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Corticosteroids in Urology

Corticosteroids are used in six discrete urologic domains: perioperative antiemesis and analgesia (ERAS), metastatic castration-resistant prostate cancer (abiraterone co-administration, steroid switch, standalone secondary hormonal therapy), renal-transplant immunosuppression and rejection treatment, contrast-allergy premedication for urologic imaging, interstitial cystitis / bladder pain syndrome with Hunner lesions, and as an adjunct in medical-expulsive therapy for distal ureteral stones.[1][9][16][19][25][27] Each role has its own agent preference, dose, and evidence profile, and the reconstructive / functional urologist should know all six — most of them come up in a given month of practice.

This article is the drug-class pharmacology hub — agents, doses, and indication-by-indication evidence. Perioperative stress dosing of the chronic-steroid-using patient, adrenal-crisis recognition and treatment, and the wound-healing consequences of chronic steroids on urethroplasty / prosthetic / bowel-anastomotic reconstruction are covered separately at Perioperative steroids — that page is workflow-focused and should not be duplicated here.

For the topical / intralesional counterparts see High-potency topical corticosteroids (genital LS, vulvar dermatoses) and Intralesional corticosteroids (urethral-stricture adjunct, keloids).

Agent Selection at a Glance​

AgentRelative anti-inflammatory potencyDurationTypical urologic dose / routeBest-supported indication
Dexamethasone25–30× hydrocortisone36–72 h (long-acting)4–8 mg IV single dose; 0.5 mg PO dailyPONV prophylaxis; mCRPC steroid switch
Methylprednisolone~5× hydrocortisone12–36 h250–500 mg IV pulse × 3 d; 32 mg POAcute cellular rejection; contrast premed
Prednisone~4× hydrocortisone12–36 h5 mg PO BID (abiraterone); 25 mg PO taperProstate cancer concurrent steroid; IC/BPS Hunner lesions
Deflazacort~3× hydrocortisone12–36 h30 mg PO × 10 dMET adjunct to tamsulosin
Hydrocortisone1× (reference)8–12 hStress dosing onlyAdrenal-insufficiency coverage — see Perioperative steroids

1. Dexamethasone — Perioperative Antiemesis and Analgesia​

PONV prophylaxis is the commonest perioperative use in urologic surgery — particularly after laparoscopic / robotic nephrectomy, prostatectomy, pyeloplasty, and any case with steep Trendelenburg.

QuestionAnswerEvidence
Dose4–5 mg IV (SAMBA guideline); 4 mg ≈ 8–10 mg efficacyDe Oliveira 2013 meta — NNT 3.7 for 24-h PONV[2]
TimingAt inductionStandard
CombinationDex + 5-HT₃ antagonist (ondansetron) > 5-HT₃ alone for laparoscopic casesSom 2016 meta — OR 0.38; NNT 6.6[3]
PADDI substudyDex 8 mg IV ↓ PONV incidence and severity; ↓ day-2 severe PONV (RR 0.58; p = 0.02); primary composite endpoint did not reach significanceCorcoran 2022[4]

Perioperative analgesia / ERAS incorporation​

  • ≥ 0.1 mg/kg IV reduces pain scores at rest and with movement at 2 h and 24 h with opioid-sparing effect (De Oliveira 2011 meta, 24 RCTs, n = 2,751).[5]
  • Intermediate (0.11–0.2 mg/kg) = high (≥ 0.21 mg/kg) — no benefit above 0.2 mg/kg; low doses less effective.[5]
  • High-dose (≥ 15 mg) (Laconi 2024 meta, 47 RCTs, n = 3,943) — ↓ rescue opioid by 10 mg oral-morphine-equivalents; OR 0.29 for PONV; modest VAS reduction (−6.18 mm at 24 h); no increase in major AEs (OR 0.88).[6]
  • Postoperative sore throat — dex ≥ 0.2 mg/kg within 30 min of induction ↓ sore throat (OR 0.44) and hoarseness (OR 0.42) — relevant for steep-Trendelenburg RARP / RARC with prolonged intubation.[7]
  • Peripheral nerve block prolongation — perineural or IV dex prolongs block duration, relevant for TAP, ilioinguinal, and penile blocks in urology.[8]

Safety — single-dose perioperative dexamethasone​

The Polderman 2018 Cochrane review (26 RCTs, n = 4,603) and Toner 2017 meta (56 RCTs) are the anchor safety analyses:[1][28]

  • No increased SSI (Peto OR 1.01; 95% CI 0.80–1.27)[1]
  • No effect on wound healing detected — but diabetics largely excluded[1]
  • Hyperglycemia (non-diabetic) — mild: + 13 mg/dL over first 12 h[1]
  • Hyperglycemia (diabetic) — more pronounced: + 32 mg/dL (very low-quality evidence, n = 74)[1]
  • High-dose GC meta — no increase in major AEs (Laconi 2024)[6]

Coordinate glucose management in diabetics (see Diabetes).

