Double-J versus single-J stent placement in kidney transplant recipients: a systematic review and meta-analysis of postoperative outcomes

Background: Kidney transplantation remains the definitive treatment for end-stage renal disease, and double-J (DJ) and single-J (SJ) ureteral stents are widely used to lower urological complications after surgery. Yet which stent performs better, and how safely, is still debated. This meta-analysis compared clinical outcomes between DJ and SJ stents in kidney transplant recipients. Methods: We searched PubMed, ScienceDirect, Scopus, EBSCO, Wiley, and Springer through April 10, 2025, for randomized controlled trials and observational studies comparing DJ and SJ stents. Data were extracted following PRISMA guidelines, and risk of bias was assessed with the Cochrane risk-of-bias tool and the Newcastle-Ottawa Scale. Analyses were run in Cochrane RevMan 5.4. Results: Six studies covering 3,479 patients met inclusion criteria. DJ stents lowered the risk of urinary tract infection compared with SJ stents (odds ratio [OR], 0.58; 95% confidence interval [CI], 0.46-0.73; P<0.0001), reduced serum creatinine at 6 months (mean difference [MD], -8.15 μmol/L; 95% CI, -12.08 to -4.22; P<0.0001), and shortened hospital stay (MD, -5.62 days; 95% CI, -5.79 to -5.45; P<0.0001). However, DJ stents also carried a higher risk of ureteral stenosis (OR, 3.42; 95% CI, 1.47-7.99). Delayed graft function, urine leakage, hematuria, and estimated glomerular filtration rate did not differ significantly between groups. Conclusions: DJ stents lower urinary tract infection rates, shorten hospital stays, and improve serum creatinine at 6 months, but raise the risk of ureteral stenosis. Other postoperative outcomes are comparable between DJ and SJ stents.