A review of six comparative studies involving 3,479 kidney transplant recipients found a mixed picture for the two ureteral stents it examined. Double-J, or DJ, stents were associated with lower odds of urinary tract infection, lower serum creatinine at six months and a shorter hospital stay than single-J, or SJ, stents. But the same pooled analysis associated DJ stents with higher odds of ureteric stenosis, the narrowing outcome tracked in the review.
The results do not point to one stent as the clear winner. They describe associations between stent type and postoperative outcomes, rather than showing that DJ stents caused the apparent benefits or the higher stenosis risk. That distinction is important because the evidence included only one randomized controlled trial alongside five retrospective studies.
The strongest differences ran in opposite directions
The infection result favored DJ stents. The pooled odds ratio for urinary tract infection was 0.58, with a 95% confidence interval of 0.46 to 0.73 and P<0.0001. In this comparison, an odds ratio below 1 indicates lower odds in the DJ group. The analysis also reported I²=74%, showing that the results varied substantially between the studies contributing to the estimate.
The ureteric stenosis result pointed the other way. DJ stents were associated with higher odds of stenosis than SJ stents, with an odds ratio of 3.42 and a 95% confidence interval of 1.47 to 7.99. The reported I² was 66%, another indication that the study findings were not uniform. Because the stenosis estimate was influenced mainly by retrospective evidence, the review treats it as suggestive rather than conclusive.
Some measures favored DJ stents
The review also found lower serum creatinine in the DJ group at six months. The pooled mean difference was –8.15 µmol/L, with a 95% confidence interval from –12.08 to –4.22 and P<0.0001. But the result was not mirrored by the overall analysis of estimated glomerular filtration rate, or eGFR. That comparison showed no significant difference: mean difference –0.28, 95% confidence interval –2.31 to 1.76, I²=13% and P=0.79.
Hospital stay was shorter among patients receiving DJ stents in the pooled analysis. The mean difference was –5.62 days, with a 95% confidence interval from –5.79 to –5.45 and P<0.0001. As with the other findings, the figure represents an association in the studies brought together by the review; it does not establish that the stent type itself caused a shorter stay.
Several outcomes showed no clear separation
The analysis found no statistically significant difference in delayed graft function, an outcome included in the review of postoperative results. The odds ratio was 0.81, with a 95% confidence interval of 0.60 to 1.10 and I²=63%. The interval included the possibility of no difference between the stent groups.
Urine leakage and hematuria also did not differ significantly between DJ and SJ stents. For urine leakage, the odds ratio was 0.69, with a 95% confidence interval of 0.34 to 1.41. For hematuria, it was 1.22, with a 95% confidence interval of 0.78 to 1.93. These results mean the review did not detect a statistically significant difference for either outcome; they do not establish that the two stents are identical in every respect.
How the evidence was assembled
The authors searched PubMed, ScienceDirect, Scopus, EBSCO, Wiley and Springer through April 10, 2025. They looked for randomized controlled trials and observational studies comparing DJ and SJ stents in kidney transplant recipients. Six studies met the inclusion criteria, covering 3,479 patients.
Data extraction followed PRISMA guidelines, a reporting framework for systematic reviews. The review assessed risk of bias with the Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale, and the analyses were conducted with Cochrane RevMan 5.4.
For continuous measurements, such as serum creatinine and hospital stay, the reviewers used mean differences. For outcomes recorded as events, such as infection or stenosis, they used odds ratios. The meta-analysis applied fixed-effects models and reported 95% confidence intervals around the pooled estimates.
Why the findings need a careful reading
The evidence base was uneven. One of the six studies was randomized, while five were retrospective. The review therefore combines evidence with different levels of protection against factors that may influence outcomes, making it inappropriate to read the pooled associations as proof of cause and effect.
There was also notable variation in several pooled comparisons. The heterogeneity measure was I²=74% for urinary tract infection, I²=66% for ureteric stenosis and I²=63% for delayed graft function. In practical terms, the studies did not all point to exactly the same result, so the pooled figures should be read as summaries of a varied evidence base.
That caution is especially relevant to the stenosis finding. The association was statistically significant in the pooled estimate, but the review's interpretation was that it remains suggestive rather than conclusive because retrospective studies and variation between studies influenced the result.
A trade-off remains
Taken together, the review links DJ stents with fewer urinary tract infections, lower six-month serum creatinine and shorter hospital stays, while linking them with more ureteric stenosis. It found no statistically significant differences in delayed graft function, overall eGFR change, urine leakage or hematuria.
The article was published online on August 20, 2026, and reported no potential conflict of interest relevant to the article. Its findings offer a comparison of postoperative outcomes, but the retrospective-heavy evidence leaves the balance between the apparent benefits and the stenosis association unresolved.
Paper data and sources
Original title: Double-J versus single-J stent placement in kidney transplant recipients: a systematic review and meta-analysis of postoperative outcomes.
Authors: Steven Aviano Shenelo, Steffi Audrey Julianto
Journal/Repository: Clinical transplantation and research
Status: Peer-reviewed
First online: 2026-08-20
DOI: 10.4285/ctr.25.0096
Original paper · Full text