The beneficial effect of alpha-blockers for ureteral stent-related discomfort: systematic review and network meta-analysis for alfuzosin versus tamsulosin versus placebo

Abstract

BackgroundThis study was carried out a network meta-analysis of evidence from randomized controlled trials (RCTs) to evaluate stent-related discomfort in patients with alfuzosin or tamsulosin versus placebo.MethodsRelevant RCTs were identified from electronic databases. The proceedings of appropriate meetings were also searched. Seven articles on the basis of RCTs were included in our meta-analysis. Using pairwise and network meta-analyses, comparisons were made by qualitative and quantitative syntheses. Evaluation was performed with the Ureteric Stent Symptoms Questionnaire to assess the urinary symptom score (USS) and body pain score (BPS).ResultsOne of the seven RCTs was at moderate risk of bias for all quality criteria; two studies had a high risk of bias. In the network meta-analysis, both alfuzosin (mean difference [MD];−4.85, 95 % confidence interval [CI];−8.53–−1.33) and tamsulosin (MD;−8.84, 95 % CI;−13.08–−4.31) showed lower scores compared with placebo; however, the difference in USS for alfuzosin versus tamsulosin was not significant (MD; 3.99, 95 % CI;−1.23–9.04). Alfuzosin (MD;−5.71, 95 % CI;−11.32–−0.52) and tamsulosin (MD;−7.77, 95 % CI;−13.68–−2.14) showed lower scores for BPS compared with placebo; however, the MD between alfuzosin and tamsulosin was not significant (MD; 2.12, 95 % CI;−4.62–8.72). In the rank-probability test, tamsulosin ranked highest for USS and BPS, and alfuzosin was second.ConclusionThe alpha-blockers significantly decreased USS and BPS in comparison with placebo. Tamsulosin might be more effective than alfuzosin.

Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review

“…Like carried out before for drug treatment of SRS, the initial object of our systematic review was to perform a network meta-analysis comparing the potential of the different methods of treatment and prevention described above. 12 RCTs were further checked for eligibility to be included in that network meta-analysis. Inclusion criteria were: (i) study assesses measures to treat or prevent SRS; (ii) standard indications for ureteral stenting; and (iii) use of USSQ, and reporting of at least urinary symptoms score and body pain score.…”

“…Inclusion criteria were: (i) study assesses measures to treat or prevent SRS; (ii) standard indications for ureteral stenting; and (iii) use of USSQ, and reporting of at least urinary symptoms score and body pain score. However, aside from eight trials assessing drug treatment, which were already the subject of the metaanalyses described above, 12,14 just two further studies 25,26 met the inclusion criteria. Although many of the trials using the USSQ did not provide the actual numbers for USSQ total score and subscores, the remaining studies applied a multiplicity of tools to assess stent-related morbidity (i.e.…”

“…However, according to the results of the rank-probability test carried out, the authors assumed that tamsulosin might be more effective than alfuzosin in patients with ureteral stents. 12 Amongst all trials carried out on a 1 -blockers in the treatment of SRS, there is only a single study that could not show a beneficial treatment effect. In 2015, Park et al compared the efficacy of tamsulosin, solifenacin (oral antimuscarinic) and combination therapy of both agents within an open-label, randomized controlled trial, and found no beneficial effects for all of the groups.…”

Meta-Analysis of Stenting versus Non-Stenting for the Treatment of Ureteral Stones

“…Alpha-blockers effectively reduced the morbidity of ureteral stents [45,46]. A meta-analysis showed that, tamsulosin and alfuzosin, which were the most commonly applied drugs, had the similar function to relief the stents-related discomfort [47]. …”

Ureteral stenting can be a negative predictor for successful outcome following shock wave lithotripsy in patients with ureteral stones

“…In addition, the decision to proceed with ureteral stenting requires much caution because it is a relatively invasive procedure. Furthermore, we should also consider the possibility of stent-related voiding symptoms, such as bladder irritation symptoms and flank pain or discomfort [2627]. In their randomized control study, Ghoneim et al [9] noted that microscopic hematuria, pyuria, dysuria, and suprapubic pain were significantly more common in patients with a ureteral stent than in those without.…”