| Sumario: | Introduction: Ureteropelvic junction obstruction causes upper urinary tract obstruction, resulting in pain, infections, and renal impairment. Pyeloplasty with Double-J stents is the standard treatment, but stents cause significant morbidity. Stentless approaches may reduce symptoms while maintaining efficacy. Methods: Systematic review following Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines (International Prospective Register of Systematic Reviews: CRD42025643943). PubMed, Embase, and Cochrane were searched through March 2025. "Studies comparing stented versus stentless pyeloplasty in adults (≥18 years) were included". Primary outcomes were surgical success and complications. Secondary outcomes included urinary leakage, reintervention, and hospital stay. Narrative synthesis was performed due to heterogeneity. Results: Ten studies encompassing 5820 patients were included, comprising one randomized controlled trial, four prospective, and five retrospective studies. Success rates ranged from 66.7% to 100% for stented procedures and 88%–100% for stentless approaches, with no significant difference in most studies. Stented patients experienced higher rates of lower urinary tract symptoms (64.7%–100%) compared to stentless groups (0%–3.8%), as well as hematuria (27%–95.4%) versus 0%–4.3%, with variable urinary tract infection rates. Stentless groups showed increased urinary leakage up to 24%, though mostly self-limited. Twenty-three stentless patients required secondary stenting, while thirteen stented patients needed reintervention for stricture or complications. Conclusions: Stentless pyeloplasty is effective in selected adults, significantly reducing stent-related morbidity without compromising success rates when performed with meticulous technique and appropriate patient selection.
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