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).
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.
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.
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.
World journal of urology. 2026 Jun 13*** epublish ***
Angelo Cormio, Carlo Giulioni, Carlotta Nedbal, Khi Yung Fong, Steffi Kar-Kei Yuen, Stefano Mancon, Demetra Fuligni, Sohani N Dassanayake, Amelia Pietropaolo, Bhaskar K Somani, Begona Ballesta Martinez, Luigi Cormio, Giuseppe Carrieri, Vineet Gauhar, Daniele Castellani
Department of Urology and Renal Transplantation, Policlinico di Foggia, University of Foggia, Foggia, Italy., Urology Unit, Villa Igea Private Hospital, Ancona, Italy., Department of Urology, ASST Fatebenefratelli Sacco, Milan, Italy., Department of Urology, Sengkang General Hospital, Singapore, Singapore., EAU Endourology Section, Arnhem, The Netherlands., Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Milan, Italy., Urology Unit, Azienda Ospedaliero Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy., Department of Urology, University Hospital Southampton, NHS Trust, Southampton, UK., Department of Urology, University Hospital del Vinalopo, Alicante, Spain., Urology Unit, Department of Medicine and Surgery, LUM University, Strada Statale 100 km 18, Casamassima, 70010, Bari, Italy., EAU Endourology Section, Arnhem, The Netherlands. .