Choosing the optimal ureteral stent design, size, and material in different situations: a review from the European association of urology endourology

Purpose: Ureteral stents are widely used to maintain upper urinary tract drainage in diverse clinical scenarios; however, guidance on selecting the optimal stent configuration remains limited. This narrative review evaluates the clinical relevance of ureteral stent design, size, material composition, and surface coating technologies to support evidence-based device selection in routine practice. Methods: A focused narrative literature review was conducted using the PubMed, Scopus, and Web of Science databases, supplemented by cross-referencing key publications. Studies addressing the structural characteristics, biomaterial properties, and coating technologies of ureteral stents, as well as their clinical implications, were appraised thematically. Results: Conventional double-J stents remain the most used configuration. However, several modifications-including loop-tail, extraction-string, magnetic-tip, and multilength designs-have been introduced to improve positioning accuracy and patient comfort. Alternative stent types, such as mono-J, suture, anti-reflux, grooved, and tumor stents, offer scenario-specific advantages in selected indications. Material composition, particularly silicone and polyurethane-based platforms, significantly influences flexibility, handling characteristics, resistance to encrustation, and patient tolerance. Surface engineering strategies-including lubricating, antimicrobial, anti-fouling, and drug-eluting coatings-aim to reduce infection, biofilm formation, and stent-related symptoms, although clinical evidence remains heterogeneous. Structural parameters such as diameter and length are key determinants of symptom burden and quality of life. Conclusion: Optimal ureteral stent selection requires individualized evaluation of device design, material properties, size, and coating technologies. No single stent configuration demonstrates universal superiority across all clinical scenarios; therefore, indication-specific selection remains essential to optimize drainage efficiency and minimize complications.