Do ureteral stents improve clinical outcomes in renal transplantation? A systematic review and meta-analysis comparing stented and non-stented anastomosis techniques

Background: Urological complications following renal transplantation (RT) remain a significant clinical challenge. The role of ureteral stents in mitigating these complications is a subject of ongoing debate. This study aimed to assess whether ureteral stents improve clinical outcomes in RT, comparing stented and non-stented anastomosis techniques. Methods: An extensive search was conducted in PubMed, Embase, Cochrane Central Register of Controlled Trials, and the Chinese Biomedical Literature Service System from inception to November 26, 2025, following the PRISMA and AMSTAR standards. This study was registered with PROSPERO (CRD42024557423). The primary outcomes were urological mechanical complications (UMCs) and urinary tract infections (UTIs), whereas the secondary outcomes included hematuria, graft rejection, renal function, cost-effectiveness, stent-related complications, and quality of life (QOL). The Mantel-Haenszel test was used to calculate pooled risk ratios (RRs) and 95% confidence intervals (CIs) for the outcomes. Results: Sixteen RCTs involving 2,486 patients met the inclusion criteria. Meta-analysis revealed that the stent group had a significantly lower incidence of urine leakage (RR = 0.25, 95% CI [0.13-0.47]) and ureteral obstruction or stricture (RR = 0.42, 95% CI [0.25-0.71]) compared to the non-stent group. However, the incidence of UTIs was higher in the stent group (RR = 1.41, 95% CI [1.08-1.84]). No significant differences were observed in hematuria, graft rejection, or renal function between groups. Conclusions: Routine ureteral stent placement in RT significantly reduces the incidence of UMCs despite potentially increasing the risk of UTIs. This balance between benefits and risks supports the continued use of ureteral stents in RT, pending further high-quality studies.