2. Corticosteroids in Metastatic Castration-Resistant Prostate Cancer​

The most nuanced use of corticosteroids in urology — and the one most often changing at the reconstructive-urology / uro-oncology interface.

Abiraterone co-administration — required to prevent mineralocorticoid excess​

Abiraterone blocks CYP17 → adrenal cortisol synthesis drops → compensatory ACTH rise → mineralocorticoid excess (HTN, hypokalemia, edema). Concurrent glucocorticoid suppresses the ACTH drive.[9]

NCCN Prostate Cancer Guidelines v5.2026:[9]

SettingRegimen
Standard abiraterone + prednisone (CRPC)Prednisone 5 mg PO BID
Standard abiraterone + prednisone (CSPC, no docetaxel)Prednisone 5 mg PO daily
Fine-particle abiraterone (Yonsa)Methylprednisolone 4 mg PO BID

The prednisone → dexamethasone "steroid switch" at progression​

When mCRPC progresses on abiraterone + prednisone, switching to abiraterone + dexamethasone 0.5 mg daily can restore PSA responses in a meaningful subset — now an NCCN-recognized secondary hormonal option for M1 CRPC.[9]

StudynPSA₃₀PSA₅₀Outcome
SWITCH phase II (Romero-Laorden 2018)2646.2%34.6%Median biochem PFS 5.3 mo; radiologic PFS 11.8 mo; AR-gain in ctDNA predicted non-response[10]
Yang 2021 (retrospective, China)13046.2%29.2%PFS 5.0 mo, OS 18.7 mo; PSA ≤ 20 ng/mL at switch and mCRPC-free survival ≥ 18 mo predicted response[11]
AbiDex (UK, Muller 2022)33——73% rebound biochem response; bPFS 9 mo (AA+P) → 19 mo (AA+P then AA+D) (HR 0.28)[12]

Mechanism of the switch: long-term prednisone may drive resistance via glucocorticoid-receptor (GR) activation — the GR has substantial overlap with AR DNA-binding sites and can rescue expression of AR-regulated genes.[13][14] Dexamethasone, as a more potent GR agonist at lower absolute dose, may provide better AR suppression with less mineralocorticoid activity. AR point mutations activated by glucocorticoids may additionally cause steroid-specific resistance.[14]

Glucocorticoids as standalone secondary hormonal therapy​

  • Prednisone 5 mg BID or dexamethasone 0.5 mg daily induces PSA responses in ~24% of mCRPC patients as monotherapy.[14]
  • Venkitaraman 2015 randomized phase 2 — dex 0.5 mg daily more active than prednisolone 5 mg BID (PSA response 47% vs 24%, p = 0.05; median time-to-PSA-progression 9.7 vs 5.1 mo).[15]
  • COU-AA-302 placebo arm — 24% achieved > 50% PSA decline on prednisone + placebo; 16% had objective response.[14]

Chemotherapy co-administration​

Both docetaxel and cabazitaxel are given with daily concurrent prednisone, though prednisone may be omitted on chemotherapy days when dexamethasone is given as premedication.[9]

The critical caveat — glucocorticoids as disease drivers​

Emerging principle: glucocorticoids can become disease drivers through GR-mediated rescue of AR-regulated gene expression when given with AR-targeting therapy. Best practice: do not continue glucocorticoids indiscriminately in progressing mCRPC — consider steroid switch, steroid withdrawal, or transition to next-line therapy rather than maintaining a regimen on which the patient is progressing.[14]

3. Methylprednisolone in Renal Transplantation​

Induction and maintenance. Standard triple immunosuppression is tacrolimus + antimetabolite (mycophenolate) + low-dose glucocorticoids. Adequate tacrolimus exposure with low-dose glucocorticoids and antimetabolite is central to preventing early acute rejection and de novo donor-specific antibodies.[19]

