Double-J Ureteral Stenting in Obstetrics and Gynecology: Pivotal or Problematic?

Abstract

Background and Objectives: Double-J stents are urinary catheters that are frequently used in urology. They are now also used in other specialist areas such as obstetrics and gynecology. However, the use of double-J stents is not without side effects. The aim of this review was to highlight the indications and possible adverse effects of the use of these stents in obstetrics and gynecology. Materials and Methods: We analyzed works published after 1995 in the PUBMED, SCOPUS, and Web of Science databases related to the use of double-J stents in obstetrics and gynecology, as well as reported adverse events. We carried out a narrative review of the available literature on this topic. Results: We identified 69 relevant publications that we included in the review. In obstetrics, indications include the treatment of gestational hydronephrosis, some urological conditions during pregnancy, such as obstructive urinary calculi, with or without superinfection, or intraoperative use for cesarean section or hysterectomy after cesarean section, to protect from, or to solve, ureteral lesions. In gynecology, they are used preoperatively or intraoperatively to protect the ureter during gynecological operations in the pelvic area or postoperatively to repair some ureteral injuries. They are also indicated for ureteral obstructions that occur after pelvic radiotherapy for gynecological neoplasms. Complications associated with the use of double-J stents include more frequent urinary tract infections, lower urinary tract symptoms, calcifications and misplacements. Conclusions: Double-J stents are widely used in obstetrics and gynecology and are characterized by good efficiency and safety, although some side effects may occur (lower urinary tract symptoms, hematuria, complications in birth outcomes), which do not limit their use. Summary of evidence: In this review, we analyzed the indications and complications of double-J ureteral stenting in obstetric and gynecologic patients. We found that the procedure is safe, both in the treatment of ureteral obstruction and in the resolution of postoperative complications. No serious complications of ureteral stenting have been noted that would constitute a contraindication to its use. Future prospective studies in large patient cohorts are necessary to validate our data.