Stent-related Symptoms Research Articles

Pharmacological treatment of bladder stent symptoms

Background: Ureteric stenting is a ubiquitous procedure, but it is associated with symptoms that affect psychological well-being and quality of life. While many factors are linked to worse symptomatology, some innovative modifications to the stent’s structure, as well as treatments, have been studied to reduce their clinical impact. Pharmacotherapy is a well-evaluated treatment modality derived from the treatment of lower urinary tract symptoms not related to stents. Objective: This review focuses on these pharmacological treatments. Several drug classes have been trialed to treat stent-related symptoms. Most of these studies investigated adrenoceptor modulators (both alpha-blockers and beta-3 agonists), muscarinic receptor antagonists, phosphodiesterase-5 inhibitors, as well as novel pharmacological modalities. Most trials and subsequent meta-analyses support treatment over placebo and controls, and some drugs are better at treating certain symptom domains, such as phosphodiesterase-5 inhibitors working on sexual issues. Furthermore, a combination therapy with alpha-blockers and muscarinic receptor antagonists appears to be superior to monotherapy with either of them. Treatments are also well tolerated. Conclusion: However, initiating pharmacotherapy should be part of a shared decision-making approach that balances the severity of symptoms and the duration the stents will remain in situ against potential side effects.

Novel Stanley Stent Symptom Status Score (s5 score) for predicting ureteral stent-related symptoms

Background It is a known fact that endourological procedures frequently require placement of double J (DJ) ureteral stent. These patients can have stent-related symptoms (SRS) after DJ stent placement which can be distressing with increased morbidity. Though intraoperative and postoperative factors for SRS have been studied, research work is deficient in preoperative prediction of these symptoms which is the need of the hour. Thus, we aim to find out the factors which can lead to SRS after ureteroscopic lithotripsy (URSL) surgeries. Further, we aim to establish a scoring system which will help us predict the possibility of SRS and take necessary actions to minimise them.Materials and methodsOur study includes 150 URSL cases with DJ stenting where we correlated various factors with the presence of SRS. Information regarding preoperative, intraoperative and postoperative factors which may lead to SRS were noted down. All patients completed Ureteral Stent Symptom Questionnaire (USSQ) to evaluate the symptoms at 1 and 3 weeks after stent placement and 1 week after removal of the stent. The statistical data were evaluated using SPSS 24 Statistics.ResultsIn our study, we found that SRS correlated statistically with factors namely body mass index (BMI) > 25 kg/m2, loin pain, stone size > 1 cm, haematuria, bilateral stone disease, incomplete distal curl, distal end crossing midline and these could predict the occurrence of SRS. Based on the significant preoperative factors, we constructed the Stanley Stent Symptom Status Score (S5 Score) which predicts the possibility of developing SRS.ConclusionThorough understanding of factors which can lead to SRS can help us take steps to reduce the morbidity related with this frequent procedure. Stanley Stent Symptom Status Score (S5 Score) predicts the occurrence of these symptoms preoperatively. This score is first of its kind which will pave the way for deeper understanding and prediction of these symptoms preoperatively.

252 Analysis of the High Readmission Rate Following Elective Ureteroscopy – the Need for Improved Patient Information on Stent-Related Symptoms

252 Analysis of the High Readmission Rate Following Elective Ureteroscopy – the Need for Improved Patient Information on Stent-Related Symptoms

Relief of double-J stent-related symptoms: a comparison between mirabegron, tamsulosin and solifenacin

BackgroundInserting ureteral stents is a routine intervention that often results in problems. The cornerstone for treating stent-related symptoms is pharmacological therapy. This study was conducted to evaluate and to compare the effectiveness of mirabegron, tamsulosin, solifenacin and control in reducing double-J stent-related symptoms.ResultsPatients were evaluated preoperatively, one week after stent insertion and two weeks after the start of medications by the Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), overactive bladder questionnaire (OAB-q) and visual analogue pain scale (VAPS). Solifenacin and mirabegron groups had significantly lower sexual scores after the 1st and 2nd weeks post-operatively (PO) when compared with the control group. Mirabegron group had significantly lower sexual scores after 1st and 2nd weeks PO when compared with patients in tamsulosin and solifenacin groups. Patients in mirabegron group had significantly fewer additional problems after the 1st and 2nd weeks PO when compared with patients in the control and tamsulosin groups.ConclusionsTo sum up, mirabegron was found to be superior to solifenacin in lowering urinary symptoms scores, sexual performance scores and work performance scores at both first and second weeks post-operatively. Mirabegron is a good alternative choice for SRSs when tamsulosin or solifenacin is ineffective or not tolerated.