Acute cellular rejection — pulse methylprednisolone is first-line:[20][21][22]

  • IV methylprednisolone 250–500 mg daily × 3 days → 60–70% success
  • Oral prednisone 250 mg may be equally efficacious in some rejection grades[21]
  • Histologic rejection takes ~ 10 days to clear — 5-day biopsies still show rejection features in 60% of eventual responders[22]
  • Do not declare steroid resistance before day 5 of pulse therapy[21]
  • Steroid-resistant rejection: anti-T-cell antibodies (ATG) — similar 60–70% success rate[21]

Antibody-mediated rejection is treated with glucocorticoids + plasmapheresis + IVIG.[19]

Early steroid withdrawal. The Woodle 2021 landmark 15.8-year follow-up RCT established long-term safety of early corticosteroid withdrawal in kidney-transplant recipients — despite which only ~30% of eligible patients have been treated with withdrawal since publication, partly because of a 7% higher biopsy-confirmed (low-grade) rejection rate in the withdrawal arm.[23]

4. Contrast-Allergy Premedication​

Directly relevant to urologic imaging — CT urogram, staging CT, contrast-enhanced MRI in renovascular / stone / tumor workups.

ACR Manual on Contrast Media 2025:[16]

  • Oral premedication preferred over IV in most settings
  • No evidence supports premedication ≤ 2 hours (oral or IV)
  • IV regimen with minimum 4–5 h may be efficacious when oral impossible

Standard oral regimens:[16]

RegimenDoseSchedule
Methylprednisolone 32 mg32 mg PO13 h and 2 h before contrast
Prednisone 50 mg50 mg PO13 h, 7 h, and 1 h before contrast
AdjunctDiphenhydramine 50 mg1 h before contrast

Breakthrough reactions occur in ~2.1% of premedicated patients with prior reactions (3–4× general population rate); ~81% are similar-severity to the index reaction.[16]

The evolving controversy. A 2025 ACR/AAAAI consensus statement notes discordance between the ACR (recommends premedication) and the Anaphylaxis Practice Parameters (recommend against routine glucocorticoid/antihistamine premedication).[17][18]

Risks of premedication that matter for the urologic workflow:[16]

  • Transient hyperglycemia (+20–80 mg/dL non-diabetics; +100–150 mg/dL diabetics)
  • Transient leukocytosis
  • Diagnostic delay — retrospective data showed 13-h oral premedication added median +25 hours to CT and increased hospital-acquired infection risk. In urgent urologic evaluations (e.g., suspected stone with obstruction and sepsis, suspected abscess, post-op leak) the delay may cause more harm than the reaction it prevents — consider IV premedication or alternative imaging.

5. Prednisone in Interstitial Cystitis / Bladder Pain Syndrome​

AUA/SUFU 2022 IC/BPS Guidelines: systemic long-term glucocorticoid administration should not be offered as primary treatment (Grade C) — serious AEs (new-onset diabetes, pneumonia with septic shock, hypertension) outweigh benefit.[25]

However:

  • Short-term prednisone for symptom flares is not precluded
  • Prednisone may be considered in severe refractory ulcerative IC (Hunner lesions): Soucy 2005 prospective series, 14 patients with Hunner ulcers unresponsive to first-line therapies — prednisone 25 mg daily tapered to minimum effective dose produced 38% reduction in O'Leary index and 88% pain reduction (p = 0.0001) in 9 responders (64%) continuing therapy at 16 months. Five dropped out for lack of benefit or AEs.[26]

For the full IC/PBS framework including intravesical therapy, see the class-level IC/PBS clinical article and the intravesical IC/BPS agents hub.

6. Corticosteroids as MET Adjunct for Distal Ureteral Stones​

Pure-urologic application of oral corticosteroid as an adjunct to α-blocker for distal ureteral stone expulsion:

  • Porpiglia 2006 (prospective) — tamsulosin + deflazacort 30 mg/day × 10 d: 84.8% expulsion vs tamsulosin alone 60% vs deflazacort alone 37.5% vs analgesics only 33.3% (p < 0.001)[27]
  • Corticosteroid monotherapy is not effective MET — deflazacort-alone expulsion rate matched controls (37.5% vs 33.3%)[27]

Not all MET guidelines incorporate corticosteroid — some trials have been negative and the American and European guidelines diverge. The practical use case is ~5–10 mm symptomatic distal ureteral stones where expulsion time matters clinically.

