Ureteral Stent Symptom Research Articles

The Beneficial Effects of Alpha-Blockers, Antimuscarinics, Beta 3-Agonist, and PDE5-Inhibitors for Ureteral Stent-Related Discomfort: A Systematic Review and Meta-Analysis from KSER Update Series

Background and Objectives: Ureteral stents are widely used in the field of urology but can cause varying degrees of side effects. This study utilized a network meta-analysis to evaluate stent-related discomfort (SRD) in patients with alpha-blockers (alfuzosin, tamsulosin, and silodosin), antimuscarinics (solifenacin), beta 3-agonists (mirabegron), and phosphodiesterase 5-inhibitors (tadalafil) versus a placebo. Materials and Methods: Relevant randomized controlled trials (RCTs) from 2006 to 2021 were identified from electronic databases, including PubMed, EMBASE, and the Cochrane Library. The following identifiers were included to assess the urinary symptom score (USS): participants (patients with ureteral stents), interventions (patients who took medication for stent discomfort), and outcomes (comparisons of the Ureteric Stent Symptoms Questionnaire (USSQ)). We also executed an independent quality assessment using the Scottish Intercollegiate Guidelines Network (SIGN). Results: A total of 16 RCTs were identified, and they included 1865 patients. Compared with the placebo, mirabegron (mean difference (MD): −3.87; 95% confidence interval (CI): −10.6–2.35), tadalafil (MD: −4.47; 95% CI: −10.8–1.63), and silodosin (MD: −4.02; 95% CI: −12–4.01) did not show significant differences to the placebo, whereas others did. Alfuzosin, mirabegron, silodosin, solifenacin, and tadalafil were not inferior to tamsulosin in terms of the USS using Bayesian analyses. In the random effect model, P-score tests showed that solifenacin possessed the highest P-score (p = 0.8484); tamsulosin was the second highest (p = 0.7054). As a result of the rank-probability test, solifenacin was also ranked highest in terms of USS, and tamsulosin was ranked second. Conclusions: Compared with the placebo, solifenacin, tamsulosin, and alfuzosin significantly decreased the USS. In our study, solifenacin may be considered the most effective medication for SRD.

Development of Prediction Models for Severe Pain and Urinary Symptoms After Ureteroscopy With Ureteral Stent Placement: Results From the STENTS Study and Initial Validation of Pain Interference.

We developed prediction models for severe pain and urinary symptoms after ureteroscopy with ureteral stent placement. The development cohort included 424 adults and adolescents enrolled in the multicenter STENTS prospective cohort study who underwent ureteroscopy with stent placement for urinary stones. The validation cohort was an independent prospective cohort of 115 adults. The outcomes were severe pain intensity and pain interference, measured by Patient-Reported Outcomes Measurement Information System, and severe urinary symptoms, measured by the Ureteral Stent Symptom Questionnaire. The top quartile of symptoms on postoperative days 1 and 3 were defined as severe. Generalized estimating equation models were used to predict severe symptoms on postoperative days 1, 3, 5, and 7 to 9 in the development cohort and severe pain interference on days 1 and 7 in the validation cohort. Female sex, younger age, higher BMI, baseline pain interference, number of chronic pain conditions, renal stone location, and history of anxiety predicted severe pain. In the development cohort, the C-statistics were 0.83 (95% CI 0.80-0.85) for severe pain interference and 0.82 (95% CI 0.79-0.84) for severe pain intensity. A model in which baseline urinary symptoms replaced pain interference had excellent discrimination for severe urinary symptoms (C-statistic 0.83; 95% CI 0.81-0.85). In the validation cohort, the C-statistic was 0.7 for severe pain interference (95% CI 0.54-0.78). Preoperative characteristics accurately predicted severe pain and urinary symptoms after ureteroscopy with stent placement. On further validation, these models could guide clinical decisions to improve surgical outcomes.

Allium covered metal stent for treatment of malignant ureteral obstruction.

