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Bellos TC, Katsimperis SN, Kapsalos-Dedes SG, Tzelves LI, Kostakopoulos NA, Mitsogiannis IC, Varkarakis IM, Papatsoris AG, Deliveliotis CN. Ureteral Stent-Related Symptoms and Pharmacotherapy: A Brief Narrative Review. J Clin Pharmacol 2023; 63:1091-1100. [PMID: 37476926 DOI: 10.1002/jcph.2314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
The purpose of this article is to review the effects of different types of pharmacotherapy on symptoms that affect the quality of a patient's life after stent insertion. A thorough Medline/PubMed nonsystematic review was conducted from 1987 to January 2023, using the terms: "pigtail" OR "ureteral stents" AND "lower urinary tracts symptoms" OR "LUTS" AND "pharmacotherapy" OR "drugs". Relevant studies conducted in humans and reported in English language were included. The available reviews and articles associating the use of drugs with stent-related symptoms (SRS) provide conflicting results. Most of them show a clear benefit of alpha blockers, particularly alfuzosin, on treating urinary SRS, and hence there is a strong recommendation for the use of alpha blockers for the treatment of SRS in the guidelines of the European Association of Urology. Anticholinergics and mirabegron have shown a significant benefit in dealing with irritative bladder symptoms. In contrast, the findings for combination therapies are contradictory, with some studies showing that combination therapy is no superior to monotherapy with regards to most of the subsets of the Ureteral Stent Symptom Questionnaire (USSQ), whereas others present a clear benefit of combination therapies, specifically silodosin and solifenacin, in treating stent-associated lower urinary tract symptoms (LUTS), in comparison with any other type of monotherapy or combination therapy. Many studies suggest that some categories of pharmacotherapy, such as alpha blockers, can alleviate SRS. However, there is conflicting evidence concerning most other types of medical treatment. Randomized trials with the largest number of patients are needed to investigate the effectiveness of novel approaches on SRS.
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2
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Danilovic A. Editorial Comment: The effects of pregaba-lin, solifenacin and their combination the-rapy on ureteral double-J stentrelated symp-toms: A randomized controlled clinical trial. Int Braz J Urol 2022; 48:358-360. [PMID: 35170901 PMCID: PMC8932024 DOI: 10.1590/s1677-5538.ibju.2022.02.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Alexandre Danilovic
- Departamento de Urologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
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3
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Kim BS, Choi JY, Jung W. Does a Ureteral Stent with a Smaller Diameter Reduce Stent-Related Bladder Irritation? A Single-Blind, Randomized, Controlled, Multicenter Study. J Endourol 2020; 34:368-372. [DOI: 10.1089/end.2019.0482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bum Soo Kim
- Department of Urology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Jae Young Choi
- Department of Urology, College of Medicine, Yeungnam University, Daegu, Korea
| | - Wonho Jung
- Department of Urology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
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4
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Jefferson FA, Okhunov Z, Veneziano D, Rivas JG, Meneses AD, Cacciamani GE, Socarras MR, Wikenhiezer J, Landman J. Precise characterization of urinary tract innervation using three-dimensional reconstruction: A contemporary review. Actas Urol Esp 2019; 43:397-403. [PMID: 31167713 DOI: 10.1016/j.acuro.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/19/2022]
Abstract
A precise understanding of the autonomic innervation of the urinary tract is crucial to successful management of urologic disease given the important role that neurophysiology plays in genitourinary pathology. Recent studies using a combination of contemporary histopathology and imaging technologies have furthered our understanding of the spatial nerve distribution in the kidneys, ureters, and bladder. The findings of these recent studies may have important clinical applications in expanding our knowledge of the etiology and treatment of disease processes affecting the urinary tract. In this narrative review, our goal is to provide an overview of the autonomic innervation of the urinary tract. Specifically, we aim to provide a three-dimensional gender-specific description of renal, ureteral and vesical innervation. We also highlight some possible opportunities for clinical and investigational application of this new knowledge.