7. Niche Applications​

  • Post-ureteroscopy pain/inflammation — Hamidi 2018 matched-pair analysis (n = 144) found methylprednisolone after uncomplicated unstented URS ↓ pain scores (POD 0: 3.3 vs 3.9, p = 0.012; POD 1: 2.8 vs 3.4, p = 0.02), ↓ renal-colic episodes (4.2% vs 13.2%, p = 0.036), and ↓ parenteral analgesic consumption (18 vs 36 mg, p = 0.009).[24]
  • Fournier gangrene — not standard (management is surgical debridement + broad-spectrum antibiotics + resuscitation).[30][31] A single case report described remission with high-dose corticosteroids in a necrotizing-vasculitis-driven case when surgery and antibiotics failed — possible niche role in rare vasculitis-dominant presentations.[29]
  • Idiopathic segmental ureteritis — case report of successful prednisolone treatment of bilateral idiopathic segmental ureteritis after ureteral stenting failed.[32]
  • Ureteral stent-related symptoms — α-blockers are first-line; corticosteroids not systematically studied for this indication. Patient factors (age, depression, chronic pain) drive stent-symptom intensity more than surgical factors.[33][34][35]

Cross-Reference — What's Covered on the Perioperative Steroids Page​

To avoid duplication, the following sit at Perioperative steroids:

TopicWhere it lives
Chronic-steroid patient identification (who is at risk of adrenal crisis)Perioperative steroids
Stress-dose regimens by surgical complexity (minor / moderate / major)Perioperative steroids
Adrenal-crisis recognition and treatmentPerioperative steroids
Wound-healing consequences of chronic steroids on urethroplasty / prosthetics / bowel anastomosisPerioperative steroids
Preop mitigation (taper before elective reconstruction)Perioperative steroids
Dexamethasone 4–8 mg at induction as an adjunctBrief on both pages — this article for drug-class pharmacology and evidence, perioperative page for the OR workflow including interaction with stress-dose coverage

Keep the two articles separate: one is about managing chronic-steroid patients in the perioperative period, the other is about corticosteroid-class pharmacology across six indications. They cross-link but do not consolidate.

Practical Pearls​

  • Dexamethasone 4 mg IV at induction is safe and effective PONV prophylaxis in urologic surgery — Cochrane 4,603-patient safety data show no increased SSI or wound-healing impairment.[1][28]
  • Do not stack corticosteroids. A stress-dosed chronic-steroid patient does not additionally need 8 mg dex at induction — the stress dose covers the antiemetic effect.
  • mCRPC steroid switch (prednisone → dexamethasone 0.5 mg daily) is now an NCCN-recognized option at progression; PSA₃₀ ~46%, PSA₅₀ ~29–35%. Low PSA at switch and AR-normal ctDNA predict response.[9][10][11][12]
  • Glucocorticoids are not passive in mCRPC — they can drive disease through GR-mediated AR gene rescue. Do not continue indiscriminately in progressing patients.[14]
  • Methylprednisolone 250–500 mg IV × 3 d is first-line for acute cellular rejection; do not declare steroid resistance before day 5.[20][21]
  • Contrast premedication requires ≥ 4–5 h to be effective — a premedication order ≤ 2 h before contrast is pharmacologically hollow.[16] Weigh the diagnostic-delay cost in urgent urologic scenarios.
  • AUA 2022 does not endorse long-term systemic steroids for IC/BPS — reserve prednisone for Hunner-lesion disease refractory to first-line therapy.[25][26]
  • Deflazacort MET only works as an adjunct to an α-blocker — never as monotherapy.[27]
  • For perioperative stress dosing / adrenal crisis / chronic-steroid wound-healing consequences, use the Perioperative steroids page — do not re-derive the protocol from this article.