Evaluation of Tolerance Towards Ureteral Double-J-Stents in Children: An Unmet Need

Abstract Background Ureteric double-J-stents (DJS) are commonly applied devices in urology that often cause irritative symptoms in adults, leading to decreased quality of life. Little is known about how they are tolerated by children. Furthermore, standardized patient-centered care for children has not yet been established. Aims The aim of this study was to assess the tolerance of children towards DJS by evaluating their irritative symptom rate and to raise awareness of the need for a standardized evaluation method. Methods A prospective observational single-center study was conducted over a period of 14 months on children with indwelling DJS. A questionnaire addressing 5 categories (voiding symptoms, general symptoms, social activities and/or sexual health, catheter removal, and medication) was developed for different age groups and employed after stent removal. Results Twenty patients requiring DJS with a mean age of 5.8 years (ranging from 3 months to 15 years) were enrolled in the study. During the indwelling time (mean 6 weeks), 65% (n=13) of the patients suffered from irritative symptoms (intermittent pain and/or voiding problems). There was a positive association between age and the reported pain score (Spearman's ρ = 0.54, p = 0.04). Conclusion Irritative symptoms caused by DJS were systematically assessed in children for the first time. To guarantee patient-centered care, our study's high rate of irritative symptoms must be accounted for when employing DJS. With the questionnaire, we provide an example of a sensitive tool to evaluate the management of children with DJS and treatment options to reduce stent-related symptoms.

Comparison of the efficacy and complications of tolterodine and α-adrenergic receptor blockers in improving ureteral stent-related symptoms: A systematic review and meta-analysis.

We conducted a systematic evaluation of the therapeutic efficacy and complications of tolterodine and α-adrenergic receptor blockers in alleviating ureteral stent-related symptoms. Until August 2023, we conducted a comprehensive literature search on PubMed, Embase, Web of Science, and Cochrane Library to identify randomized controlled trials evaluating the efficacy and complications of tolterodine and α-adrenergic receptor blockers in treating ureteral stent-related symptoms. Two reviewers independently screened studies and extracted data. The scores from various domains of the Ureteral Stent Symptom Questionnaire (USSQ) were summarized and compared, and statistical analysis was performed using RevMan 5.4.0 software. A total of 8 studies met the inclusion criteria for our analysis. These studies were conducted at different centers. All studies were randomized controlled trials, involving a total of 487 patients, with 244 patients receiving α-adrenergic receptor blockers and 243 patients receiving tolterodine. The results showed that tolterodine demonstrated significantly better improvement in body pain (MD, 1.56; 95% CI [0.46, 2.66]; p = 0.005) (MD, 0.46; 95% CI [0.12, 0.80]; p = 0.008) (MD, 3.21; 95% CI [1.89, 4.52]; p = 0.00001) among patients after ureteral stent placement compared to α-adrenergic receptor blockers at different time points. Additionally, at 4 weeks, tolterodine showed superior improvement in general health (MD, 0.15; 95% CI [0.03, 0.27]; p = 0.01) and urinary symptoms (MD, 1.62; 95% CI [0.59, 2.66]; p = 0.002) compared to α-adrenergic receptor blockers, while at 6 weeks, tolterodine showed better improvement in work performance (MD, -1.60; 95% CI [-2.73, -0.48]; p = 0.005) compared to α-adrenergic receptor blockers. Additionally, the incidence of dry mouth (RR, 4.21; 95% CI [1.38, 12.87]; p = 0.01) is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, there were no significant statistical differences between the two drugs in other outcomes. This meta-analysis suggests that tolterodine is superior to α-adrenergic receptor blockers in improving physical pain symptoms after ureteral stent placement, while α-adrenergic receptor blockers are more effective than tolterodine in enhancing work performance. Additionally, the incidence of dry mouth is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, higher-quality randomized controlled trials are needed to further investigate this issue.

