Is There a Role for α-Blockers in Ureteral Stent Related Symptoms? A Systematic Review and Meta-Analysis

Yakoubi, Rachid; Lemdani, Mohamed; Monga, Manoj; Villers, Arnauld; Koenig, Philippe

doi:10.1016/j.juro.2011.04.061

Cited by 78 publications

(49 citation statements)

References 28 publications

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“…Two previous meta-analyses by Yakoubi et al (four RCTs) and Lamb et al (five RCTs) have investigated the same topic and some of the major outcomes as the present meta-analysis, including urinary tract symptoms and pain (33,34). However, these meta-analyses had limitations, including: i) A single method (USSQ) was used to evaluate USS, therefore other questionnaires, including the IPSS, VAPS, SF-36 and OABq were not included; ii) an unreasonable method was used by Lamb et al to detect publication bias (<10 studies); iii) Lamb et al used the Jadad Scale to assess risk of bias, which lacks a consideration of allocation concealment and is not recommended for use by the Cochrane Collaboration (35); iv) no sensitivity analysis was performed and significant between-trial heterogeneity was detected; v) small sample sizes; vi) no adverse events were reported.…”

Section: Discussionmentioning

confidence: 69%

“…As compared with previous meta-analyses conducted by Yakoubi et al (33) and Lamb et al (34), numerous studies meeting the inclusion criteria have emerged in recent years, and the targets observed for USSQ have altered (15,27-29,31,32). Joshi et al (5) performed a study including 309 patients in order to broadly collate these symptoms and the USSQ was developed, covering a total of six sections and 38 scoring items, including: Urinary symptoms, pain, general health, work performance, sexual matters and additional problems (5).…”

Section: Discussionmentioning

confidence: 91%

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

Zhang

Cheng

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The present meta-analysis aimed to evaluate the current evidence for the use of α 1 -blockers in relieving ureteric stent-related symptoms (USS). Electronic databases, including PubMed, Embase and Cochrane Library, were searched and two independent reviewers identified relevant parallel randomized controlled trials (RCTs), assessed trial quality and extracted data. Review Manager (version 5.2) was used to conduct a meta-analysis of the data. Significant advantages were demonstrated in the treatment group based on International Prostate Symptom Score (IPSS), voiding symptom sub-scores [mean difference (MD), -2.66; 95% confidence interval (CI), (-4.36, -0.96)], Ureteral Stent Symptom Questionnaire (USSQ) urinary symptoms score (MD, -5.84; 95%CI, -9.35 to -2.33), IPSS quality of life score (MD, -1.46; 95%CI, -2.64 to -0.28) USSQ quality of life score (MD, -0.69; 95%CI, -1.10 to -0.28), USSQ pain score (MD, -3.97; 95%CI, -5.52 to -2.42), Visual Analog Pain Scale (MD, -1.53; 95%CI, -2.25 to -0.80) and USSQ general health score (MD, -1.82; 95%CI, -2.47 to -1.18). No significant differences were detected from the following results: IPSS storage symptom sub-score (MD, -0.93; 95%CI, -2.28 to 0.43), USSQ sexual matters score (MD, -0.10; 95%CI, -0.79 to 0.59), USSQ work performance score (MD, 1.64; 95%CI, and USSQ additional problems score (MD, -2.02; 95%CI, -4.55 to 0.52). However, significant between-trial heterogeneity was detected following statistical analysis and there were insufficient data to trace its source. The existing RCT data supported the hypothesis that α 1 -blockers beneficially influence pain, urinary symptoms and the quality of life of patients with an indwelling ureteral stent.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 91%

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

Zhang

Cheng

et al. 2015

Experimental and Therapeutic Medicine

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“…Considering the current study and the two meta-analyses that have been recently published (21,22), it seems that alpha-blockers can effectively relieve stent-related symptoms.…”

Section: Discussionmentioning

confidence: 69%

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

et al. 2013

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Objective: To evaluate the effects of terazosin and tolterodine on ureteral stent discomfort. Materials and Methods: Of 163 patients assessed for eligibility, 104 patients were randomly assigned to receive placebo, 2 mg of terazosin twice daily, 2 mg of tolterodine daily, or both terazosin plus tolterodine during the stenting period. Prior to stenting and at stent removal, the International Prostate Symptom Score (IPSS), the IPSS quality of life (QoL) subscore and the Visual Analog Scale for Pain were determined. The patients also reported their analgesic use during the stenting period. Results: Ninety-four patients completed the study. We noted significant decreases in the total IPSS scores (p = 0.002), irritative subscore (p = 0.039), QoL (p = 0.001), flank pain (p = 0.013), voiding pain (p = 0.01) and amount of analgesics used (p = 0.02) in the groups. However, neither the obstructive subscore nor the suprapubic pain improved significantly (p = 0.251 and p = 0.522, respectively). The patients receiving terazosin plus tolterodine experienced significant reductions in the total IPSS, irritative symptoms, QoL, flank pain, voiding pain and decreased analgesics use compared with those patients receiving placebo. However, compared with placebo, terazosin monotherapy did not affect pain levels, and tolterodine monotherapy did not improve QoL, flank pain or analgesics use. Conclusions: Terazosin plus tolterodine improves ureteral stent-related complications, including irritative symptoms, the amount of analgesics used, QoL, flank pain and voiding pain but does not decrease obstructive symptoms or suprapubic pain. This trial was registered at www.clinicaltrials.gov as NCT01530243.

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“…Factors that contribute to DJ--associated morbidity include stent design, size, positioning, associated UTI, and duration (25). Recent use of drug eluting stents (26) and alpha blockers (27) were reported to cause less pain and discomfort.…”

Section: Discussionmentioning

confidence: 99%

Emergency double-J stent insertion following uncomplicated Ureteroscopy: risk-factor analysis and recommendations

et al. 2013

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Purpose: Emergency double-J (DJ) stenting following "uncomplicated" ureteroscopic (UURS) stone treatment is both morbid and costly. Our study aims at identifying those patients who are more likely to require such an extra procedure. Handling of this complication will also be highlighted. Materials and Methods: 319 cases of UURS cases were selected out of 903 patients, who were admitted for URS stone treatment at King Abdullah University Hospital during the period from May, 2003 to December, 2010. Thirty-eight of them (11.9%) had emergency post-URS DJ stenting within 24 hours of discharge. The medical records of all UURS cases were retrospectively reviewed. Comparison in demographic and stone-related variables was made using 2-paired t-test with P < 0.05. Operative findings of 38 stented patients were outlined. Results: Significant risk factors for emergency stenting were noted in males with larger (> 1.5 cm) and proximal stones (38 stented vs. 281 unstented). Operative risk factors among the 38 patients were: initial procedure time > 45 minutes (42.1%), ureteral wall edema (21.1%), repeated access for stones > 1.5 cm (21.1%), impacted stone (10.5%) and ignored or missed stones/fragments (4.6%). Conclusions: The need for emergency DJ stenting following UURS stone treatment is not uncommon. The routine insertion is impractical and weakly-supported. With risk-factor stratification, selective and individualized DJ stenting policy is recommended.

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Is There a Role for α-Blockers in Ureteral Stent Related Symptoms? A Systematic Review and Meta-Analysis

Abstract: Existing evidence from randomized, controlled trials shows that α-blockers are associated with improvement in ureteral stent symptoms and supports their use in routine clinical practice.

Cited by 78 publications

References 28 publications

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

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

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

Emergency double-J stent insertion following uncomplicated Ureteroscopy: risk-factor analysis and recommendations

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