Hu Q. et al., 2025: Ureteral Stents in the Management of Pediatric Urolithiasis: A Systematic Review.
Qibo Hu 1, Hongbo Liu 1, Kai Chen 2, Weifeng Yang 1, Wei Ru 1, Xiang Yan 1
1Department of Urology, Pediatric Urolith Centre, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Centre for Child Health, Hangzhou, China.
2Department of Urology, the First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Zhejiang, China.
Abstract
Purpose: Ureteral stents are extensively utilized in the treatment of urolithiasis. Given the anatomical and physiological differences between children and adults, the rational, effective, and safe application of ureteral stents in pediatric patients is a matter of significant clinical interest. This review summarizes the classification, application scenarios, and potential adverse effects of ureteral stents in pediatric urolithiasis, aiming to provide a reference for clinical decision-making related to ureteral stents in children with urinary tract stones. Materials and Methods: A systematic review was conducted by searching PubMed, Embase, and Cochrane with the keywords "ureteral stent," "urolithiasis," and "pediatric" up to June 4, 2024. The review exclusively included comparative trials. Information regarding patient medical records and treatment efficacy were meticulously extracted. Results: For uncomplicated cases, routine placement of ureteral stents before and after extracorporeal shock wave lithotripsy, ureteroscopic lithotripsy, percutaneous nephrolithotomy, and open stone surgery do not confer significant clinical benefits. Selective stent placement is recommended for complex cases with intraoperative ureteral injury, ureteral stricture, anatomical or functional solitary kidney, or renal impairment. Novel ureteral stents have shown promise in reducing stent-related complications, avoiding secondary anesthesia, and decreasing health care-related costs. Conclusions: Currently, there is no consensus on the indications for ureteral stent placement in children in clinical practice. Urologists should selectively place ureteral stents based on the medical center's conditions, the child's condition, and intraoperative findings. The future development direction of ureteral stents is to improve the postoperative quality of life of patients, reduce stent-related complications, and facilitate stent removal.
J Endourol. 2025 Jul 10. doi: 10.1089/end.2024.0442. Epub ahead of print. PMID: 40638067.
Comments 1
The use of stenting in relation to SWL of stones in children has remained a matter of debate over the years.
Basically, it has been observed that the child’s ureter has a pronounced capacity to transport and eliminate fragments.
In this report a systematic review of stenting for SWL, RIRS and PCNL was carried out. Only two comparisons were reported for a small number of SWL-treated children.
The bottom-line of this report is that for uncomplicated cases there is no need for stenting in pediatric patients. Only when special problems can be expected such as large stone burdens, ureteral strictures and anatomical abnormalities should stenting be considered. This conclusion is strongly supported by my own experience of SWL-treated children.
Hans-Göran Tiselius