Comparing efficacy and safety of mirabegron, tamsulosin, and solifenacin in ureteral stent-related symptoms: outcomes from a network meta-analysis

Comparing efficacy and safety of mirabegron, tamsulosin, and solifenacin in ureteral stent-related symptoms: outcomes from a network meta-analysis

Association between material and design used in a ureteral stent with complication in ureteral catheterisation: A systematic review

The double-J stent is one of the ureteral catheters with curved ends for fixation. Since its introduction in 1978, catheterisation using a double-J stent has become one of the most frequently performed procedures in urology. However, double-J stents may lead to various complications, causing patient discomfort, pain, and bladder symptoms. Technological advancements in stent design aim to minimise these complications and enhance comfort. This review aimed to determine the association between the material and design used in ureteral stents and complications in ureteral catheterisation. We conducted a systematic review following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) checklist. Screening based on specific inclusion criteria was employed to select potential studies. A database search yielded a total of 124 studies. Nine full texts were evaluated for eligibility, resulting in the exclusion of one paper. Our findings indicate that ureteral stent insertion significantly increases the frequency of pain and urinary symptoms while decreasing overall health. The choice of materials and design plays a crucial role in minimising pain and improving the quality of life for patients. Physical properties such as firmness and tensile strength also affect the quality of life, with higher firmness and tensile strength causing lower quality of life. Stent material and design choice were context-dependent. Using soft stents and specialised soft distal pigtails has been shown to reduce patient stent-related symptoms. Silicone stents showed the least bladder symptoms than polymeric stents. Polymeric stents also showed no difference in utility from metallic stents for long-term usage.

La boîte à outils de l’urétéroscopie ou « ce qu’il faut emporter sur une île déserte »

Flexible ureteroscopy is now widely used as the preferred option to surgically treat a urinary stone, due to several technological advancements. Thus, choosing the adequate equipment is challenging, but respect safety concepts. Indeed, placing the safety wire (nitinol, 0,035’’, « stiff ») under rigid cystoscopy is not mandatory but improve safety. Regarding ureteral access sheath (UAS), considerations are similar : UAS facilitates vision, pressure and temperature control but can also be responsible of ureteral injuries at insertion. Suction devices are now undervaluation and could not be discussed. To limit the barotrauma risk, irrigation devices with manual pumps should be used (40cmH20). Choosing a flexible ureteroscope (fURS) is challenging; a special attention has to be given to size, deflexion, working channel position and vision. Thus, using a single fURS is hardly imaginable. Both Holmium:Yttrium-Aluminium-Garnet(Ho:YAG) et Thulium Fiber (TFL) lasers are recommended to treat urinary stones during fURS, with a potential advantage of TFL on thin pulverization. A wide variety of baskets exists and size and shape have to be considered before acquisition. Finally, if ureteral stenting is not mandatory in uncomplicated cases, silicone stents present a lower risk of encrustation and stent-related symptoms compared to polyurethane ones.

Effect of theophylline on stent-related symptoms in patients undergoing Double-J ureteral stent insertion: a randomized controlled trial.

To investigate the effect of oral theophylline on stent-related syndrome (SRS) after Double-J insertion. Double-J stent is widely using in many urological procedures. Infection, hematuria, and discomfort are some of common complication after stenting. Theophylline is a dimethylated xanthine that inhibits phosphodiesterase and blocks adenosine receptors. To relaxing effect of theophylline on smooth muscles and its effects on the urinary system, it seems it could reduce complications after inserting Double-J stent especially ureteral stent syndrome. In this double-blind placebo-controlled randomized clinical trial, 67 patients were enrolled. Mean (SD) age of control and theophylline group was 51.8 (12.5) and 43.9 (10.4) years old, respectively. Patients were randomized into two groups of control and theophylline. All patients were stenting with silicon Double J. Theophylline group received 100mg of theophylline, twice daily for 30days, while control group received placebo. Stent symptoms were assessed by questionnaire and urine culture was performed before stent removal at removal day. Statistical analysis was performed using Chi-squared test and t test with P < 0.05 considered significant. Logistic regression models were fitted, crudely and adjusted for age and sex. Of 67 eligible patients, 60 completed the study. Theophylline significantly decreased percentages of gross hematuria (P < 0.001), dysuria (P < 0.001), and urinary frequency (P < 0.001). Microscopic hematuria (P = 0.042) and chills (P = 0.042) also decreased after theophylline. Theophylline could be an effective and safe choice for reducing SRS among patients undergoing Double-J stent insertion.