Malignant ureteral obstruction (MUO) has the potential to result in a range of outcomes, including varying degrees of hydronephrosis and renal impairment. Allium covered metal stents have provided a new, highly effective treatment option for MUO. Our objective was to evaluate the safety and efficacy of the Allium covered metallic stent for the treatment of malignant ureteral obstruction. Clinical data of 29 patients who underwent endoscopic insertion of an Allium ureteral stent between October 2019 and August 2021 at Yongchuan Hospital, affiliated with Chongqing Medical University, were analyzed retrospectively. At one, three, six and 12 months after insertion, serum creatinine was measured, the width of the renal pelvis was rechecked under ultrasound guidance, and the position and shape of the stent were checked by abdominal x-ray. Data on long-term stent patency, incidence of complications, changes in renal function and hydronephrosis grade were collected and analyzed. Ureteral stent symptom questionnaire (USSQ) was administered preoperatively and after six months in 22 patients with previous stent history. Allium covered metal stents (n = 33) were implanted successfully in 29 patients who were followed for three to 22 months, with 32/33 stents remaining patent. Serum creatinine levels decreased in 17 patients (p < 0.001), and hydronephrosis decreased in 24 patients. Clavien-Dindo grade I complications were observed in seven patients, Clavien-Dindo II in one patient, whereas stent displacement and stent encrustation occurred in one patient each (Clavien-Dindo III-IV). USSQ scores had significantly improved six months after stent insertion (p < 0.001). Allium ureteral stents are a safe and effective treatment option for malignant ureteral obstruction, with good long-term patency, helping to preserve renal function and improve quality of life.

Complete intraureteral stent placement reduces stent-related pain in normotensive subjects and in diabetes: Subgroup analysis of a prospective randomized clinical trial

Purpose: Pain is a common symptom that is associated with ureteral stent placement, but its degree of perception might vary among individuals. Compared with conventional stent placement (C-SP), complete intraureteral stent placement (CIU-SP) has shown promise in reducing stent-associated pain. This study aimed to investigate the effect of patient characteristics and comorbidities on pain reduction after CIU-SP. Materials and methods: Patients who underwent ureteroscopic lithotripsy and stent placement were randomized into the CIU-SP and C-SP groups. Stent-associated symptoms were evaluated using the Ureteral Stent Symptom Questionnaire on day 7, immediately before stent removal. Stent-associated pain was determined by the answer to question P1 (yes or no). Subgroup analysis was conducted based on various patient characteristics and comorbidities. Results: Of the 103 randomized patients, 91 (45 in CIU-SP and 46 in C-SP) were included in the final analysis. Body pain was reported by 31 (68.9%) after CIU-SP and 41 (89.1%) after C-SP (P = 0.021). Compared with C-SP, CIU-SP significantly reduced pain in the normotensive population (66.7% versus 93.7%, P = 0.006) but not in hypertensive individuals (77.8% versus 76.9%, P = 1.000). Conversely, compared with C-SP, CIU-SP was associated with less pain in patients with diabetes (37.5% versus 88.9%, P = 0.05) but not in patients without diabetes (75.7% versus 89.2%, P = 0.221). Age, sex, stone laterality, body mass index, and smoking status did not influence the reduction of pain after CIU-SP. Conclusion: Compared with C-SP, CIU-SP was effective in reducing stent-associated pain, especially in normotensive and diabetic populations. These findings align with existing literature, which emphasized the potential impact of hypertension on decreased pain perception and highlighted the known association between diabetes and bladder hypersensitivity.

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.

Optimizing the outcome of non-pre-stented flexible ureteroscopic lithotripsy regarding the quality of life, when to remove the stent?

ObjectivesTo investigate the safety of short-term stenting following flexible ureteroscopic lithotripsy (fURL) for patients without preoperative stents. Retaining double-J stent for 1–2 weeks after fURL is a common practice. At present, data on short-term stenting after non-pre-stented fURL is still lacking.Methods182 patients who met inclusion criteria were retrospectively divided into the 2-days group (2-day removal, 76 cases) and the 1-week group (1-week removal, 106 cases). The study endpoint was stent-associated adverse symptoms assessed by follow-up and completed validated questionnaires on postoperative days (POD) 7 and 12. A postoperative imaging review was performed 1 month after the surgery.ResultsNo statistical differences were found in the patients’ demographic and stone-related characteristics. The 2-days group showed fewer urinary tract symptoms and lower scores on the ureteral stent symptom questionnaire on POD 7: less backache during urination (p = 0.004), less hematuria (p = 0.031), less frequent urination (p = 0.004), lower urinary symptoms index (p < 0.001), lower general health index (p < 0.001), and lower performance index (p < 0.001). There were no significant differences in fever (p = 0.372), visual analogue scale score (p = 0.760), and painkiller requirements (p = 0.160) on POD 7. The average general health score and work performance score remained significantly higher in the 1-week group patients at 5 days after removal compared to the 2-days group patients at 5 days after removal. (p < 0.001, p = 0.005). Five patients in the 2-days group and 15 patients in the 1-week group returned to the emergency department for additional treatments. No patient required rehospitalization. Stone-free rates were 85.5% in the 2-days group and 80.2% in the 1-week group (p = 0.499), respectively, and none of the patients got aggravating hydronephrosis.ConclusionsCompared to the common 1-week stent removal option, short-term stenting after non-pre-stented fURL is safe, which can enhance the patient’s quality of life.

