Effects of Tamsulosin, Solifenacin, and Combination Therapy for the Treatment of Ureteral Stent Related Discomforts

Abstract

PurposeTo evaluate the effect of tamsulosin, solifenacin, and combination therapy of two agents in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents.Materials and MethodsA total of 168 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease. All patients received polyurethane double-J ureteral stents (6 Fr, 24 or 26 cm), which were removed a mean of 14 days postoperatively. A total of 48 patients were given no medication (Group 1), 43 patients were given tamsulosin 0.2 mg once daily (Group 2), 45 patients were given solifenacin 5 mg once daily (Group 3), and 32 patients were given a combination of two agents postoperatively (Group 4). International Prostate Symptom Score/quality of life (IPSS/QoL) and visual analogue pain scale (VAPS) questionnaires were completed by each patient at 1 day postoperatively and on the day of stent removal.ResultsIn the total group of patients, the mean age was 50.24±12.90 years. There was a significant difference in the IPSS total score between group 1 and groups 3 and 4. Group 4 also differed significantly from group 1 in the irritative subscore. The obstructive subscore differed between groups 2 and 4 and group 1. There was a statistically significant difference between group 1 and group 4 in the QoL score. There were no significant differences in the VAPS.ConclusionsCombination therapy with tamsulosin and solifenacin improved both irritative and obstructive symptoms more than in the other groups. Combination therapy should be strongly considered for patients who complain of stent-related symptoms.

Effects of Terazosin and Tolterodine on Ureteral Stent Related Symptoms: A Double-Blind Placebo-Controlled Randomized Clinical Trial

“…Alpha-blockers relieve flank pain by decreasing the muscle tone of the ureter, bladder trigone and prostatic urethra by blocking the alpha-adrenergic receptors and thus reducing bladder outlet resistance and pressure during micturition. Moreover, anticholi-nergics decrease bladder overactivity and contraction by mediating the muscarinic receptors, thereby reducing urinary symptoms (15,18). To the best of our knowledge, this is the first study showing that the combination of terazosin and tolterodine improved stent-related discomforts and decreased consumption of analgesics.…”

“…Previous studies (19,23) have shown no impact of anticholinergic on stent discomforts, whereas Lim et al (15) have demonstrated a reduction in the total IPSS in patients receiving solifenacin compared with those receiving no medication. We believe that the effect of tolterodine on urinary symptoms may be caused by either informing the patients about the possible increase in symptoms by activity that could reduce activities of daily living and consequent trigone irritation by the stent tail or blockade of muscarinic receptors by tolterodine.…”

“…Given a mean difference of 3.5 in the total IPSS score (mean of total IPSS score of three treatment groups minus mean of control group) and 4.5 SD among the groups based on the study of Lim and coworkers (15), the sample size was calculated as 26 patients per groups with a statistical power of 80%. A Chi-squared test, one-way ANOVA, Tukey HSD test, the Kruskal-Wallis test (due to skewed distribution of data) and multiple comparison rank-sum tests were used, as appropriate; p < 0.05 was considered statistically significant.…”

“…The similarity between stent-related urinary symptoms and conditions including overactive bladder syndrome and benign prostatic hyperplasia is main reason for using those to treat stent-related symptoms (6,14). Given these notions, some studies have demonstrated the impacts on stent-related discomforts (14,15). The objective of this trial was to determine the effectiveness of terazosin and tolterodine in improving the stent-related symptoms in patients undergoing unilateral stenting.…”

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

“…1. A total of 21 potentially eligible studies were identified and seven studies were subsequently excluded for not fulfilling the inclusion requirements, one of which was not a RCT (20). 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).…”