Patients undergoing double J substitution with a pigtail suture stent report a significant decrease of stent-related symptoms. Results from a prospective multicenter longitudinal trial

PurposeTo compare stent-related symptoms (SRS) in patients with double J (DJ) undergoing substitution with a pigtail suture stent (PSS) after ureteroscopy (URS), through the Ureteral Stent Symptom Questionnaire (USSQ).Materials and methodsPatients with DJ undergoing URS for stone treatment were enrolled in this prospective multicenter longitudinal study. The USSQ was submitted thrice: 2 weeks after DJ, 2 weeks after PSS and 4 weeks after PSS removal (baseline). Primary endpoint: to compare Urinary Symptom Index Score and the rate of patients with pain 2 weeks after DJ and PSS. Secondary endpoints: to compare other USSQ scores and single answers 2 weeks after DJ and PSS, and DJ and PSS USSQ scores with baseline.Results93 patients were enrolled. 2 weeks Urinary Symptom Index Score (p < 0.001) and the percentage of patients complaining of pain (60.2% vs 88.2%, p < 0.001) were significantly in favour of PSS compared to DJ. 2 weeks scores were significantly improved with PSS compared to DJ: Pain Index (p < 0.001), VAS (p < 0.001), General Health Index (p < 0.001) and Work Performance Index (p < 0.001). All urinary symptoms were significantly decreased with PSS, including renal pain during micturition and pain interfering with life. Pain Index Score (p = 0.622) and VAS (p = 0.169) were comparable to baseline with PSS, while differed with DJ.ConclusionsPatients undergoing DJ substitution with PSS after URS report a significant decrease of SRS. Urologists may consider positioning PSS after URS in pre-stented patients to reduce the impact of SRS.

Efficacy of combined phytotherapy (NefroBest® and UroBest®) in female patients with urolithiasis and preoperative drainage of upper urinary tract before ureteroscopy

Introduction. In most cases, double-J stent placement is the initial method of drainage in patients with urolithiasis. Until ureteroscopic intervention, most patients report «stent-related symptoms» that reduce the quality of life.Objective. To improve the results of treatment in female patients with urinary stone disease (USD) and preoperative drainage of the upper urinary tract using double-J stent by assessing the effect of the NefroBest® and UroBest® complexes on the prevention of the development of «stent-related symptoms» and inflammatory processes.Materials &amp; methods. The study group included 90 female patients with USD, who were performed ureteroscopic interventions with preoperative stent placement from March to September 2023 in the Yudin City Clinical Hospital. Patients were divided into two groups: the main group 1 (n = 30) — patients who received phytotherapy with NefroBest® (30 days) and UroBest® (7 days) complexes after placement of an internal ureteral stent; the control group 2 (n = 60) — patients who did not receive specific therapy postoperatively.Results. According to the USSQ, in group 1 the median score due to urinary symptoms was 22 points, and in group 2 — 28 points (p = 0.001), when assessing symptoms associated with pain — 12 and 18 points (p &lt; 0.001), general health — 17 points both and work performance — 9 and 11 points, respectively. Among patients in group 1, stonefree rate was observed in 90.0%, and among patients in group 2 — in 93.3%. In group 1, antibacterial therapy in the postoperative period was in 37.0% of patients, and in group 2 – among 53.0%.Conclusion. The co-use of the NefroBest® and UroBest® complexes in female patients with USD and preoperative drainage of the upper urinary tract using double-J stent can reduce the severity of symptoms associated with urination and pain, and postoperatively resulted in a lower incidence of infectious-inflammatory complications.

Ureteral stent related symptoms: A comparative study.

