Does omitting a ureteral stent affect the outcomes of uncomplicated ureteroscopy for ureteral and kidney stones in adults? Results from a systematic review and meta-analysis of comparative randomized trials by the EAU endourology section.

PURPOSE: This systematic review and meta-analysis aimed to comprehensively evaluate postoperative outcomes of ureteroscopy (URS) for ureteral and renal stones, comparing patients managed with a postoperative double-J stent (DJ) versus those without a stent or with a short-term ureteral catheter (< 24 h).

METHODS

Following PRISMA 2020 guidelines, PubMed, Cochrane CENTRAL, and Scopus were searched without date restriction through January 2026. The PICOS framework guided inclusion criteria, restricted to prospective randomized controlled trials in adults or children with ureteral or renal stones undergoing URS. Outcomes included surgical time, stone-free rate (SFR), postoperative pain (VAS and USSQ), analgesic requirements, lower urinary tract symptoms (LUTS), complications, and readmission. Risk of bias was assessed using the Cochrane RoB 2 tool.

RESULTS

Thirty-two randomized trials (3,572 patients) were included. No study dedicated to children was found. Seven studies demonstrated low risk of bias across all domains, 19 studies showed some concerns, the remaining 6 studies had high overall risk of bias. Stent omission significantly reduced operative time (MD - 6.91 min), days 1-15 postoperative pain (37-45% risk reduction, ), analgesic requirements (55-82% reduction), dysuria (65%), urgency (81%), and hematuria (52-57%), with superior general health USSQ scores at weeks 2-4. SFR was equivalent between groups, with no significant differences in fever, UTI, urinary retention, ureteral stenosis, unplanned visits, or readmission.

CONCLUSIONS

Routine DJ stenting after uncomplicated URS in adults is unnecessary and increases morbidity without improving efficacy. Clinicians should adopt a selective stenting strategy, reserving DJ stents for specific indications. For pre-stented patients, a short-term overnight ureteral catheter represents a valid alternative to DJ stenting.