Pediatric ureteral stenting: state-of-the-art review

In this scoping review, we mapped the available clinical evidence on the use of double-J (DJ) ureteral stents in pediatric patients across reconstructive, stone-related, and other endourological indications, synthesizing contemporary data on techniques, sizing, dwell time, removal strategies, outcomes, and emerging technologies. A scoping review was conducted in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). The review protocol was prospectively registered in PROSPERO (CRD420251147003). PubMed, Scopus, Cochrane Library, and Web of Science were searched without date limits to 9 September 2025. Original clinical studies on double-J (DJ) ureteral stents in children were screened, data were extracted into a harmonized database, and risk of bias was appraised using RoB 2, ROBINS-I, or the Joanna Briggs Institute checklist as appropriate. Fifty studies (2003–2025) were included. In reconstruction, internal DJ and externalized stents achieved similar success after pyeloplasty; externalized options commonly enabled office removal without general anesthesia (GA) but often increased length of stay and/or operating time. During ureteroneocystostomy for vesicoureteral reflux, routine stenting was associated with worse adjusted short-term outcomes; these findings are consistent with selective use. In stone disease, routine pre-stenting before ureteroscopy or extracorporeal shock-wave lithotripsy did not improve stone-free rates and increased infectious morbidity; when performed, a short dwell time (~ 2 weeks) was adequate. Across indications, modifiable drivers of morbidity included prolonged dwell, bilateral placement, and multiple lifetime stents. Practical aids included the “Age + 10 cm” length rule and strategies that reduce GA exposure (e.g., stent-on-string with disciplined protocols). Magnetic DJ systems showed high outpatient retrieval success with familiar complication profiles, while anti-biofilm/anti-encrustation coatings remain promising but require pediatric clinical validation. Pediatric ureteral stenting practices vary widely across indications. The mapped literature suggests broadly comparable success between internal and externalized stents in reconstruction, while highlighting the importance of dwell time, anesthesia exposure, and individualized decision-making. In stone disease, routine pre-stenting does not appear to confer consistent benefit. Overall, careful patient selection, planned dwell duration, and structured follow-up remain central to optimizing outcomes, while prospective multicenter studies are needed to strengthen the evidence base.