Tubeless Ureteroscopy: A Comprehensive Literature Review

Stent omission post-ureteroscopy, defined as performing ureteroscopic stone treatment without placement of a postoperative ureteral stent, has evolved from an experimental concept to a recognized, guideline-endorsed practice for appropriately selected patients. A persistent gap exists between the available evidence and clinical adoption, with ureteral stent placement remaining the predominant practice following ureteroscopic procedures at most centres worldwide, reflecting ongoing tension between clinical caution and evidence-based care. This comprehensive literature review synthesizes evidence from randomized controlled trials, systematic reviews, meta-analyses, registry studies, and prospective cohort studies examining the safety, efficacy, patient-reported outcomes, healthcare utilization, and patient selection criteria for tubeless ureteroscopy published through February 2026. Key findings consistently demonstrate that stent omission in uncomplicated cases reduces lower urinary tract symptoms, hematuria, and stent-related morbidity without meaningfully increasing the risk of postoperative complications or unplanned healthcare encounters. Evolving technologies, including laser dusting techniques, high-powered holmium and thulium fiber lasers, suction ureteral access sheaths, and single-use flexible ureteroscopes, have further expanded the candidate pool for stentless approaches. Landmark trials such as the SOUL study and a 2025 multicenter randomized controlled trial provide the most rigorous modern evidence supporting stent omission. Tubeless ureteroscopy is safe, superior for patient experience, and warranting of broader adoption in appropriately selected patients. Current evidence supports American Urological Association and European Association of Urology guideline recommendations for stent omission in uncomplicated cases.