Background: Implanting a JJ stent during ureteroneocystostomy reduces the risk of urinary leakage and ureteral stenosis after kidney transplantation, but it may also predispose to urinary tract infections (UTIs). Long stent retention (>30 days) is associated with an increased risk of UTIs, with a major negative impact on graft and patient outcomes. In recent studies, there is a trend towards earlier stent removal (< 4 weeks), however, there is no consensus about the preferred time of removal. The aim of this systematic review and meta-analysis is to give an overview of currently available literature to determine whether the data can indicate a more definite time of ureteric stent removal.
Methods: Comprehensive searches were conducted in MEDLINE, Embase and CENTRAL (the Cochrane Library). All reference lists were manually scrutinized. The methodology was in accordance with the Cochrane Handbook for interventional systematic reviews, and written based on the PRISMA statement. Articles discussing JJ-stents and their time of removal were included. Studied outcome measures were UTIs, urinary leakage and ureteral stenosis.
Results: 53 articles were identified, of which 21 articles were included in this systematic review, seven in the meta-analysis. Meta-analysis showed significant reduction of UTI when stents are removed within three weeks (OR 0.41, CI 95%, 0.23 to 0.72, p = 0.002). The overall analysis of included studies regarding incidence of urinary leakage (n=13) and incidence of ureteral stenosis (n=10) shows that there is no difference between early and late stent removal.  
Conclusions: Ureteric Stent removal within three weeks after kidney transplantation is associated with a significant reduction of UTIs compared to removal after three weeks. Earlier stent removal does not lead to a higher incidence of urinary leakage and ureteral stenosis. Based on these results, we recommend that ureteric stents should be removed within three weeks after kidney transplantation.