Drug treatment of bothersome lower urinary tract symptoms after ureteric JJ-stent insertion: A contemporary, comparative, prospective, randomised placebo-controlled study, single-centre experience

Abstract

ObjectiveTo provide a guide for medication to alleviate bothersome lower urinary tract symptoms (LUTS) in patients after JJ ureteric stenting.Patients and methodsBetween June 2011 and June 2015, a prospective randomised placebo-controlled study was conducted on 200 consecutive cases of ureteric stones that required JJ stents. All patients had signed informed consent and JJ-stent placement confirmed by X-ray. The patients were randomised into five groups: A, solifenacin 5 mg; B, trospium chloride 20 mg; C, antispasmodic; and E, α-blocker; and a placebo group (D). A standard model was created to lessen patient selection bias. Eligible patients were enrolled and assessed for side-effects and bothersome LUTS using the validated Ureteric Stent Symptoms Questionnaire. Appropriate statistical analysis was carried out.ResultsIn all, 150 male patients in the five groups were compared. LUTS were less in groups A and B (P < 0.05), while dry mouth was significantly reported in Group A. Individual comparisons with the placebo group showed a non-significant difference with Group C, while Group E had significant nocturia improvement. Selective comparison of two best groups (A and B) showed less frequency in Group B, while the other LUTS were less in Group A with comparable side-effects.ConclusionsIn symptomatic patients following JJ-stent insertion, anti-muscarinic medication, namely solifenacin 5 mg or trospium chloride 20 mg, was the best. The advantage of trospium over solifenacin is in the control of frequency rather than the other symptoms. Addition of an α-blocker (alfuzosin 10 mg) is valuable when nocturia is the predominant symptom.

Ureteral Stent‐Related Symptoms and Pharmacotherapy: A Brief Narrative Review

“…The side effects between those 2 groups were comparable. 18 According to El-Nahas et al, solifenacin is superior to tamsulosin as pharmacotherapy for alleviating SRS, with the total USSQ scores being 61 in the solifenacin group, 76 in the tamsulosin group, and 83 in the placebo group (P < .001). The USSQ scores, except the sexual health index, were better in the solifenacin group (P < .05).…”

“…20 One study claims that solifenacin is superior to trospium chloride in controlling the symptoms attributed to pigtails, 17 whereas another study suggests that they are equal in all urinary domains of USSQ. 18 Some studies have explored the effects of a beta-3 agonist, namely mirabegron, on pigtail symptoms, where the patients that received mirabegron after pigtail insertion exhibited lower postoperative IPSS values and higher Overactive Bladder Questionnaire (OAB-q) values, compared with those who received a combination of tamsulosin and solifenacin, 16 whereas another study proves that mirabegron and tamsulosin have similar adequacy for the relief of SRS and that patients on mirabegron had lower analgesic requirements. 19 Regarding combination therapies, 1 study claims that they act faster on SRS than monotherapies and have a positive effect on almost all domains of the USSQ, except in the work and sexual domains, in patients receiving a combination of oxybutynin and tamsulosin, compared with patients that received only tamsulosin.…”

The effect of intravesical stent length and Propiverine on ureteral stent related symptoms - Prospective controlled trial

“…However, symptoms may persist through other receptors or mechanisms. In addition, the superiority of antimuscarinics over each other has not been proven yet (24). When considering the possible adverse effects of combination therapy due to using more than one drug, the different antimuscarinic molecules may be examined for stent-related symptoms.…”

The Effect of Intravesical Stent Length and Propiverine on Ureteral Stent Related Symptoms – Prospective Randomized Controlled Trial

“…However, symptoms may persist through other receptors or mechanisms. In addition, the superiority of antimuscarinics over each other has not been proven yet [21]. When considering the possible adverse effects of combination therapy due to using more than one drug, different antimuscarinic molecule may be examined for stent-related symptoms.…”