Ureterorenoscopic (URS) stone fragmentation and removal is currently the preferred treatment modality for managing ureteral stones, offering high success rates and minimal invasiveness. Following ureteroscopic lithotripsy (URSL), ureteral stent placement is a widely accepted practice aimed at facilitating urinary drainage, preventing obstruction, and reducing postoperative complications such as ureteral edema and stricture formation. Despite its advantages, ureteral stenting is associated with several adverse effects, including urinary tract infections, suprapubic discomfort, hematuria and lower urinary tract symptoms, which can significantly impact patient quality of life. The necessity of routine stent placement after URSL remains a topic of debate. This study aims to systematically evaluate the symptoms, necessity, potential benefits, and adverse effects of ureteral stent placement following URSL.

This prospective study was conducted at Chi Mei Medical Center between January 2022 and December 2024. Data were collected from patients who underwent ureteroscopic lithotripsy (URSL) for ureteral stones, performed by a single surgeon. A total of 286 patients meeting the inclusion criteria were enrolled and divided into two groups: the stented group (225 patients) and the unstented control group (61 patients). Patient outcomes were assessed based on several parameters, including operative time, stone-free rate, postoperative pain, LUTS, hospital stay, stent-related complications, and rehospitalization rate. Statistical analyses were performed to compare these variables between the two groups.

There was no statistically significant difference between the stented and non-stented groups in stone-free rate or the incidence of intraoperative complications. Postoperative pain was reported in 14.4% of patients in the non-stented group, which was significantly lower than the 28.7% observed in the stented group. LUTS were more frequently reported in the stented group (33.7%) compared to the non-stented group (26.7%), with a statistically significant difference particularly in the domains of urinary frequency and urgency. Hematuria was observed in 13.7% of patients in the stented group and 10% in the non-stented group. Additionally, there were statistically significant differences between the two groups in terms of mean operative time and the use of non-narcotic analgesics, all favoring the non-stented group.

Routine ureteral stent placement following URSL is not mandatory and may be associated with significant stent-related adverse effects. Patients with ureteral stents experience a higher incidence of bladder irritation and LUTS compared to those without stents. The decision to place a stent should be based on intraoperative findings, carefully weighing the risks and benefits. In cases of uncomplicated URSL, stent omission appears to be a safe and effective approach, potentially improving patient comfort and reducing postoperative morbidity.