Effect of Terazosin on Lower Urinary Tract Symptoms and Pain due to Double-J Stent: A Double-Blind Placebo-Controlled Randomized Clinical Trial

Abstract

Objective: We evaluated the effect of terazosin in the improvement of lower urinary tract symptoms and flank pain in patients with internal ureteral stents. Methods: In this double-blind randomized clinical trial, 73 patients with unilateral ureteral stone and hydroureteronephrosis who underwent insertion of an internal ureteral stent after transureteral lithotripsy (TUL) were randomized into two groups. 37 patients received terazosin 2 mg (once nightly) for 4 weeks and 36 patients received placebo for the same time duration. After 4 weeks, all patients were asked about the incidence of frequency, nocturia and urgency by an International Prostate Symptom Score (IPSS) questionnaire, flank pain and pain during urination by a visual analog scale (VAS) score, and hematuria. Results: The mean VAS score was 2.21 in the terazosin group compared with 4.93 in the control group (p < 0.001). Nearly all the patients in the placebo group reported flank pain during urination but this was only reported in 54.5% of the patients in the terazosin group (p < 0.001). All criteria measured by the IPSS in the terazosin group were significantly lower than those in the placebo group (p = 0.0001). Conclusions: Administration of terazosin for patients with an internal ureteral stent relieved some stent-related symptoms such as flank pain, pain during voiding, frequency, nocturia and urgency, but had no effect on hematuria.

α1-blockers for the reduction of ureteric stent-related symptoms: A systematic review and meta-analysis

“…In a study conducted by Mokhtari et al, the incidence of hematuria was similar between two groups; 57.6% in the terazosin group and 60.6% in the placebo group. Furthermore, as measured by IPSS urinal frequency, urgency and nocturia were significantly lower in the terazosin group, as compared with the placebo group (P<0.001) (28).…”

“…A Russian article published in Urologiia met the inclusion criteria according to the English abstract in PubMed; however it was subsequently excluded, since the full text could not be located (21). A total of 14 RCTs including 1,075 patients were included in the present meta-analysis (13,15,16,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

“…Table I outlines the characteristics of each study included in the present meta-analysis. All included studies were RCTs; eight studies were performed in Asia, (24)(25)(26)(27)(28)31,32) three in Europe (13,16,22), two in Africa (15,29), and one in America (23). Participant ages ranged from 17-87 and the follow up periods were 1-6 weeks.…”

“…VAPS was adopted in nine studies (13,15,16,23,25,26,28,30,32) and USSQ pain score was applied in six trials (13,16,(22)(23)(24)(25) In eight studies, analgesics and/or antibiotics were used in all patients as a general therapy. No significant differences in the rates of employment and sexual activity were demonstrated between the treatment groups.…”

“…In order to evaluate the intensity of pain experienced by patients with an indwelling ureteral stent in the included studies, three approaches, the USSQ, VAPS and SF-36 pain scores, were used. VAPS data from nine studies (13,15,16,23,25,26,28,30,32) were pooled and a random effects model demonstrated a significant difference between the α 1 -blocker and control groups (MD, -1.53; 95% CI, -2.25 to -0.80) (Table IV); however, no significant differences were detected following sensitivity analysis. Similarly, USSQ pain scores (MD, -3.97; 95% CI, -5.52 to -2.42) (Table IV) were significantly decreased in patients treated with α 1 -blockers.…”