In urology, ureteral stents are used to treat obstructive diseases. Hematuria (54%), fever, discomfort, and lower urinary system symptoms are the predominant symptoms related to ureteral stent. This article links stent symptoms to double-j width and length, as well as patient's height, weight, and body mass index (BMI). Ureteric Stent Symptoms Questionnaire (USSQ) was used to measure ureteral stent symptoms at 1st and 4th week of stent in situ as well as the 4th week after pigtail removal. A 200-patient prospective study, where patients were allocated into four groups following ureteral stent insertion depending on the stent characteristics. Those groups were: 4.8 Fr./26 cm (Group A), 4.8 Fr./28 cm (Group B), 6 Fr/26 cm (Group C), and 6 Fr/28 cm (Group D). Men comprised 53.5% of 200 patients. Participants had an average age of 49 ± 15.5 years, height of 175 ± 8.94 cm, and BMI of 23.8 ± 7.6 cm. The laboratory results were identical between groups. At the first and fourth week, groups had similar urine symptoms, pain severity, health status and occupational activities. The difference in pain location was statistically significant. Group A had 82.4% renal back pain in the first week, whereas Group B had 68.8%, Group C 31.3% and Group D 62.5 (p = 0.04). At the fourth week, 64.7% of Group A patients reported kidney front pain, compared to 100% of Group B, 93.3% of Group C, and 100% of Group D (p = 0.04). There was statistical significance in the sexual activity of the patients. 24.4% of Group C patients stopped sexual activity before stent installation, compared to 10.6%, 8.3%, and 6.4% of the other groups (p = 0.03). A moderate percentage of patients had active sexual activity at week 4 (Group A: 7.8%, Group B: 5.8%, Group C: 8.2%, Group D: 4.1%), p = 0.83. In multivariate analysis, urinary catheter group, age, weight, height, and BMI did not significantly affect urine index score (UIS), pain index score (PIS), general health (GH), quality of work (QW), and quality of sex (QS). Despite various attempts to establish the best ureteral stent, the effect of double-j stent physical features on stent-related symptoms remained unknown. No verdict is conceivable without adequate empirical data.

Factors associated with unplanned clinical encounters for ureteral stent-related symptoms.

Ureteral stent-related symptoms (USRS) often result in unplanned phone calls and ER visits. We hypothesize that patient factors can be identified to predict these unplanned encounters. Retrospective analysis of indwelling ureteral stent placements from 2014 to 2019 at a single institution by CPT code was performed. Patient demographics, discharge medications, and clinical factors were evaluated using multiple logistic regression with respect to postoperative telephone and emergency room (ER) encounters for USRS. Of 374 patients, 75 (20.1%) had one or more encounters for USRS: 48 (12.8%) called the clinic and 39 (10.4%) returned to the ER. Chronic opioid use was predictive of calls to clinic and ER visits (OR 3.21 [CI 1.42-6.97], p < 0.01 and OR 3.64 [CI 1.45-8.98], p < 0.01). Survival analysis stratified by history of chronic opioid use and discharge opioid prescriptions demonstrated that opioid naïve patients receiving opioids at discharge had unplanned encounters sooner and more often [Calls p = 0.025, ER p = 0.041]), whereas patients with chronic opioid usereturned to the ER sooner and more frequently when prescribed additional opioids (Calls p = 0.4, ER p = 0.002). Patients with a history of chronic opioid use may experience more intense USRS or have a lower threshold to seek medical care than opioid naïve patients and tend to bypass calling the clinic for the ER. Given that none of the studied medications reduced unplanned patient contact for USRS, urologists should consider upfront definitive management of urinary obstruction when appropriate.

COMPARISON OF PHARMACOLOGY AGENTS EFFECT IN TREATING URETERAL STENT RELATED SYMPTOMS: SYSTEMATIC REVIEW &amp; META-ANALYSIS OF RANDOMIZED CONTROLLED TRIAL¬

Objective: We wish to update existing meta-analyses to assess the effectiveness of pharmacological agents against ureteral stent-related symptoms with better design of RCTs, as well as more valid and reliable measurement methods. Material &amp; Methods: Relevant published articles up to February 2022 were obtained from PubMed, CENTRAL, Google Scholar, Science Direct, and DOAJ. All single-blind or double-blind RCTs with various comparisons using pharmacological agents and/or placebo in patients with ureteral stent-related symptoms, with outcome assessment using USSQ at week 1 and week 4 during stent placement was included in the study. Statistical parameter Mean Difference (MD) with 95% CI was used to measure effect size. The p value less than 0.05 indicates statistical significance. Results: Alpha blockers (2 studies, 85 samples) significantly reduced fourth week UIS compared to placebo (MD: – 5.46, 95% CI: – 7.47 to -3.46, I2 = 0%, P = &lt; 0.001), and alpha blockers (2 studies, 42 samples) significantly reduced first week SIS compared to combination therapy (MD: – 0.82, 95% CI: – 1.56 to – 0.08, I2 = 0%, P = 0.03). The results of the meta-analysis of USSQ scores in other domains have no significant differences. Conclusion: Alpha blockers were better than placebo in reducing UIS due to ureteral stent in the fourth week of stent placement, and better than combination therapy in reducing SIS due to ureteral stent in the first-week post stenting. However, more RCTs are needed with larger samples and better designs to reach valid conclusions.&#x0D; Keywords: Stents, Randomized Controlled Trials as Topic, Single-Blind Method.