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Affiliation(s)
- F A Jefferson
- Departamento de Urología, Universidad de California, Irvine, Estados Unidos.
| | - Z Okhunov
- Departamento de Urología, Universidad de California, Irvine, Estados Unidos
| | - D Veneziano
- Departamento de Urología, Transplante riñón, Grande Ospedale Metropolitano, Reggio Calabria, Italia
| | - J G Rivas
- Departamento de Urología, Hospital la Paz, Madrid, España
| | - A D Meneses
- Departamento de Urología, São Marcos Hospital, Piauí, Brasil
| | - G E Cacciamani
- Departamento de Urología, Universidad del Sur de California, Los Angeles, Estados Unidos
| | - M R Socarras
- Departamento de Urología, IRCCS San Raffaele Hospital, Ville Turro Division, Milán, Italia
| | - J Wikenhiezer
- Departamento de Anatomía Neurobiológica, Universidad de California, Irvine, Estados Unidos
| | - J Landman
- Departamento de Urología, Universidad de California, Irvine, Estados Unidos
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5
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Re: Comparing the Efficacy of Tolterodine and Gabapentin versus Placebo in Catheter Related Bladder Discomfort after Percutaneous Nephrolithotomy: A Randomized Clinical Trial. J Urol 2018. [DOI: 10.1016/j.juro.2018.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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6
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Jo JK, Kim JH, Kim KS, Chung JH, Kim YT, Choi HY, Song ES, Lee B, Lee SW. Effect of highly concentrated hyaluronic acid/chondroitin sulphate instillation on ureteric stent-induced discomfort after ureteroscopic lithotripsy: a multicentre randomised controlled pilot study. BJU Int 2018; 122:858-865. [DOI: 10.1111/bju.14392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jung Ki Jo
- Department of Urology; Hanyang University Seoul Hospital; Seoul Korea
| | - Jae Heon Kim
- Department of Urology; Soonchunhyang University Hospital; Soonchunhyang University Medical College; Seoul Korea
| | - Kyu Shik Kim
- Department of Urology; Hanyang University Guri Hospital; Guri Korea
| | - Jae Hoon Chung
- Department of Urology; Hanyang University Seoul Hospital; Seoul Korea
| | - Yong Tae Kim
- Department of Urology; Hanyang University Seoul Hospital; Seoul Korea
| | - Hong Yong Choi
- Department of Urology; Hanyang University Guri Hospital; Guri Korea
| | - Eun-Seop Song
- Department of Obstetrics and Gynecology; Inha University School of Medicine; Incheon Korea
| | - Bora Lee
- Department of Biostatistics; Clinical Trial Center; Soonchunhyang University Bucheon Hospital; Bucheon Korea
| | - Seung Wook Lee
- Department of Urology; Hanyang University Guri Hospital; Guri Korea
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7
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Re: Efficacy of Tamsulosin, Oxybutynin, and Their Combination in the Control of Double-J Stent-Related Lower Urinary Tract Symptoms. J Urol 2018; 199:326. [DOI: 10.1016/j.juro.2017.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2017] [Indexed: 11/19/2022]
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8
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Arndt P, Leistner ND, Neuss S, Kaltbeitzel D, Brook GA, Grosse J. Artificial urine and FBS supplemented media in cytocompatibility assays for PLGA-PEG-based intravesical devices using the urothelium cell line UROtsa. J Biomed Mater Res B Appl Biomater 2017; 106:2140-2147. [DOI: 10.1002/jbm.b.34021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 09/17/2017] [Accepted: 09/24/2017] [Indexed: 12/16/2022]
Affiliation(s)
- P. Arndt
- Department of Urology; RWTH Aachen University, Pauwelsstraße 30; 52074 Aachen Germany
| | - N. D. Leistner
- Department of Neuro-Urology; University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Centre Godeshöhe; Bonn Germany
| | - S. Neuss
- Helmholts Institute for Biomedical Engineering; Biointerface Group, RWTH Aachen University; Aachen Germany
- Institute of Pathology, RWTH Aachen University; Aachen Germany
| | - D. Kaltbeitzel
- Institute of Plastics Processing, RWTH Aachen University; Aachen Germany
| | - G. A. Brook
- Institute of Neuropathology, RWTH Aachen University; Aachen Germany
| | - J. Grosse
- Department of Urology; RWTH Aachen University, Pauwelsstraße 30; 52074 Aachen Germany
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9
