Clinical Report: Advances in Pediatric Double-J Ureteral Stenting

Overview

This review synthesizes clinical evidence from 50 studies on pediatric double-J (DJ) ureteral stenting, highlighting its use in reconstruction, stone disease, and other endourological conditions. It emphasizes tailored approaches considering pediatric anatomical and clinical factors, with emerging techniques aiming to reduce anesthesia exposure and improve patient outcomes.

Background

Ureteral stents in pediatric urology serve to maintain urinary drainage and support during reconstructive surgeries such as pyeloplasty and ureteroneocystostomy, as well as in managing stone disease and obstructive uropathy. Pediatric patients present unique challenges including smaller ureteral caliber, growth considerations, infection risk, and minimizing anesthesia exposure, necessitating adaptations from adult stenting practices. Double-J stents are the predominant internal devices used, with variations in insertion route, stent size, dwell time, and removal strategies tailored to indication and patient factors. This review categorizes stenting practices by indication and summarizes outcomes relevant to children and families.

Data Highlights

The review included 50 clinical studies published between 2003 and 2025 from North America, Europe, and Asia. Study designs comprised randomized and prospective trials, nonrandomized cohorts, single-arm series, and database analyses. The literature search initially identified 3,011 records, with 1,536 excluded at screening and 124 full texts assessed, resulting in 50 studies meeting inclusion criteria focused on pediatric DJ stents. Risk of bias assessments were performed using RoB 2, ROBINS-I, and JBI checklists.

Key Findings

• DJ stents are routinely used in pediatric reconstructive surgeries, especially pyeloplasty and ureteroneocystostomy, to maintain ureteral patency and reduce complications such as edema and leakage.
• Stent selection (caliber, length) and insertion route (retrograde, antegrade, transrenal) vary according to patient age, anatomy, and surgical indication.
• Emerging stent removal techniques, including magnetic-end retrieval and stent-on-string, aim to reduce the need for general anesthesia and facilitate office-based removal, though adoption depends on patient size and institutional protocols.
• In stone disease management, stents support pre- and post-procedural drainage around ureteroscopy and extracorporeal shock wave lithotripsy, with variable dwell times and removal strategies.
• DJ stents are also used in other endourological conditions such as ureterocele incision, vesicoureteral reflux surgery, and urgent decompression of obstructive uropathy, offering alternatives to percutaneous nephrostomy in selected cases.
• Clinical outcomes reported include procedural success, complication rates, reintervention frequency, anesthesia burden, and cost considerations, with practice patterns reflecting center expertise and patient-specific factors.

Clinical Implications

Clinicians should individualize pediatric ureteral stenting strategies based on patient age, anatomy, and indication to optimize outcomes and minimize risks. Adoption of novel stent removal methods may reduce anesthesia exposure and family burden but requires careful patient selection. Awareness of variable practice patterns and outcomes can guide shared decision-making and institutional protocol development.

Conclusion

Pediatric double-J ureteral stenting is a versatile tool across multiple urological indications, with evolving techniques enhancing safety and patient experience. Continued research and standardized reporting are needed to refine best practices tailored to the pediatric population.

References

1. European Urology Guidelines/2025 -- Pediatric Ureteral Stenting Practice
2. PRISMA-ScR/2018 -- Scoping Review Methodology
3. Risk of Bias Tools/2019 -- RoB 2 and ROBINS-I