Foley catheter after ureteroscopy and JJ stent placement: a randomised prospective European Association of Urology Section of Urolithiasis-Young Academic Urologists (EULIS-YAU) endourology study.

To evaluate the effects of inserting a Foley catheter after ureteroscopy (URS) and JJ stent placement on pain scores, voiding patterns, biochemical parameters and postoperative complications. A randomised clinical trial (1:1) with adult patients following unilateral URS + JJ stent placement was planned. In Group A, no Foley catheter was placed, in Group B, a Foley catheter was placed following URS + JJ stent placement. The primary objective was to evaluate effect of placing a Foley catheter on International Prostate Symptom Score (IPSS), Ureteric Stent Symptom Questionnaire (USSQ) score and postoperative biochemical parameters. The secondary objective was to evaluate postoperative complications. A total of 112 patients were included (56/group). A ureteric access sheath was used in each patient. Patients had similar demographic and surgical parameters. The pre- and postoperative biochemical analyses including white blood cell count, C-reactive protein, procalcitonin and creatinine levels were similar between the two groups. The IPSS were similar between the two groups. All the subdomains of the USSQ were similar between two groups except Total Body Pain score, which was lower in Group B. The visual analogue scale scores were similar. Complications were all Clavien-Dindo Grade I and II, and the complication rate was 5.4% and 8.9% in Group A and B, respectively. Placing a Foley catheter following URS + JJ stent placement did not show significant effects on postoperative biochemical parameters and voiding symptoms. However, a Foley catheter lowered the Total Body Pain score on the USSQ without having significant effects on VAS scores. The practice of placing a Foley catheter following URS and JJ stent placement should be based on surgeon's preference keeping in mind the potential positive effect on pain scores.

Comparative Approaches in Treating Double-J Stent Syndrome: Monotherapy or Combination Therapy?

Introduction: The application of double-J ureteral stents in urology is widespread, but their use is often accompanied by complications and bothersome symptoms, affecting patients' quality of life (QoL). While various medications have been tested for alleviating the symptoms associated with double-J stents, consensus on their effectiveness remains elusive. This study aims to investigate the effectiveness of tamsulosin, solifenacin, mirabegron, desloratadine, and combination therapy using a Romanian-adapted version of the Ureteral Stent Symptom Questionnaire (USSQ). Materials and Methods: A prospective, observational, randomised trial was conducted at the Urology and Renal Transplant Clinic of Dr. "C.I. Parhon" Clinical Hospital in Iasi between 1 January 2022 and 1 August 2023. Three hundred twenty seven patients who underwent their first double-J stent insertion were evaluated with the Romanian-adapted USSQ at baseline and 30 days post-insertion. Patients were randomly divided into six groups based on the prescribed medications: control, tamsulosin, mirabegron, solifenacin, desloratadine, and combination therapy. Results: The data suggest a significant reduction in symptoms in patients who received medication compared with the control group. Furthermore, the combined medication of solifenacin 10 mg and tamsulosin 0.4 mg was particularly effective in reducing pain with statistical significance compared to the control group (p = 0.001). The highest mean scores for urinary symptom severity were observed in the control group (12.37 ± 6.82), and the lowest was in the mirabegron group (9.94 ± 5.82). The individuals who received a daily dose of 50 mg of mirabegron saw the most notable influence on their job. Conclusions: While no single medication emerged as a "miracle drug" for managing symptoms related to double-J stent insertion, the combination therapy of solifenacin and tamsulosin is the most promising option for improving symptoms related to double-J stent insertion and QoL. Additional extensive research is required to validate these initial results.

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.

