Association between postoperative JJ stent duration and stone-free rates after retrograde intrarenal surgery: a large retrospective cohort study.

OBJECTIVE

Routine JJ stenting after retrograde intrarenal surgery (RIRS) is common, however the optimal postoperative stent dwelling period to maximize stone-free rate (SFR) remains unclear. This study evaluated the effect of different postoperative JJ stent durations on SFR after RIRS.

METHODS

In this single-center retrospective cohort study, 665 patients who underwent RIRS between August 2022 and May 2025 were analyzed. All patients received a postoperative JJ stent and were categorized by stent duration: Group 1 (0-30 days), Group 2 (31-60 days), Group 3 (61-90 days), and Group 4 (>90 days). Demographics, stone characteristics, perioperative variables, and SFR-assessed by non-contrast computed tomography one week after stent removal-were compared. Residual fragments >4 mm were considered unsuccessful; outcomes were further stratified into three groups as: no residual fragment, 0-2 mm, and 2.1-4 mm residual fragments. ROC and Youden index analyses were used to explore whether a postoperative stent-duration interval was associated with higher observed SFR.

RESULTS

Groups included 286, 178, 85, and 116 patients, respectively. Baseline characteristics were comparable. The SFR was statistically significantly higher in Group 1 (75.2%) compared to the other groups (p = 0.006). Postoperative complications, hospitalization time, and operation duration were also similar (all p > 0.05). ROC analysis revealed a 26-27-day interval associated with the highest SFR, although discriminatory performance was modest (AUC: 0.595, p < 0.001) indicating that this finding should be interpreted as exploratory rather than a validated clinical threshold. Multivariate analysis revealed no additional factors other than stent duration affecting SFR.

CONCLUSION

. Earlier postoperative JJ stent removal within the first month was associated with higher SFR in this cohort; however, this association should be interpreted cautiously given the modest discriminatory performance observed in ROC analysis. Prolonged stenting beyond approximately 4 weeks does not improve SFR or reduce complications. Prospective randomized trials are needed to validate these findings.