.2% (50/58). Complications occurred in 5 patients (10.6%), most of which were minor and managed conservatively with stenting or antibiotics. The methodological quality of available studies revealed moderate risk of bias. CONCLUSION: PCB appears to be a promising, safe, and effective endourological option for the treatment of ureteral strictures, particularly in patients unsuitable for major reconstruction. However, current evidence is limited to small case series and animal models. Prospective, multicenter studies with standardized outcome measures and longer follow-up are essential to validate these encouraging early results and to define the role of PCB in future clinical practice.