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Zhao PT, Hoenig DM, Smith AD, Okeke Z. A Randomized Controlled Comparison of Nephrostomy Drainage vs Ureteral Stent Following Percutaneous Nephrolithotomy Using the Wisconsin StoneQOL. J Endourol 2017; 30:1275-1284. [PMID: 27736198 DOI: 10.1089/end.2016.0235] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE We compared postoperative outcomes and quality of life (QoL) between patients who received a nephrostomy tube vs a ureteral stent following percutaneous nephrolithotomy (PCNL) in a prospective, double-blind, randomized manner. MATERIALS AND METHODS Between September 2015 and March 2016, we randomized 30 patients undergoing PCNL to receive nephrostomy drainage (Group 1: 8F or 10F) or Double-J ureteral stent (Group 2) at conclusion of surgery. Nephrostomy tubes were removed within 48 hours (before discharge) and ureteral stents were removed at least 2 weeks after surgery. Patients' QoL was assessed with the Wisconsin StoneQOL questionnaire preoperatively and then 7 to 10 days and 30 days following surgery. Inclusion criteria included an uncomplicated procedure, normal preoperative renal function, and clinically insignificant residual stone fragments on postoperative imaging. We calculated the preoperative and postoperative QoL score difference between the two groups. We also evaluated perioperative characteristics, inpatient analgesic requirements, length of stay (LOS), and postsurgical complications. OUTCOME Patient characteristics between Groups 1 and 2 were comparable with similar age (58.3 vs 54.7, p = 0.534), gender ratio, and stone burden (276.6 mm2 vs 259 mm2, p = 0.84) and composition. There was no significant difference between perioperative outcomes, including stone-free rate (93.3% vs 86.7%), operative times (125.7 minutes vs 115 minutes, p = 0.29), estimated blood loss (103.3 mL vs 100.7 mL, p = 0.9), LOS (3.2 days vs 1.9 days, p = 0.1), and complications (2 in each group). Inpatient analgesic requirements were also the same (both 21.1 mg, p = 1.0). Assessment of QoL using the Wisconsin StoneQOL questionnaire showed significant differences between preoperative and postoperative health-related QoL in 18 of the 28-question instrument at 7 to 10 days. Patients in Group 2 had significantly worse QoL change and a multitude of negative responses on the StoneQOL assessment, not only those commonly associated with stent irritation. Eighty percent of participants in Group 2 also attributed their complaints to having a stent placed. Both groups had similar QoL status at 30 days after surgery. CONCLUSION Despite the literature advocating "tubeless" PCNL with ureteral stent placement at conclusion of surgery, our randomized prospective study shows that QoL is significantly worse with stent placement than with temporary nephrostomy drainage in the immediate aftermath following PCNL, using a validated QoL assessment instrument specific for nephrolithiasis.
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Affiliation(s)
- Philip T Zhao
- 1 Department of Urology, NYU School of Medicine , New York, New York.,2 The Smith Institute for Urology , Hofstra Northwell School of Medicine, New Hyde Park, New York
| | - David M Hoenig
- 2 The Smith Institute for Urology , Hofstra Northwell School of Medicine, New Hyde Park, New York
| | - Arthur D Smith
- 2 The Smith Institute for Urology , Hofstra Northwell School of Medicine, New Hyde Park, New York
| | - Zeph Okeke
- 2 The Smith Institute for Urology , Hofstra Northwell School of Medicine, New Hyde Park, New York
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10
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Effects of naftopidil on double-J stent-related discomfort: a multicenter, randomized, double-blinded, placebo-controlled study. Sci Rep 2017. [PMID: 28646216 PMCID: PMC5482907 DOI: 10.1038/s41598-017-04505-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
To evaluate the effect of naftopidil 75 mg once daily for ureteral double-J (DJ) stent-related discomfort after a ureteroscopic procedure using a multicenter, randomized, double-blinded, placebo-controlled study. 100 patients with indwelled retrograde DJ ureteral stents after ureteroscopic stone removal or retrograde intrarenal surgery (RIRS) were randomized 1:1 to receive either placebo or naftopidil during the stenting period. At the time of stent removal, the Ureteral Stent Symptom Questionnaire (USSQ), the International Prostate Symptom Score and the total amount of used analgesics were reported. Of the 92 patients who completed the study, 49 patients were enrolled in the placebo group, and 43 patients in the naftopidil group. USSQ urinary symptom scores (30.90 vs. 29.23, p = 0.299) and USSQ body pain scores (22.28 vs. 19.58, respectively, p = 0.286) were lower in the naftopidil group than in the placebo group, but the difference was not significant. Multivariate analysis showed that the use of a ureteral access sheath during RIRS was the only significant predictor of postoperative DJ-related pain (OR = 2.736, p = 0.031). The use of naftopidil once daily did not significantly reduce DJ ureteral stent-related discomfort. Larger-scaled prospective studies should be conducted to evaluate the effects of naftopidil on DJ stent-related symptoms and surgeries.
