Does an anti-reflux ureteral stent offer real benefits for children after endoscopic surgery for upper urinary tract stones? A single-center randomized controlled trial.

OBJECTIVE

To determine whether anti-reflux ureteral stents improve postoperative stent-related symptoms and complications compared with conventional Double-J (DJ) stents in children undergoing ureteroscopic lithotripsy (URL) or retrograde intrarenal surgery (RIRS).

METHODS

Children undergoing URL and RIRS were prospectively randomized in a 1:1 ratio by block randomization to receive either a 4.8-Fr anti-reflux stent or a 4.7-Fr conventional DJ stent. Postoperative symptoms were assessed 2 weeks after surgery using age-adapted versions of the pediatric ureteral stent symptom questionnaire (PUSSQ), with separate forms for toilet-trained and pre-toilet-trained children. Stone-free rates and stent-related complications were also evaluated. The trial was registered at ClinicalTrials.gov (NCT06569173).

RESULTS

A total of 88 children were included. Baseline characteristics were comparable between the two groups in both strata. Among toilet-trained children, the incidence of flank pain was lower (P = 0.047) in the anti-reflux stent group than the conventional DJ stent group, but body pain scores (P = 0.031) and urinary symptom scores (P = 0.009) were higher in the anti-reflux stent group. In pre-toilet-trained children, body pain scores (P = 0.048) and urinary symptom scores (P = 0.040) were also significantly higher in the anti-reflux group. No significant between-group differences were observed in other body pain manifestations, stent migration, stent extrusion, steinstrasse, or other complications. Stone-free rates were comparable between groups.

CONCLUSION

Anti-reflux stents reduced flank pain in toilet-trained children but were associated with more pronounced LUTS and body pain in both toilet-trained and pre-toilet-trained children. Overall, the anti-reflux ureteral stents may not confer a definitive clinical benefit in children after URL or RIRS.