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).
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).
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.
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.
World journal of urology. 2026 Jun 06*** epublish ***
Qibo Hu, Hongbo Liu, Wei Ru, Zheming Xu, Lizhe Hu, Xiang Yan
Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents' Health and Diseases, Hangzhou, China., Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Children and Adolescents' Health and Diseases, Hangzhou, China. .