Regional practice patterns and perceptions of ureteral stricture after ureteroscopy for ureteral stones: A survey study and expert recommendations.

Ureteral stricture is a potentially serious complication following ureteroscopy (URS) for ureteral stones. In the absence of clear guideline recommendations, practices regarding risk factors, prevention, surveillance, and management remain heterogeneous. This study aimed to evaluate multinational urologists' perceptions and real-world practices related to post-URS ureteral strictures and to develop expert consensus recommendations. A multinational, web-based survey was distributed to practicing urologists worldwide through professional networks and platforms. The questionnaire assessed respondent demographics, URS case volume, perceived incidence and risk factors, preventive strategies, laser settings, postoperative surveillance, and management approaches. Data were analyzed using question-specific denominators. Expert consensus recommendations were developed through a structured Delphi process. A total of 362 urologists from 66 countries participated, with 80.1% performing > 50 URS procedures annually. Most respondents (56.0%) reported a low ureteral stricture incidence (1-2%), although 54.1% perceived an increasing trend. Only 39.0% consistently informed patients preoperatively about this risk. Prolonged stone impaction was identified as the most important risk factor, followed by surgeon experience. Most respondents (65.3%) believed pre-stenting reduces stricture risk. Postoperative imaging practices varied considerably, with 49.4% performing surveillance selectively in high-risk cases. Endoscopic treatment was perceived to have limited long-term success, with many patients ultimately requiring reconstructive surgery. Post-URS ureteral stricture remains an uncommon but clinically relevant complication influenced by procedural and surgeon-related factors. Considerable variability in practice highlights the need for standardized, evidence-based recommendations. The expert consensus developed in this study provides practical guidance to optimize patient outcomes.