Mirabegron for the Treatment of Ureteral Stent-related Symptoms: A Systematic Review and Meta-analysis

Comparation of intraureteral stent and conventional stent at different stages: a systematic review with meta-analysis

INTRODUCTION

Stent related symptom (SRS) is the most common adverse effect of ureteral stenting. In recent years, many efforts have been made to develope modified ureteral stents to ameliorate SRS. It has been reported that intraureteral stents have the potential to improve the tail end adverse effect of the bladder and alleviate SRS. However, there still lack of evidence for the efficacy and the safety of clinically applying intraureteral stents. The aim of this work is to investigate the efficacy and safety of intraureteral stents.

EVIDENCE ACQUISITION

A systematic review was performed by using the PubMed, Web of Science, Medline, Embase, and Cochrane library. The studies published before February 2023 were included. The study selection was following the guideline from Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The searching strategy was: "Pigtail suture stent" OR "Intra-ureteric stent" OR "Suture Stent" OR "Intraureteral stent" AND "Ureteroscopy" OR "Urinary calculi" OR "Stent-related symptoms" OR "Lower urinary tract symptoms". The data from randomized clinical trials which meet the selection criteria were extracted. Revman 5.4 was employed to proceed the meta-analysis.

EVIDENCE SYNTHESIS

A total of six randomized clinical trials of intraureteral stents were included in this systematic review and meta-analysis. According to the different investigation time, the results could be divided into four stages: early-stage, middle-stage, late-stage, and long-term evaluation. Urinary symptoms, pain score, and general health were significantly improved in intraureteral stents group at middle stage. For late-stage, intraureteral stent achieved better outcomes in urinary symptoms index, VAS score, quality of life, general health, and pain score. However, for early-stage and long-term evaluation, there was no significant difference between two groups.

CONCLUSIONS

This systematic review and meta-analysis reveal that regardless of the stage of treatment, the efficacy and safety of intraureteral stent are no worse than that of conventional stent. During 7-14 days postoperation, which is the most commonly time for clinically using ureteral stent, most of the outcomes of intraureteral stent are better than those of conventional stent. Hence, it is confirmed that intraureteral stent is worth for more clinical study and application.

Mirabegron and antimuscarinics for treating ureteral stent-related symptoms: a systematic review and meta-analysis of RCTs

Objective: We conducted a meta-analysis to assess the efficacy and safety of mirabegron (50 mg/day) and antimuscarinics in treating ureteral stent-related symptoms (SRSs). Methods: All randomized controlled trials (RCTs) were identified by searching PubMed, Embase, Web of Science, and Cochrane Library. The RevMan version 5.3.0 software was used for statistical analysis. Results: This meta-analysis included five RCTs involving 317 patients. A fixed effects model revealed that mirabegron was superior to antimuscarinics in treating urinary symptoms (MD -1.39, 95% CI -2.63 to -0.15, p = 0.03) and general health (MD -1.65, 95% CI -2.60 to -0.69, p = 0.0007) 1 week after treatment initiation. We observed no significant differences in body pain (MD 0.05, 95% CI -1.06 to 1.15, p = 0.94), work performance (MD -0.86, 95% CI -1.77 to 0.06, p = 0.07), and sexual matters (MD 0.03, 95% CI -0.77 to 0.83, p = 0.94). Two weeks after treatment initiation, the ureteral stent symptom questionnaire (USSQ) revealed no significant differences between the two groups. The mirabegron group demonstrated a significant improvement in the quality of life (QoL) (MD -0.18, 95% CI -0.34 to -0.01, p = 0.03), while the International Prostate Symptom Score did not reveal a significant difference between the two groups (MD -0.74, 95% CI -1.79 to 0.32, p = 0.17). Regarding safety, a pooled data analysis presented that the incidence of constipation was lower in the mirabegron group (OR 0.10, 95% CI 0.01 to 0.77, p = 0.03). The mirabegron and antimuscarinics groups did not differ significantly concerning the risk of dry mouth (OR 0.15, 95% CI 0.02 to 1.27, p = 0.08). Conclusion: Mirabegron is superior to antimuscarinics in alleviating ureteral SRSs and improving QoL. Additionally, mirabegron 50 mg/day presented safety with a lower incidence of constipation.

Impact of Ureteral Stent Material on Stent-related Symptoms: A Systematic Review of the Literature

Context

Ureteral stents are essential implants that are used on a daily basis. Since their invention, advances in stent design have been directed towards alleviating stent-related symptoms. It remains unclear how the material composition of the stent affects stent-related symptoms.

Objective

To review the literature and define the clinical impact of ureteral stent material on stent-related symptoms.

Evidence acquisition

A literature search of the Embase, MEDLINE (PubMed), and Web of Science databases was conducted on December 17, 2021 to collect articles comparing stent composition materials regarding stent-related symptoms. Thirteen publications met the inclusion criteria, of which only one met the high-quality requirements of the Cochrane Collaboration tool for assessing the risk of bias in randomized trials.

Evidence synthesis

Most trials, including the highest quality trial, seem to support that silicone double-J (DJ) stents reduce stent-related symptoms compared to nonsilicone DJ stents. Regarding physical properties, it seems that "soft" or "flexible" DJ stents reduce stent-related symptoms. However, since there was only one high-quality study with a low risk of bias, it is impossible to draw a definitive conclusion owing to the lack of quality data.

Conclusions

Silicone DJ stents, and by extension "soft" DJ stents, appear to reduce stent-related symptoms compared to nonsilicone polymers and "hard" DJ stents. No definitive conclusion can be drawn owing to a lack of quality evidence. Creating a standard for measuring and reporting physical stent properties should be the first step for further research.

Patient summary

A ureteral stent is a small hollow tube placed inside the ureter to help urine drain from the kidney. We reviewed the literature on the impact of stent material on stent-related symptoms. We found that silicone may reduce stent-related symptoms, but no definitive conclusion can be drawn and further studies are needed.