Omission of postoperative double-J stents after uncomplicated URS reduces pain and analgesic requirementsSkipping Stents After Kidney Stone Surgery Reduces Patient Pain

World journal of urology Published June 15, 2026 Study authors: Cormio Angelo, Giulioni Carlo, Nedbal Carlotta, Fong Khi Yung, Yuen Steffi Kar-Kei, Mancon Stefano, … PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider omitting routine double-J stents after uncomplicated URS in adults to reduce postoperative pain and analgesic needs.

This meta-analysis of randomized trials evaluated the impact of omitting postoperative double-J (DJ) stents compared to standard DJ placement or short-term ureteral catheters in 3572 adults undergoing ureteroscopy (URS) for ureterolithiasis and nephrolithiasis. The analysis indicates that stone-free rates are equivalent between groups when stenting is omitted.

Key findings include a significant reduction in operative time by 6.91 min with stent omission. Furthermore, patients who did not receive a postoperative stent experienced a 37-45% risk reduction in pain during days 1 to 15, and a 55-82% reduction in analgesic requirements. Specific symptoms showed substantial reductions: dysuria decreased by 65%, urgency by 81%, and hematuria by 52-57%.

Safety data indicated no significant differences between groups regarding fever, UTI, urinary retention, ureteral stenosis, unplanned visits, or readmission. A noted limitation is the lack of specific data for pediatric patients. The authors conclude that routine DJ stenting after uncomplicated URS in adults is unnecessary and increases morbidity without improving efficacy.

How this fits prior evidence

This meta-analysis addresses a gap regarding postoperative management following ureteroscopy. While prior evidence discussed pain management techniques like ESPB ropivacaine for ureteral stones, this study specifically evaluates the impact of stent omission on overall morbidity and recovery metrics. It confirms that omitting stenting reduces complications such as dysuria and hematuria compared to standard practice.

A large review of clinical trials looked at how skipping a double-J stent after uncomplicated ureteroscopy (URS) affects patients with kidney or ureteral stones. The study included over 3,500 adults to compare those who did not receive a stent against those who received a stent or a short-term catheter.

The results showed that omitting the stent led to significantly shorter surgery times and much lower levels of pain for patients in the days following their procedure. Patients who did not have a stent also reported fewer issues like painful urination, urgency, and blood in their urine. Specifically, these symptoms were reduced by 52% to 81%.

While skipping the stent improved comfort, it did not change how well the surgery worked at removing stones. There were no significant differences in serious complications like infections or urinary retention between the two groups. Because this study only included adults, the findings may not apply to children.

What this means for you:

Skipping a double-J stent after certain kidney stone surgeries can reduce pain and symptoms without affecting success.

Common questions

Does skipping the stent make the surgery less effective?

No, the study found that the stone-free rate was equivalent between patients who received a double-J stent and those who did not. Skipping the stent does not change how well the procedure removes kidney or ureteral stones.

How much can skipping the stent reduce my pain?

Patients who did not receive a stent saw a 37% to 45% reduction in risk for postoperative pain. They also required significantly less pain medication, with some groups showing an 82% reduction in analgesic requirements.

Are there any risks to skipping the stent?

The study found no significant differences in serious complications like fever, infection, or urinary retention between those who had a stent and those who did not. However, this specific data only applies to adults.

Study Details

Study typeMeta analysis

Sample sizen = 3,572

EvidenceLevel 1

PublishedJun 2026

PMID42287462

View Original Abstract ↓

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.

Omission of postoperative double-J stents after uncomplicated URS reduces pain and analgesic requirementsSkipping Stents After Kidney Stone Surgery Reduces Patient Pain

How this fits prior evidence

Common questions

Study Details

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Omission of postoperative double-J stents after uncomplicated URS reduces pain and analgesic requirementsSkipping Stents After Kidney Stone Surgery Reduces Patient Pain

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