Comparison of ureteral stent-related symptoms in high-inserted stents with conventional ones

Objective: To assess whether high-inserted urinary stents (HIUS) provide substantial enhancements in patient comfort and overall quality of life, we compared the stent-related symptoms of HIUS and conventional ureteric stents (CUS). Methodology: We randomly assigned 54 patients who received simple ureteroscopic lithotripsy to a high-inserted or standard stent group. Baseline Ureteral Stent Symptom Questionnaire (USSQ) and visual analogue scale pain levels were assessed 2 weeks postoperatively and 4 weeks following stent removal. Also contrasted was subdomain analysis of all Stent-Related Symptoms (SRS) and stent problems. Results: Significant intergroup differences were seen in urinary symptoms, pain index on VAS, and overall health domain scores (p&lt;0.001). No significant difference was seen in the work performance index (p=0.077) or sexual matter score (p=0.064). The HIUS group had significantly higher scores on USSQ subdomains, including frequency, urgency, incomplete emptying, burning at voiding, hematuria grade, difficulties with heavy physical activity, feeling comfortable, resting in bed due to symptoms, decreasing routine activities, and sexual intercourse pain (p&lt;0.001). Patients in both groups who quit sex life owing to stents were similar (p=0.745). Complication rates were similar in both groups. Conclusion: HIUS dramatically reduced stent-related urine discomfort and pain. Thus, HIUS can be employed in clinical practice, especially for short-term stent implantation after simple ureteroscopic lithotripsy.

The effect of ureteral double J stent insertion on work performance in patients undergoing endoscopic stone treatment.

Despite the developments in the material of the double J (DJ) stents and the production of thinner ones of desired sizes, patients continue to experience troublesome DJ stent-related symptoms in their lives. This study aimed to determine how DJ stenting affects patients' work performance after endoscopic stone surgery. A total of 107 patients underwent placement of a ureteral stent after ureterorenoscopy (URS)/retrograde intrarenal surgery (RIRS), and only active and full-time working patients were included. All patients were asked to complete the validated Turkish version of the work performance score (WPS) questionnaire in the Ureteral Stent Symptom Questionnaire (USSQ) the day before stent removal and again one month after stent removal. Of the participants, 32.7% (n = 35) were female and 67.3% (n = 72) were male; the mean age was 41 (19-80) years. The workday loss had no statistically significant correlation with patient BMI, stone size, or stent indwelling time (p >0.005); however, a statistically significant negative correlation was detected with patient age (r = -0.335, p <0.001). The medians of WPSs with the stent and without the stent were 6 (3-15) and 3 (3-12), respectively (p <0.001). Although DJ catheterization is a crucial tool for urological practice, it may increase the social and economic burden of patients due to reduced work performance and lost workdays. Therefore, limiting the duration of the DJ stent's stay and providing treatments to minimize patient symptoms will positively impact their professional lives. It would be beneficial to avoid DJ stenting in routine practice unless medically necessary.

Effect of perioperative tamsulosin on successful ureteral access sheath placement and stent-related symptom relief: A double-blinded, randomized, placebo-controlled study.

