Ureteric stone-related renal colic is a prevalent urological condition that poses a significant health burden on patients and healthcare systems. Accordingly, negative ureteroscopy in setting of stented patients are reported up to 14% in the literature and result in unnecessary costs and technical inefficiencies. While ureteral stents have demonstrated efficacy relieving obstruction, their exact effect on spontaneous passage of ureteric calculi is unclear. As such, a systematic evaluation of the literature is essential to identify the impact of ureteral stents on spontaneous stone passage.

A systematic search in MEDLINE, Embase, and PubMed (January 1989–February 2025) was performed to identify studies investigating indwelling ureteric stents and spontaneous stone passage. Two independent reviewers screened abstracts and full texts, with a third resolving conflicts. Quality assessment was conducted using ROBINS-I and RoB-2 tools. Data on stone size, location, number, passage rates, and follow-up duration were extracted.

A total of 2588 patients in 15 studies investigating spontaneous stone passage in stented patients were included. One included study was a randomised controlled trial but the rest were prospective cohort studies (n=6) or retrospective cohort studies (n=8). Three studies directly compared stented and control groups, whereas 12 studies only investigated stented patients. Mean/median overall stone sizes ranged from 4.7 to 9 mm in diameter. Passed stone sizes ranged from 3.2 to 8.4mm and retained stone sizes ranged from 6 to 9.4mm. Follow up duration ranged from 13.7 days to 3 months.. The overall spontaneous stone passage rates with stents in situ varied significantly from 1.7 to 82.5% likely due to various factors including stone size, location, duration of follow up, and method of stone passage detection. When comparing stented and non-stented patients, two studies demonstrated impaired stone passage rates in stented patients (13.9% vs 26.8% and 14% vs 20%) but only one of these studies were statistically significant. Three studies compared patients with retrograde ureteral stents and nephrostomies and found statistically significant increased stone passage rates in nephrostomy cohorts.

Stone passage rates with stents vary widely due to heterogeneity in study design, patient characteristics, and follow-up duration. Some studies suggest stents may impair passage, but evidence remains inconclusive due to limited high-quality comparative data. This review confirms that stone passage is possible with indwelling stents. Additionally, nephrostomies appear to be associated with improved likelihood of stone passage compared to ureteral stents. This study underscores the need for larger prospective trials to clarify the true impact of stenting on stone passage and guide clinical management.