Considerations in ureteral stent selection in order to minimize symptoms

Ureteral stent-related symptoms are common after stent placement. Various characteristics of stent design have been previously investigated to mitigate this issue. Our review summarizes available literature on stent design parameters (diameter, material, position, length, distal loop modifications) and their effect on stent-related symptoms, including pain.

We identified articles from PubMed, Medline, EMBASE, Web of Science, and Grey Literature using a search strategy employing MESH search headings (i.e, ureteral stent diameter, length, composition, material, durometer, and stent-related pain).

Out of 2,970 identified studies, 26 met eligibility criteria. Most diameter studies found patients with > 6Fr stents reported significantly increased stent-related symptoms. A few did report more migration with thinner stents. Almost half of durometer studies found composition made no difference in symptoms. Distal loop modification studies found minimizing intravesical material decreased stent-related pain. All studies on positioning found patients reported more severe urinary, pain and quality of life symptoms when stents crossed the bladder midline. No difference in stent-related symptoms was seen between multi-length and standard stents patients.

Adverse symptoms occur commonly after ureteral stent placement. No definitive recommendations on the model stent can be provided due to the heterogeneity of studies. Though the number of robust studies is limited, data suggest stents crossing midline, larger diameters, and those without distal material-reduction modifications may worsen stent-related symptoms. Future studies are needed to better understand the ideal stent design.