This study investigated the effect of administering tamsulosin before surgery on the successful insertion of a 12/14 French (F) ureteral access sheath (UAS) during the procedure, as well as the impact of preoperative and postoperative tamsulosin use on symptoms related to the ureteral stent. This study was a randomized, single-center, double-blinded, placebo-controlled trial involving 200 patients who underwent unilateral retrograde intrarenal surgery. Patients received either tamsulosin (0.4 mg) or placebo 1 week before surgery until stent removal. Patients were randomly assigned to one of four groups. Group 1 received tamsulosin throughout the study period. Group 2 received tamsulosin before surgery and placebo after surgery. Group 3 received placebo before surgery and tamsulosin after surgery. Group 4 received placebo before and after surgery. The USSQ (Ureteral Stent Symptom Questionnaire) was completed between postoperative days 7 and 14 immediately before stent removal. A total of 160 patients were included in this analysis. Their mean age was 55.0±11.0 years, and 48 patients (30.0%) were female. In the group that received preoperative tamsulosin, the success rate of 12/14F UAS deployment was significantly higher than that of the preoperative placebo group (88.0 vs. 75.3%, p=0.038). Preoperative and postoperative tamsulosin did not significantly alleviate symptoms related to the ureteral stent. Our results revealed that preoperative administration of tamsulosin improved the success of larger-sized UAS, whereas preoperative and postoperative tamsulosin use did not significantly alleviate symptoms related to ureteral stents.

Randomized controlled trial comparing the effectiveness of tamsulosin, tamsulosin with tolterodine and double J stent position in controlling stent related symptoms after ureteroscopic lithotripsy

Background: Objective of the study was to determine the effect of stent position and medications in preventing stent-related symptoms. Methods: This was a prospective study conducted at Meenakshi Mission Hospital and Research Centre Madurai, Tamil Nadu, India. 150 patients who underwent ureteroscopic lithotripsy with indwelling stent were distributed into three groups. On demand analgesics were given to group 1 (n=50), Tamsulosin 0.4 mg daily for group 2 (n=50) and tamsulosin 0.4 mg and tolterodine 4 mg daily for group 3 (n=50). The patients were also subclassified into appropriate or inappropriate group according to stent position. All patients completed various domains of Ureteral stent symptom questionnaire (USSQ) on 1st and 7th postoperative days. Appropriate tests statistics were performed using EPI-Info statistical software package. Results: In control group, patients with appropriate stent position had significantly lower symptom scores than those with inappropriate stent position (p value~0.0001) in all domains of USSQ except global quality of life score (p value=0.08). Addition of tamsulosin 0.4 mg (group 2) had superadded beneficial effect in appropriate position group, but not in patients with inappropriately positioned stents. Patients taking both tamsulosin 0.4 mg and tolterodine 4 mg (group 3) had no significant improvement in symptom scores in appropriate position group (all domains of USSQ) and inappropriate position group (most domains). Conclusions: Appropriate stent position is the most important independent factor than medications in preventing stent related symptoms; tamsulosin has superadded benefit in patients with correctly positioned stents.

Tamsulosin Versus Mirabegron in Relieving Ureteric Stent-Related Symptoms: A Prospective, Double-Blinded, Randomized Controlled Trial.

Introduction Alpha-adrenergic blockers like tamsulosin are widely used in the treatment of stent-related symptoms due to ureteric stents. Recently, mirabegron has emerged as a potential alternative. So, our study aimed to compare the effect of mirabegron and tamsulosin on ureteric stent-related morbidity. Methods In this randomized controlled study, 80 patients undergoing uncomplicated ureteroscopic lithotripsy with double J stenting for ureteric stones were enrolled. They were divided into two groups: Group A (n=40) received mirabegron (25mg) and Group B (n=40) received tamsulosin (0.4mg). Outcomes were assessed using the Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptoms Score (IPSS), and the visual analog pain scale. The t-test and the Chi-square test were utilized to study theefficacy of the interventions across both groups. Results The USSQ urinary symptom score (25.5 vs 33.45; p < 0.001) and body pain score (16.15 vs 26.02; P < 0.001) were significantly lower in the mirabegron group. However, the general health score (17.0 vs 17.28; p = 0.62) and work performance score (7.6 vs 8.0; p = 0.28) did not show a significant difference. The storage symptom score was significantly lower in the mirabegron group (3.98 vs 5.1; p = 0.001). Furthermore, the mirabegron group reported a better quality of life score (2.18 vs 3; p < 0.001). Conclusion Mirabegron has been shown to reduce urinary symptoms associated with ureteric stents and also results in a better quality of life when compared with tamsulosin. However, large-scale, prospective, multicentric studies are further required to holistically evaluate and comprehend the beneficial effects of mirabegron on stent-related morbidity.