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11
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Wada K, Sadahira T. Editorial Comment from Dr Wada and Dr Sadahira to Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review. Int J Urol 2017; 24:260-261. [DOI: 10.1111/iju.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Koichiro Wada
- Department of Urology; Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Takuya Sadahira
- Department of Urology; Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Sciences; Okayama Japan
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12
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Assimos DG. Re: Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-Blinded, Placebo-Controlled Study. J Urol 2017. [DOI: 10.1016/j.juro.2016.12.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Zhang YM, Chu P, Wang WJ. PRISMA-combined α-blockers and antimuscarinics for ureteral stent-related symptoms: A meta-analysis. Medicine (Baltimore) 2017; 96:e6098. [PMID: 28207522 PMCID: PMC5319511 DOI: 10.1097/md.0000000000006098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND As a monotherpay, a-blockers and anti-muscarinics are both efficacy for ureteral stent-related symptoms (SRS). The aim of the study was to systematically evaluate their efficacy of a combination therapy for SRS. METHODS Relevant studies investigating α-blockers and/or anti-muscarinics for SRS were identified though searching online databases including PubMed, EMBASE, Cochrane Library, and other sources up to March 2016. The RevMan software was used for data analysis, and senesitivity analysis and inverted funnel plot were also adopted. RESULTS Seven randomized controlled trials (RCTs) and 1 prospective controlled trial including 545 patients were selected. Compared with α-blockers, the combination group achieved significant improvements in total International Prostate Symptom Score (IPSS) [-3.93 (2.89, 4.96), P < 0.00001], obstructive subscore [-1.29 (0.68, 1.89), P < 0.0001], irritative subscore [-2.93 (2.18, 3.68), P < 0.00001], and quality of life score [-0.99 (0.42, 1.55), P < 0.001]. Compared with antimuscarinics, there were also significant differences in total IPSS [-3.49 (2.43, 4.55), P < 0.00001], obstructive subscore [-1.40 (0.78, 2.01), P < 0.00001], irritative subscore [-2.10 (1.30, 2.90), P < 0.00001], and quality of life score [-1.18 (0.58, 1.80), P < 0.001] in favor of combination group. No significant difference was found in the visual analog pain score and the urinary symptoms score in Ureteral Stent Symptom Questionnaire (USSQ). No significant difference in complications was found. CONCLUSIONS Current analysis shows significant advantages of combination therapy compared with monotherapy of α-blockers or antimuscarinics alone mainly based on IPSS. More RCTs adopting validated USSQ as outcome measures are warranted to support the finding.
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14
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Dellis AE, Papatsoris AG, Keeley FX, Bamias A, Deliveliotis C, Skolarikos AA. Tamsulosin, Solifenacin, and Their Combination for the Treatment of Stent-Related Symptoms: A Randomized Controlled Study. J Endourol 2017; 31:100-109. [DOI: 10.1089/end.2016.0663] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Athanasios E. Dellis
- Second Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens, Maroussi, Greece
| | - Athanasios G. Papatsoris
- Second Department of Urology, School of Medicine, Sismanogleion Hospital, National and Kapodistrian University of Athens, Maroussi, Greece
| | - Francis X. Keeley
- Southmead Hospital, Bristol Urological Institute, Bristol, United Kingdom
| | - Aristotelis Bamias
- Department of Therapeutics, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Deliveliotis
- Second Department of Urology, School of Medicine, Sismanogleion Hospital, National and Kapodistrian University of Athens, Maroussi, Greece
| | - Andreas A. Skolarikos
- Second Department of Urology, School of Medicine, Sismanogleion Hospital, National and Kapodistrian University of Athens, Maroussi, Greece
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15
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Doricakova A, Theile D, Weiss J, Vrzal R. Differential effects of the enantiomers of tamsulosin and tolterodine on P-glycoprotein and cytochrome P450 3A4. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2017; 390:49-59. [PMID: 27678410 DOI: 10.1007/s00210-016-1304-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/07/2016] [Indexed: 02/06/2023]
Abstract
