Is Routine Double-J Stenting Necessary in Pediatric Pyeloplasty?

Background The role of routine internal drainage with a double-J (DJ) ureteral stent in pediatric pyeloplasty remains controversial. While stents are frequently used in minimally invasive approaches, their necessity in open surgery is debated, particularly regarding their impact on postoperative complications. This study aimed to evaluate whether the routine use of DJ stents influences postoperative complication rates in pediatric pyeloplasty within a multicenter international collaborative cohort. Methodology We performed a retrospective analysis of a pooled multicenter database including pediatric patients undergoing pyeloplasty (open, laparoscopic, and robotic) across four international institutions. Patients were categorized according to DJ stent use. The primary outcome was the overall postoperative complication rate. Secondary outcomes included urinary tract infection (UTI), reoperation, and length of hospital stay. Laparoscopic and robotic cases, in which DJ stents were routinely used, served as contemporary reference controls. Comparative analyses were performed between stented and non-stented cases, with statistical significance defined as a p-value <0.05. Results A total of 231 pediatric pyeloplasty cases with complete documentation regarding DJ stent utilization (presence or absence) were included in the comparative analysis. Open pyeloplasty cases were performed with or without DJ stenting, while minimally invasive approaches predominantly included routine stenting. Complication rates were 26.7% in the stented group and 20.4% in the non-stented group (p = 0.39). Reoperation rates were 3.7% and 4.5%, respectively (p = 0.81). No statistically significant differences were observed in rates of UTI, reoperation, or length of stay. Outcomes remained consistent across surgical approaches and stent utilization strategies. Conclusions Routine use of a DJ stent does not reduce postoperative complications in pediatric pyeloplasty. In this multicenter cohort, comparable outcomes were observed with and without internal drainage. These findings suggest that routine DJ placement is likely unnecessary in most open pyeloplasty cases and support a selective rather than universal stenting strategy.