PURPOSE: Radical cystectomy with continent diversion is the standard treatment for muscle-invasive bladder cancer. Evidence supporting the necessity of ureteral stent use after this procedure is limited. This study compares 30-day postoperative outcomes of radical cystectomy with continent diversion using neobladder reconstruction in patients managed with and without ureteral stents. METHODS: A retrospective cohort study using the 2019-2022 ACS-NSQIP database included 1,318 patients who underwent radical cystectomy with continent diversion using neobladder reconstruction. We compared baseline characteristics and perioperative factors between the stented (n = 1,216) and stentless group (n = 102). Univariate and multivariate analyses assessed the relationship between stent use and perioperative outcomes, as well as 1:1 propensity score matching. RESULTS: Patient demographics and comorbidities were comparable between the two groups. Similarly, preoperative and intraoperative factors showed no significant differences, except for a higher drain placement rate in the stented group (98.6% vs. 89.2%, p <
0.002). Postoperatively, the stented cohort exhibited higher odds of minor complications (CD grade 1-2
OR 1.66, p = 0.018), and an increased incidence of progressive renal insufficiency (8.7% vs. 1.3%, p = 0.024) and bleeding requiring transfusion (29.8% vs. 19.6%, p = 0.030). Ureteral obstruction, urinary leak, anastomotic leak rates, hospital stay, and readmission and reoperation rates remained similar between the two groups. Propensity score matching (1:1) for patients with and without stents supported the results of the multivariate logistic regression. CONCLUSION: Stent omission after radical cystectomy with continent diversion using neobladder reconstruction was not associated with significant differences in major complications, ureteral obstruction, readmission, or reoperation rates. It is potentially a safe alternative associated with fewer minor complications.