References​

1. Polderman JA, Farhang-Razi V, Van Dieren S, et al. "Adverse side effects of dexamethasone in surgical patients." Cochrane Database Syst Rev. 2018;11:CD011940. doi:10.1002/14651858.CD011940.pub3

2. De Oliveira GS, Castro-Alves LJ, Ahmad S, Kendall MC, McCarthy RJ. "Dexamethasone to prevent postoperative nausea and vomiting: an updated meta-analysis of randomized controlled trials." Anesth Analg. 2013;116(1):58–74. doi:10.1213/ANE.0b013e31826f0a0a

3. Som A, Bhattacharjee S, Maitra S, Arora MK, Baidya DK. "Combination of 5-HT3 antagonist and dexamethasone is superior to 5-HT3 antagonist alone for PONV prophylaxis after laparoscopic surgeries: a meta-analysis." Anesth Analg. 2016;123(6):1418–1426. doi:10.1213/ANE.0000000000001617

4. Corcoran TB, Martin C, O'Loughlin E, et al. "Dexamethasone and clinically significant postoperative nausea and vomiting: a prespecified substudy of the randomised Perioperative Administration of Dexamethasone and Infection (PADDI) trial." Br J Anaesth. 2022;129(3):327–335. doi:10.1016/j.bja.2022.05.018

5. De Oliveira GS, Almeida MD, Benzon HT, McCarthy RJ. "Perioperative single dose systemic dexamethasone for postoperative pain: a meta-analysis of randomized controlled trials." Anesthesiology. 2011;115(3):575–588. doi:10.1097/ALN.0b013e31822a24c2

6. Laconi G, Coppens S, Roofthooft E, Van De Velde M. "High dose glucocorticoids for treatment of postoperative pain: a systematic review of the literature and meta-analysis." J Clin Anesth. 2024;93:111352. doi:10.1016/j.jclinane.2023.111352

7. Jiang Y, Chen R, Xu S, et al. "The impact of prophylactic dexamethasone on postoperative sore throat: an updated systematic review and meta-analysis." J Pain Res. 2018;11:2463–2475. doi:10.2147/JPR.S172419

8. Pehora C, Pearson AM, Kaushal A, Crawford MW, Johnston B. "Dexamethasone as an adjuvant to peripheral nerve block." Cochrane Database Syst Rev. 2017;11:CD011770. doi:10.1002/14651858.CD011770.pub2

9. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 5.2026. Updated 2026-01-23.

10. Romero-Laorden N, Lozano R, Jayaram A, et al. "Phase II pilot study of the prednisone to dexamethasone switch in metastatic castration-resistant prostate cancer (mCRPC) patients with limited progression on abiraterone plus prednisone (SWITCH Study)." Br J Cancer. 2018;119(9):1052–1059. doi:10.1038/s41416-018-0123-9

11. Yang Z, Ni Y, Zhao D, et al. "Corticosteroid switch from prednisone to dexamethasone in metastatic castration-resistant prostate cancer patients with biochemical progression on abiraterone acetate plus prednisone." BMC Cancer. 2021;21(1):919. doi:10.1186/s12885-021-08670-2

12. Muller D, Leaper A, Yadollahi S, et al. "AbiDex: retrospective UK analysis of steroid switching in patients with progression of mCRPC treated with abiraterone acetate." J Clin Oncol. 2022;40(6 Suppl):114. doi:10.1200/JCO.2022.40.6_suppl.114

13. Teo MY, Scher HI. "Lessons from the SWITCH trial: changing glucocorticoids in the management of metastatic castration-resistant prostate cancer (mCRPC)." Br J Cancer. 2018;119(9):1041–1043. doi:10.1038/s41416-018-0239-y

14. Lorente D, Mateo J, Perez-Lopez R, de Bono JS, Attard G. "Sequencing of agents in castration-resistant prostate cancer." Lancet Oncol. 2015;16(6):e279–e292. doi:10.1016/S1470-2045(15)70033-1

15. Venkitaraman R, Lorente D, Murthy V, et al. "A randomised phase 2 trial of dexamethasone versus prednisolone in castration-resistant prostate cancer." Eur Urol. 2015;67(4):673–679. doi:10.1016/j.eururo.2014.10.004

16. American College of Radiology Committee on Drugs and Contrast Media. ACR Manual on Contrast Media. 2025.

17. Wang C, Ramsey A, Lang D, et al. "Management and prevention of hypersensitivity reactions to radiocontrast media: a consensus statement from the American College of Radiology and the American Academy of Allergy, Asthma & Immunology." Radiology. 2025;315(2):e240100. doi:10.1148/radiol.240100

