Background: Ureteral JJ stents (DJS) are a common part of urological practice and are used for the management of upper urinary tract obstruction and ureteral surgery, despite their advantages; ureteral stents are not without possible morbidity. Objective: This study aimed to record the prevalence and possible reasons behind neglected DJS and its complications. The difficulties associated with their removal and risk factors correlate with these difficulties. Patients and Methods: A cohort study including 517 patients presented with fixed DJS presenting to Department of Urology, Al-Azhar University Hospitals; Cairo; Egypt. With neglected DJS (indwelling for more than 6 months). We noted the complications of neglected stents (urinary tract infection, gross hematuria, encrustation, migration and stent fragmentation), the treatment modalities and risk factors for these complications. Results: From the entire patients, 239 (46.2%) had a neglected stent with mean stenting duration 11.11 ± 8.6 months. A total of 26.8% of patients received urine acidification, 26.4% were stone formers, 32.2% presented with urinary tract infection (UTI) and 33% had gross hematuria. Encrustations on the stent were recorded in 17.2% of patients and fragmented stent in 4.6% and 2.5% migrated stent up. The stent was removed by cystoscopy in 201 cases (84.1%). Other cases needed combined endoscopic and/or open surgical procedures. Lack of urinary acidification was a significant risk factor for UTI and complex interventions for stent removal (P = 0.013 and 0.017, respectively). Stent fragmentation were more likely with longer duration of stenting (P = > 0.001). Conclusion: Neglected DJS are associated with significant morbidity, urine acidifications is protecting against complications.