Frequency and indications for double-J stenting in endourology: a review by the EAU section of endourology

BACKGROUND: Double J stents (DJS) are vital tools in endourological surgery and have a variety of indications. Their main function is to facilitate urinary drainage. Despite their many benefits, they do have drawbacks, chiefly their effect on quality of life (QoL). With the ongoing development of DJS, as well as ever-changing guidance regarding their placement, decision making regarding DJS can be difficult for clinicians to navigate. We therefore give an up-to-date summary of DJS indications and summarise the data concerning their frequency of insertion. METHODS: A narrative review of the literature was undertaken. A focused search of PubMed MEDLINE was performed with search terms including "stent frequency”, "stent indication”, “stenting”, “endourology”, “ureteroscopy”, and “percutaneous nephrolithotomy”, on all papers from 1983 to 2025 to identify key studies, systematic reviews, and meta-analyses relating to indications and frequency of DJS. RESULTS: There are numerous indications for DJS placement. These can be categorised into elective and emergency indications. Elective indications include prior to, or following, ureteroscopy (URS), percutaneous nephrolithotomy (PCNL) or extracorporeal shockwave lithotripsy (ESWL). Other elective indications include, but are not limited to, chronic ureteric obstruction and reconstructive urology. Emergency decompression of the urinary tract with DJS remains a mainstay of management of patients with ureteric obstruction. The frequency of DJS placement following URS ranges from 64 to 86%. CONCLUSION: DJS remain vital tools in endourology, with many indications. While international guidelines now agree that routine stenting after uncomplicated URS is unnecessary, practice remains heterogeneous and DJS placement following URS remains commonplace. High-quality, multi-centre, prospective, randomised controlled trials are required to definitively answer the question of when to place a DJS and for how long. Keywords: Ureteric stents, double-J stents, ureteroscopy, endourology