Present and Future of Ureteral Stent Technology: A Review by the EAU Endourology Section

Ureteral stents are indispensable in urological practice, yet they remain a leading source of procedure-related morbidity. Stent-associated pain, urinary symptoms, encrustation, and the need for secondary removal procedures represent a substantial burden for patients and healthcare systems alike. This tension between clinical necessity and patient tolerability motivated our group, in collaboration with the EAU Endourology Section, to conduct a comprehensive scoping review of contemporary and emerging ureteral stent technology.

Synthesizing 62 studies across materials science, bioengineering, pharmacology, and clinical urology, our review identified meaningful progress across several domains. Silicone-based materials demonstrate superior biocompatibility relative to conventional polyurethane; anti-reflux stent designs have shown significant reductions in irritative voiding symptoms in randomized trials; and non-cystoscopic removal systems - whether magnetic or thread-assisted - offer patients a less invasive and more convenient alternative to standard retrieval. Despite these advances, widespread clinical adoption remains inconsistent, and robust comparative data between competing technologies are limited. Biodegradable and drug-eluting stent systems, while scientifically promising, remain largely investigational.

A critical and underappreciated gap in the literature is the inconsistent use of validated patient-reported outcome measures. Without standardized symptom assessment tools, meaningful comparison across studies is impaired. The recent development and validation of the Canadian Endourology Group Stent Symptom Score (CEGSSS) represents an important step toward addressing this gap, and we encourage its adoption in future clinical trials.

The trajectory of the field points toward precision urology: stents customized to individual patient anatomy through three-dimensional printing, smart implants capable of real-time physiological monitoring, and drug-eluting platforms that integrate antimicrobial, anti-fibrotic, and anti-encrustation properties into a single device. The scientific foundation for these innovations exists. What is now required is rigorous translational research and prospective clinical validation to bridge the gap between promising prototypes and routine urological practice.

Written by: Nick Lee, MD, Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada

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