Complications and symptom burden of ureteral double-J stents: a systematic review of prevalence, risk factors, and management strategies.
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PURPOSE: Double-J (DJ) ureteral stents are essential for managing urinary tract obstruction, infection, and perioperative drainage, but up to 80% of patients develop stent-relayed symptoms (SRS), and serious events such as encrustation, infection, and calcification often needing intervention. This review assesses the prevalence, risk factors, and management of DJ stent complications. METHODS: Following PRISMA guidelines (PROSPERO CRD420251111481), MEDLINE, CINAHL, EMBASE, and Cochrane Central were searched (2015–2025) for English-language adult studies on DJ stents reporting complications or management. Pediatric, transplant, and pregnant populations, case reports, reviews, and animal studies were excluded. Two reviewers independently screened and extracted data. The primary outcome was complication incidence, with PICO framework: (P) adults with DJ stent; (I) management of stent-related complications; (O) incidence, type, and pattern of complications and risk factors. RESULTS: Forty-three studies (22,058 patients) were included. Urolithiasis was the main indication, followed by perioperative support, obstructive uropathy, and malignancy. Overall, 7,363 complications were reported. The most frequent were lower urinary tract symptoms (38.9%), pain (16.1%), hematuria (11.37%) and infectious complications (11.1%). Mechanical complications (13.3%), predominantly stent encrustation, and renal dysfunction (2%) also occurred. About one in three patients had at least one complication, often requiring readmission. Stent dwell time (7 days to 147 months) was strongly associated with encrustation and need for endourological intervention. Risk of bias was generally moderate. CONCLUSIONS: DJ stent-related complications are common, particularly LUTS, hematuria, pain, and encrustation. Prolonged dwell time markedly increases morbidity, underscoring the need for standardized follow-up and better patient education to reduce preventable events and improve outcomes.