18. Wang C, Ramsey A, Lang D, et al. "Management and prevention of hypersensitivity reactions to radiocontrast media: a consensus statement from the ACR and AAAAI." J Allergy Clin Immunol Pract. 2025. doi:10.1016/j.jaip.2025.01.042

19. Hariharan S, Israni AK, Danovitch G. "Long-term survival after kidney transplantation." N Engl J Med. 2021;385(8):729–743. doi:10.1056/NEJMra2014530

20. Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. "KDIGO clinical practice guideline for the care of kidney transplant recipients." Am J Transplant. 2009;9(Suppl 3):S1–S155. doi:10.1111/j.1600-6143.2009.02834.x

21. Bock HA. "Steroid-resistant kidney transplant rejection: diagnosis and treatment." J Am Soc Nephrol. 2001;12(Suppl 17):S48–S52.

22. Mazzucchi E, Lucon AM, Nahas WC, et al. "Histological outcome of acute cellular rejection in kidney transplantation after treatment with methylprednisolone." Transplantation. 1999;67(3):430–434. doi:10.1097/00007890-199902150-00016

23. Woodle ES, Gill JS, Clark S, et al. "Early corticosteroid cessation vs long-term corticosteroid therapy in kidney transplant recipients: long-term outcomes of a randomized clinical trial." JAMA Surg. 2021;156(4):307–314. doi:10.1001/jamasurg.2020.6929

24. Hamidi N, Ozturk E, Yikilmaz TN, Atmaca AF, Basar H. "The effect of corticosteroid on postoperative early pain, renal colic and total analgesic consumption after uncomplicated and unstented ureteroscopy: a matched-pair analysis." World J Urol. 2018;36(6):979–984. doi:10.1007/s00345-018-2210-1

25. Clemens JQ, Erickson DR, Varela NP, Lai HH. "Diagnosis and treatment of interstitial cystitis/bladder pain syndrome." J Urol. 2022;208(1):34–42. doi:10.1097/JU.0000000000002756

26. Soucy F, Grégoire M. "Efficacy of prednisone for severe refractory ulcerative interstitial cystitis." J Urol. 2005;173(3):841–843. doi:10.1097/01.ju.0000153612.14639.19

27. Porpiglia F, Vaccino D, Billia M, et al. "Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association?" Eur Urol. 2006;50(2):339–344. doi:10.1016/j.eururo.2006.02.023

28. Toner AJ, Ganeshanathan V, Chan MT, Ho KM, Corcoran TB. "Safety of perioperative glucocorticoids in elective noncardiac surgery: a systematic review and meta-analysis." Anesthesiology. 2017;126(2):234–248. doi:10.1097/ALN.0000000000001466

29. Schultz ES, Diepgen TL, von den Driesch P, Hornstein OP. "Systemic corticosteroids are important in the treatment of Fournier's gangrene: a case report." Br J Dermatol. 1995;133(4):633–635. doi:10.1111/j.1365-2133.1995.tb02719.x

30. Montrief T, Long B, Koyfman A, Auerbach J. "Fournier gangrene: a review for emergency clinicians." J Emerg Med. 2019;57(4):488–500. doi:10.1016/j.jemermed.2019.06.023

31. Hagedorn JC, Wessells H. "A contemporary update on Fournier's gangrene." Nat Rev Urol. 2017;14(4):205–214. doi:10.1038/nrurol.2016.243

32. Atsuta T, Shimizu Y, Masuda N, et al. "First report of idiopathic segmental ureteritis successfully treated by steroid therapy." Int J Urol. 2012;19(6):583–586. doi:10.1111/j.1442-2042.2012.02968.x

33. Koprowski C, Kim C, Modi PK, Elsamra SE. "Ureteral stent-associated pain: a review." J Endourol. 2016;30(7):744–753. doi:10.1089/end.2016.0129

34. Betschart P, Zumstein V, Piller A, Schmid HP, Abt D. "Prevention and treatment of symptoms associated with indwelling ureteral stents: a systematic review." Int J Urol. 2017;24(4):250–259. doi:10.1111/iju.13311

35. Harper JD, Desai AC, Maalouf NM, et al. "Risk factors for increased stent-associated symptoms following ureteroscopy for urinary stones: results from STENTS." J Urol. 2023;209(5):971–980. doi:10.1097/JU.0000000000003183