In an uncomplicated adult after vesicoureteric junction (VUJ) incision with cautery to remove a large stone, how long should the ureteral stent remain in place?

Duration of Ureteral Stent After VUJ Incision for Large Stone Removal

For an uncomplicated adult after vesicoureteric junction (VUJ) incision with cautery to remove a large stone, the ureteral stent should remain in place for 2-3 weeks (14-21 days). 1

Evidence-Based Stent Duration

The European Association of Urology (EAU) 2025 guidelines establish that routine post-ureteroscopy stenting is unnecessary after uncomplicated procedures, but stenting is mandatory when there is ureteral trauma, perforation, or significant tissue manipulation—all of which occur during VUJ incision with cautery. 2, 1

Standard Duration for Ureteral Injury

• 2-3 weeks is the established timeframe for stent placement after ureteral surgical repair or significant trauma to allow proper healing. 2
• The World Society of Emergency Surgery (WSES) guidelines specifically recommend ureteral stents after all surgical repairs to reduce failures (leaks) and strictures. 2
• Research demonstrates that stenting for less than 14 days after ureteral manipulation increases adverse events, including fever and pain (p = 0.041). 3

Why This Duration Matters

Shorter duration (<14 days) risks incomplete healing:

• Animal studies show that 1-week stenting is insufficient to ensure correct healing after ureteral incision, with urinoma formation observed in cases with premature stent removal. 4
• Three-week stenting proved effective with the least severe histological lesions at the surgical site, while 1-week stenting showed statistically significant inferior outcomes. 4

Longer duration (>21 days) increases complications:

• Stent duration exceeding 15 days significantly increases adverse events including febrile complications and pain (p = 0.041). 3
• Extended stenting increases risk of urinary tract infections (2-6% baseline risk), stent encrustation, and migration (5% incidence). 1, 5
• One case report documented vesicovaginal fistula formation from prolonged stent erosion after 15 days. 6

Mandatory Indications for Stenting in Your Case

Your scenario—VUJ incision with cautery—meets multiple absolute indications for stenting:

• Ureteral trauma/incision during the procedure (the intentional cautery incision qualifies as controlled trauma). 2, 1
• Large stone burden requiring significant manipulation. 1
• Tissue injury requiring healing time to prevent stricture formation. 2

Optimal Stent Management Protocol

Timing

• Remove stent at 14-21 days (2-3 weeks) post-procedure. 2, 3
• Aim for 14 days when possible to minimize stent-related morbidity while ensuring adequate healing. 1, 3

Adjunctive Measures

• Prescribe alpha-blockers (tamsulosin) during the stenting period to improve stent tolerability and reduce lower urinary tract symptoms. 2, 1
• Consider pull-string stents when feasible to avoid second cystoscopic procedure for removal. 7

Follow-up Imaging

• Obtain imaging before stent removal to confirm resolution of obstruction and adequate healing of the VUJ incision site. 7
• Ultrasound or CT can verify no hydronephrosis and proper healing. 8

Critical Pitfalls to Avoid

Do not remove the stent early (<14 days):

• Premature removal risks urinoma formation, incomplete healing, and subsequent stricture. 4
• The incision site requires minimum 2 weeks for initial tissue repair. 2

Do not leave the stent beyond 3 weeks unless complications arise:

• Prolonged stenting (>21 days) significantly increases infection risk, encrustation, and patient morbidity without additional healing benefit. 3, 6

Monitor for complications requiring earlier intervention:

• Fever, leukocytosis, or signs of obstruction despite stenting require immediate imaging (CT urogram) and possible percutaneous nephrostomy. 7
• Persistent gross hematuria beyond 48-72 hours warrants diagnostic evaluation. 7

Ensure antibiotic coverage:

• Obtain urine culture before stent removal, especially if stent duration approaches or exceeds 14 days. 3
• Pre-procedural antibiotics are recommended for stent removal when infection is suspected. 7

Special Circumstances Requiring Longer Stenting

Extend stenting duration only if:

• Solitary kidney (maintain drainage longer to protect renal function). 1
• Pre-existing renal insufficiency. 1
• Evidence of incomplete healing on imaging at 2-3 weeks. 7
• Development of complications requiring continued drainage. 1