An evidence-based review by the EAU Endourology on standard practices and future directions for ureteral stents in transplant patients.

PURPOSE: Although ureteral stenting is widely used in kidney transplantation (KTx) to prevent major urological complications (MUC), important uncertainties remain regarding its impact on infectious outcomes, optimal dwell time, preferred removal technique, and whether routine or selective stenting is most appropriate. This scoping review synthesizes contemporary evidence to clarify best practices and identify future directions for stent use in KTx recipients.

METHODS

A scoping review with systematic synthesis was conducted following PRISMA methodology. PubMed, Embase, and CENTRAL were searched for studies published between 1 January 2000 and 25 July 2025. Fifty-five eligible studies—including systematic reviews, randomized controlled trials, prospective and retrospective series—were included and organized according to key clinical questions.

RESULTS

Evidence on whether ureteric stenting independently increases urinary tract infection (UTI) risk is inconclusive, largely due to heterogeneity in definitions, stent durations, and prophylactic approaches. However, the association between dwell time and UTI risk is clear: stent removal between 14 and 21 days consistently reduces UTI rates without increasing MUCs. Uncertainty regarding the clinical course of stent colonization and asymptomatic bacteriuria continues to challenge evidence-based management in stented KTx recipients. Emerging removal methods—such as stent-on-string techniques, single-use cystoscopy, and magnetic stents—demonstrate reduced costs and improved patient tolerability. Internal double-J (DJ) stents show superior outcomes to external stents, and although evidence remains limited, selective stenting may be appropriate for carefully selected low-risk recipients.

CONCLUSION

Current evidence supports DJ stent insertion in KTx recipients, with removal at 14–21 days using minimally invasive, office-based techniques. Personalized selection of stent strategy, alongside evaluation of novel stent designs, represents an important direction for improving outcomes and patient experience.