Comparison of efficacy between single and double ipsilateral ureteral stent placement after ureteroscopic lithotripsy for impacted ureteral calculi: the Hotan and BTCH experience

Objective: To compare the clinical efficacy and safety of indwelling double versus single ipsilateral ureteral stents after ureteroscopic lithotripsy (URL) for impacted ureteral calculi, focusing on hydronephrosis resolution, ureteral stricture incidence, and stone-free rate (SFR), based on collaborative clinical data from A hospital and B hospital. Methods: A retrospective analysis was conducted on 150 patients with impacted ureteral calculi who underwent URL between March 2023 and November 2025, with cases contributed by the two centers. Patients were divided into two groups using propensity score matching (1:2 ratio, nearest-neighbor method without replacement) to balance baseline data (including age and stone characteristics): the double-stent group ( n = 50, indwelling two ipsilateral ureteral stents: 35 cases from B hospital, 15 cases from A hospital) and the single-stent group (control group, n = 100, indwelling one ureteral stent: 70 cases from B hospital, 30 cases from A hospital). All patients had stents removed at 1 month postoperatively, and a computed tomography was performed at 3 months for hydronephrosis assessment and SFR evaluation. Intraoperative indicators and primary outcomes were compared. Results: Baseline data were comparable between groups ( P > 0.05, standardized mean differences <0.1). Intraoperative indicators showed no differences: operation time ([55.2 ± 12.8] min vs. [57.6 ± 13.5] min, P = 0.418) and blood loss ([2.1 ± 0.9] mL vs. [2.3 ± 1.1] mL, P = 0.385). The postoperative-to-preoperative changes in inflammatory markers (white blood cell and C-reactive protein) were comparable between the two groups (all P > 0.05). At 3 months, the double-stent group had significantly larger hydronephrosis volume reduction ([30.2 ± 7.5] vs. [20.5 ± 6.8] cm 3 , P < 0.001), higher relief percentage ([70.1 ± 10.3]%, 95% confidence interval [95% CI]: 67.2–73.0 vs. [47.9 ± 12.1]%, 95% CI: 45.6–50.2, P < 0.001), and lower residual volume ([12.9 ± 5.3] vs. [22.2 ± 6.2] cm 3 , P < 0.001). Notably, the double-stent group achieved a 0.0% ureteral stricture incidence (0/50, 95% CI: 0.0%–7.0%), which was significantly lower than the 4.0% incidence in the single-stent group (4/100, 95% CI: 1.1%–9.9%) ( P = 0.042). The 3-month SFR was comparable between the two groups (93.3%, 95% CI: 82.1–98.1 vs. 90.0%, 95% CI: 82.4–94.7, P = 0.623), with no significant difference in the overall incidence of postoperative complications. Conclusion: For patients with impacted ureteral calculi undergoing URL, indwelling double ipsilateral ureteral stents not only achieve superior hydronephrosis resolution but also significantly reduce the incidence of postoperative ureteral stricture, compared with single ureteral stenting. The two groups exhibited comparable intraoperative indicators, SFR, and safety profiles. Thus, the double ipsilateral stents indwelling tactic after URL for impacted ureteral calculi is promising and clinically valuable, with further confirmation required.