Paclitaxel-coated balloon adjunct for benign ureteral and ureteroenteric strictures: a narrative review and translational proposal for enhanced endourological patency.

Background and Objective: Conventional endourological techniques, including balloon dilation and endoureterotomy, offer mechanical luminal relief but do not modulate the fibroproliferative cascade that drives restenosis. Paclitaxel-coated balloons, widely validated in vascular and urethral interventions, deliver localized antiproliferative therapy with minimal systemic exposure. Their mechanism-selective drug uptake into the urothelium, submucosa, and muscularis-may theoretically enhance long-term patency after endoscopic management. This review aims to summarize the translational rationale, mechanistic basis, and technical application of paclitaxel- and paclitaxel-dextran-coated balloons for benign ureteral and ureteroenteric strictures, and to contextualize their potential role within contemporary endourology. Methods: A narrative, non-systematic synthesis was performed integrating data from preclinical ureteral pharmacokinetic studies, vascular and urethral drug-coated balloons (DCBs) experience, and early human reports in benign ureteral and ureteroenteric strictures. The review emphasizes device characteristics, inflation parameters, drug-tissue interactions, and procedural workflows relevant to translational endourological practice. Key Content and Findings: Experimental models demonstrate time-dependent paclitaxel penetration across ureteral layers and sustained tissue residence. Early clinical experience-including a prospective pilot study and recent case-based observations-indicates that DCB use is technically feasible, exhibits an acceptable safety profile, and may achieve encouraging short-term radiologic patency. Cross-territory evidence from vascular and urethral platforms provides additional mechanistic justification for translational use in the ureter. Conclusions: Paclitaxel-based DCBs represent a technically feasible adjunct with a strong biological rationale for the endourological management of benign ureteral and ureteroenteric strictures. While mechanistic foundations and preliminary clinical signals are promising, rigorous prospective studies are required to define optimal technique, inflation parameters, patient selection, pharmacokinetics, and long-term outcomes before widespread adoption.