JJ stents on extraction string: systematic review and meta-analysis on patients’ outcomes

Abstract Background Ureteral double-J (JJ) stents are widely used in endourological practice but are frequently associated with discomfort and stent-related morbidity, particularly during removal. Extraction-string stents have been proposed to improve patient experience; however, comparative evidence regarding patient-centered outcomes remains limited. Objective To systematically review and meta-analyze randomized controlled trials comparing ureteral stents with extraction strings versus conventional stents without strings, focusing on patient-reported outcomes and stent-related complications. Methods A systematic search of PubMed, Embase, and the Cochrane Library was conducted for randomized controlled trials published between 2010 and 2025. Adult patients undergoing ureteral stent placement following endourological procedures were included. Primary outcomes were pain during stent removal and overall tolerability. Secondary outcomes included urinary tract infection, accidental stent dislodgement, urinary symptoms, and quality of life. Risk of bias was assessed using the Cochrane RoB-2 tool. Where appropriate, quantitative meta-analysis was performed using R with random-effects models. Results Six randomized controlled trials involving 786 patients were included. Meta-analysis demonstrated significantly lower pain during stent removal with extraction-string stents compared with conventional stents (mean difference − 1.42 VAS points, 95% CI − 1.91 to − 0.92). There was no significant difference in urinary tract infection rates between groups. Although extraction-string stents were associated with a higher relative risk of accidental dislodgement, absolute event rates were low, and risk differences were small. Overall quality of life was not adversely affected. Conclusion Extraction-string ureteral stents significantly reduce pain during stent removal without increasing infectious complications. While a small risk of accidental dislodgement exists, extraction-string stents appear to be a safe and effective option for selected adult patients.