[Clinical application progress, hot topics, controversies and future prospects of segmental metallic ureteral stents]

Ureteral stricture (US) is a common urological disease with complex etiologies, including benign and malignant lesions, iatrogenic injuries, and idiopathic factors. Without timely intervention, it can lead to upper urinary tract obstruction and progressive, irreversible renal impairment. Traditional re-constructive surgeries are often limited by high technical demands, significant surgical risks, and strict requirements for patient fitness. To address these challenges, segmental metallic ureteral stents (SMUSs) have gained prominence in recent years. Featuring a non-full-length design for targeted support, excellent radial strength, and a large caliber, SMUSs provide reliable drainage and allow for long-term retention. They effectively overcome the common drawbacks of traditional double-J stents, such as frequent encrustation, the need for regular replacement, and severe bladder irritation. Consequently, SMUSs have become a vital maintenance therapy for patients with malignant obstructions or those unsuitable for re-constructive surgery. Moreover, they have shown curative potential by providing long-term efficacy for certain benign strictures. However, due to the high heterogeneity of stricture etiologies, significant controversies and knowledge gaps remain in clinical practice. These mainly pertain to the precise selection of stent types for specific indications, the standardization of surgical implantation, optimal indwelling durations, and strategies for preventing and managing long-term complications. Drawing upon the latest global evidence-based medicine and large-sample follow-up data from our center, this article systematically reviews the clinical application and efficacy differences of SMUSs across malignant, benign, and radiotherapy-induced ureteral strictures. We provide an in-depth analysis of major ongoing clinical controversies and propose practical management strategies for complications leading to stent failure, including stent obstruction, migration, encrustation, recurrent infections, and high-risk ureteral fistulas.