OBJECTIVE Insertion of a ureteral stent is routinely done after ureteroscopy. Recently, several authors have questioned routine stenting after ureteroscopy for distal ureteral stones. We report our results of a randomized study comparing ureteroscopy with and without placement of stents for distal ureteral stones. METHODS A total of 48 patients undergoing ureteroscopy for distal ureteral stones were randomized to a stented group (N = 26) or a nonstented group (N = 22). Ureteroscopy was carried out with Wolf 8.5F semirigid endoscope, and the Swiss Lithoclast was used as the source of energy. Any stent was removed at 3 weeks. Patients were assessed for success, operative time, postoperative pain score, analgesic requirement, stent-related symptoms, and risk of ureteral stricture formation. Baseline variables were not significantly different in the two groups. RESULTS There was no significant difference in the two treatment groups with regard to need for ureteral dilation, use of intracorporeal lithotripsy, or occurrence of intraoperative and postoperative complications. A successful outcome was achieved in 100% of both groups. The mean pain score on day 0 was 5.23 +/- 0.95 of 10 in the stented group and 4.82 +/- 0.96 in the nonstented group; this difference was not statistically significant. Similarly, the analgesic requirement in the two treatment groups was not significantly different. However, patients with stents had significantly more pain (including flank pain with voiding: P = 0.01), urgency (P = 0.04) and dysuria (P <0.01). Radiologic follow-up was available for 83.33% of the patients at the 3-month visit. None of the patients had evidence of ureteral stricture or residual stone fragments. CONCLUSIONS In select patients undergoing ureteroscopy for distal ureteral stones, stents can be safely omitted. Patients without stents have significantly fewer lower-urinary symptoms of pain, urgency, and dysuria and are not at risk of increased complications. Avoiding stents may be particularly cost effective in developing countries.