DJ Stenting After RIRS and URSL Procedures

Introduction to DJ Stenting

The European Association of Urology recommends that routine post-URS stenting is unnecessary after uncomplicated procedures and may increase morbidity, as stated in the 2025 guidelines 1, 2
The American Urological Association provides a strong recommendation (Grade A evidence) that stenting may be omitted in patients meeting specific safety criteria, according to the 2016 guidelines 3

DJ stenting can be confidently avoided when there is no suspected ureteral injury during the procedure, no evidence of ureteral stricture or anatomical impediments, normal contralateral kidney function, no renal functional impairment, no secondary URS procedure planned, and minimal or no residual stone fragments 1, 2, 3

The European Association of Urology and the American Urological Association agree that stenting is essential in cases of ureteral trauma or perforation during the procedure, significant bleeding requiring tamponade, pre-existing ureteral stricture, solitary kidney, renal insufficiency, large residual stone burden requiring drainage, active UTI or sepsis at time of procedure, and pregnancy 1, 2, 3

Stent-related morbidity is substantial, causing bothersome lower urinary tract symptoms, pain, and temporarily reduced quality of life in most patients, with specific complications including stent migration, UTI risk, stent encrustation and breakage, and obstruction from the stent itself 3, 4
Routine stenting does not enhance stone clearance after uncomplicated procedures, and additional procedures are required for stent removal, adding cost and patient burden 3, 4

When stenting is clinically indicated, duration should be minimized, and alpha-blockers (such as tamsulosin) can improve stent tolerability, as recommended by the European Association of Urology 1, 2

The American Urological Association and the European Association of Urology recommend against stenting reflexively "just to be safe" after straightforward procedures, and against leaving stents in longer than necessary, aiming for removal within 14 days when possible 1, 2, 3

The American Urological Association recommends DJ stenting in patients with ureteral injury during ureteroscopy to prevent further complications 5, 6
DJ stenting is indicated in patients with pre-existing ureteral stricture to maintain patency 5, 7
The American College of Radiology suggests DJ stenting in patients with solitary kidney to prevent complete obstruction 5, 6
Patients with renal insufficiency require DJ stenting to maintain drainage and prevent further kidney damage 5, 7
DJ stenting is necessary in patients with large residual stone burden after ureteroscopy to ensure proper drainage 5, 6
The American College of Radiology recommends cystoscopic retrograde ureteral decompression with double-J stents in cases of ureteric obstruction with infection/sepsis prior to definitive ureteroscopic stone extraction 8, 9

Patients with fever, leukocytosis, and obstructing stone require retrograde ureteral stenting to alleviate symptoms and prevent complications 8, 9, 10
DJ stenting has been shown to be safe and effective in patients with sepsis and obstructing calculi, with a decreased duration of hospital stay and ICU admission rate compared to percutaneous nephrostomy (PCN) 9, 11

DJ stents are associated with lower urinary tract symptoms and pain, which can temporarily alter quality of life 5, 7, 6
Stent migration can occur in approximately 5% of cases 5, 7, 6
The risk of urinary tract infection is approximately 2-6% 5, 7, 6

Secondary cystoscopy is required for stent removal unless a pull string is attached to the distal end 5, 7