ASSOCIATION BETWEEN BODY HEIGHT AND DOUBLE J STENT INTRAVESICAL POSITION AND ITS RELATION WITH THE INDONESIAN VERSION OF URETERAL STENT SYMPTOM QUESTIONNAIRE (USSQ)

Objective: This study aims to determine the relationship between the patient’s body height with the intravesical double J stent position and whether its position is related to the ureteral stent symptom questionnaire (USSQ). Material &amp; Methods: A cohort study with a study population of patients inserted with double J stent size 4.7 Fr and length 26 cm was carried out at the Department of Urology Hasan Sadikin Academic Medical Center from July 2021 to July 2022. We assess the patient’s demographic features and different body heights into two categories, below and above average. Then we evaluate its stent position using a plain abdominal X-ray and the USSQ score. Results: Ninety samples were included in this study; 30 of them had a midline intravesical double J stent position, 30 pieces of contralateral, and 30 samples of ipsilateral. Only body height correlated to the stent’s position (p&lt;0.05). The results of comparative statistical tests or the association of postoperative complications between 7 days and 30 days in the position of the double J stent midline, contralateral and ipsilateral had significant results (p&lt;0.05). Stent with ipsilateral position showed a lower USSQ score. Conclusion: Men and women above the average height have a lower risk for migration stent to the contralateral side and are also associated with lower USSQ scores. Keywords: Double J stent, USSQ score, double J stent position.

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.

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.

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.

Novel Antireflux “RELIEF” Stent to Prevent Vesicoureteral Reflux

ObjectiveTo assess efficacy, comfort, & symptoms of a novel ureteral stent (RELIEF) substituting the distal semirigid coil of a traditional double-J (DJ) for a floating, monofilament tether allowing coaptation of the ureteral orifice. Ureteral instrumentation notoriously cause discomfort, urgency, frequency, dysuria & hematuria; prolonged morbidity is likely related to stent-associated vesicoureteral reflux (VUR). We hypothesized this design would eliminate VUR, be safe & provide comfort following intervention. Methods28 patients within a single institution were enrolled. Passive cystography was performed pre- & post-stent placement assessing VUR. Patients completed Ureteric Stent Symptoms Questionnaires (USSQ) before placement (baseline), post-op day 1, & day of removal. Results20 RELIEF stents were placed (11 female and 9 male). 95% demonstrated no VUR following placement. No unexpected adverse complications occurred; 1 patient opted for early stent removal for significant discomfort. Average total USSQ scores demonstrated statistically significant improvement between first and third surveys (p<0.001). Statistically significant improvement in body pain, general health & work performance scores were noted as well (p<0.05). ConclusionsThe RELIEF stent eliminates VUR with similar stent-related morbidity and overall well-tolerance. RELIEF associated USSQ scores were below published mean symptom scores for standard DJ stents and appear safe in this preliminary clinical trial.

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.

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.

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.

Alfuzosin vs. Silodosin in the Improvement of Ureteral Stent-Related Symptoms after Endoscopic Surgical Treatment of Urolithiasis: A Retrospective Comparison

Purpose In this study, we aimed to compare the efficacy of two α-blockers, alfuzosin and silodosin, which have different pharmacological properties despite being uroselective, in the treatment of double-J stent (DJS)-related symptoms. Methodology Fifty-six male patients who underwent DJS implantation and for whom all data were available were included in the study. All patients were asked to complete the validated Turkish version of the Ureteral Stent Symptom Questionnaire (USSQ), international prostate symptom score (IPSS), and international index of erectile function-5 (IIEF-5) the day before stent removal and again one month after stent removal. Statistical analysis of these variables was performed in the groups, and a value of p&lt;0.05 was considered statistically significant. Results Significant decreases in IPSS, IPSS-quality of life, and USSQ scores were observed in both Group A and Group S one month after stent removal compared with before stent removal (p&lt;0.05). Whereas no side effects were observed in the alfuzosin group (Group A), retrograde ejaculation was observed in 8 (25.2%) patients in the silodosin group (Group S) (p=0.006). Furthermore, a statistically significant increase in IIEF-5 score was observed in both groups after stent removal compared with IIEF-5 score with stenting (p&lt;0.05). Conclusion The DJS has a significant impact on patients’ quality of life and should only be used when indicated, not routinely after every endoscopic stone procedure. Considering that silodosin may cause more ejaculation problems than alfuzosin, we believe that both drugs can be used in male patients to resolve DJS-related symptoms.