Abstract
Objective: To evaluate the efficacy of tamsulosin in reducing post operative flank pain during voiding, in patients with ureteric stent.
 Study Design: This is a Randomized control trial (RCT) study.
 Place and Duration: Study carried out at Department of Urology, Jinnah Post Graduate Medical Centre, Hospital, Karachi, Pakistan, from June 2016 to November 2016.
 Methodology: 60 patients aged between 15 – 45years, undergone placement of ureteric stent to treat ureteric and renal calculi and have pain score >4, were included in the study. Divided into two groups ‘group A’ and ‘group B’. In group ‘A’ and group ‘B’ Tamsulosin and Placebo was given respectively in patients with ureteric stent and reduction in post-operative flank pain was measured and compared. Tamsulosin was given post operatively when NPO is broken after 2 hours – 6 hours. Patients having uretral trauma, patients having BPH, patient underwent TURP or TURBT, patent having urinary tract infection and patients with pregnancy or lactating females were excluded. All patients were received intravenous antibiotic (Ceftrixone 1gr). Also all patients were receive oral analgesic (diclofenic sodium 50mg BID) and antispasmodics (Drotaverine 80mg BID). Patients were discharged after 24 hours. Postoperatively stent related flank pain during voiding was assessed via Pain Scale.
 Results: 60 Patients who got operated for ureteric stent. In group ‘A’ there were 21 males (70%) and 9 females (30%), the mean age of group A was 35.67±5.99 as In group ‘B’ there were of 21 males (70%) and 9 females (30%) and mean age of group B was 35.04±6.42 (Table 1). Mean Pain score in ‘Group A’ (Tamsulosin) in week 1, 2, 3, 4, 5, 6 was 4.1, 3.5, 2.9, 2.3, 1.9, 1.3 respectively as shown in Table 2. Mean Pain score in ‘group B’ (Placebo) in week1, 2, 3, 4, 5, 6 was 6.9, 6.3, 5.9, 5.6, 5, 4.2 respectively as shown in Table 2. Average pain score in ‘group A’ and ‘group B’ came out to be 2.67 and 5.64 respectively (P value 0.005). 
 Conclusion: Alpha blockers reduces the post-operative flank pain and voiding complaints in patients with ureteric stent. Our study shows that the efficacy of Tamsulosin in reducing post-operatice flank pain in patients with uretercic stent is better than placebo.
Highlights
Ureteric stents were introduced 4 decades ago by Zimskind et al [1]
Tamsulosin was given post operatively when NPO is broken after 2 hours – 6 hours
Our study shows that the efficacy of Tamsulosin in reducing postoperatice flank pain in patients with uretercic stent is better than placebo
Summary
Ureteric stents were introduced 4 decades ago by Zimskind et al [1]. Ureteric stent is used in many of the urological procedures including management of renal and ureteric stones[2]. Available literature showed increased morbidities associated with use of ureteric stents flank pain during voiding [3]. Urinary symptoms has been reported in 78% of the patients whereas flank pain during voiding had been reported among 80% of the patients [4,5]. In spite of various attempts ideal stent could not be developed which could reduce symptoms associated with it [6,7]. Several studies have been conducted to evaluate factors which cause morbidity associated with ureteric stent placement and its treatment. Some authors postulated that alpha blockers, by blocking alpha receptors located on ureteric orifice and trigone of the urinary bladder, getting effectiveness in reducing symptoms associated with ureteric stent [10,11]
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