The pregnane X receptor (PXR) is a transcription factor regulating P-glycoprotein (P-gp; ABCB1)-mediated transport and cytochrome P450 3A4 (CYP3A4)-mediated metabolism of xenobiotics thereby affecting the pharmacokinetics of many drugs and potentially modulating clinical efficacy. Thus, pharmacokinetic drug-drug interactions can arise from PXR activation. Here, we examined whether the selective α1-adrenoreceptor blocker tamsulosin or the antagonist of muscarinic receptors tolterodine affect PXR-mediated regulation of CYP3A4 and of P-gp at the messenger RNA (mRNA) and protein level in an enantiomer-specific way. In addition, the effect of tamsulosin and tolterodine on P-gp activity was evaluated. We used quantitative real-time PCR, gene reporter assay, western blotting, rhodamine efflux assay, and calcein assay for determination of expression, activity, and inhibition of P-glycoprotein. The studied compounds significantly and concentration-dependently increased PXR activity in the ABCB1-driven luciferase-based reporter gene assay. We observed much stronger induction of ABCB1 mRNA by S-tamsulosin as compared to the R or racemic form. R or racemic form of tolterodine and R-tamsulosin concentration-dependently increased P-gp protein expression; the latter also enhanced P-gp efflux function in a rhodamine-based efflux assay. R-tamsulosin and all forms of tolderodine slightly inhibited P-gp. The effect on CYP3A4 expression followed the same pattern but was much weaker. Taken together, tamsulosin and tolterodine are demonstrated to interfere with P-gp and CYP3A4 regulation in an enantiomer-specific way.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/antagonists & inhibitors
- ATP Binding Cassette Transporter, Subfamily B/genetics
- ATP Binding Cassette Transporter, Subfamily B/metabolism
- Animals
- Cell Line, Tumor
- Cytochrome P-450 CYP3A/genetics
- Cytochrome P-450 CYP3A/metabolism
- Dose-Response Relationship, Drug
- Gene Expression Regulation, Enzymologic/drug effects
- Humans
- Isomerism
- LLC-PK1 Cells
- Mice
- Pregnane X Receptor
- Promoter Regions, Genetic
- RNA, Messenger/genetics
- RNA, Messenger/metabolism
- Receptors, Steroid/agonists
- Receptors, Steroid/metabolism
- Structure-Activity Relationship
- Sulfonamides/chemistry
- Sulfonamides/pharmacology
- Swine
- Tamsulosin
- Tolterodine Tartrate/chemistry
- Tolterodine Tartrate/pharmacology
- Transfection
- Up-Regulation
- ATP-Binding Cassette Sub-Family B Member 4
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Affiliation(s)
- Aneta Doricakova
- Department of Cell Biology and Genetics, Faculty of Science, Palacky University, Slechtitelu 27, 783 71, Olomouc, Czech Republic
| | - Dirk Theile
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johanna Weiss
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Radim Vrzal
- Department of Cell Biology and Genetics, Faculty of Science, Palacky University, Slechtitelu 27, 783 71, Olomouc, Czech Republic.
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16
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Assimos DG. Re: Ureteric Stents on Extraction Strings: A Systematic Review of Literature. J Urol 2016; 197:170-172. [PMID: 27979526 DOI: 10.1016/j.juro.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
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17
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Lee FC, Holt SK, Hsi RS, Haynes BM, Harper JD. Preoperative Belladonna and Opium Suppository for Ureteral Stent Pain: A Randomized, Double-blinded, Placebo-controlled Study. Urology 2016; 100:27-32. [PMID: 27658661 DOI: 10.1016/j.urology.2016.07.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate whether the use of a belladonna and opium (B&O) rectal suppository administered immediately before ureteroscopy (URS) and stent placement could reduce stent-related discomfort. METHODS A randomized, double-blinded, placebo-controlled study was performed from August 2013 to December 2014. Seventy-one subjects were enrolled and randomized to receive a B&O (15 mg/30 mg) or a placebo suppository after induction of general anesthesia immediately before URS and stent placement. Baseline urinary symptoms were assessed using the American Urological Association Symptom Score (AUASS). The Ureteral Stent Symptom Questionnaire and AUASS were completed on postoperative days (POD) 1, 3, and after stent removal. Analgesic use intraoperatively, in the recovery unit, and at home was recorded. RESULTS Of the 71 subjects, 65 had treatment for ureteral (41%) and renal (61%) calculi, 4 for renal urothelial carcinoma, and 2 were excluded for no stent placed. By POD3, the B&O group reported a higher mean global quality of life (QOL) score (P = .04), a better mean quality of work score (P = .05), and less pain with urination (P = .03). The B&O group reported an improved AUASS QOL when comparing POD1 with post-stent removal (P = .04). There was no difference in analgesic use among groups (P = .67). There were no episodes of urinary retention. Age was associated with unplanned emergency visits (P <.00) and "high-pain" measure (P = .02) CONCLUSION: B&O suppository administered preoperatively improved QOL measures and reduced urinary-related pain after URS with stent. Younger age was associated with severe stent pain and unplanned hospital visits.
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Affiliation(s)
- Franklin C Lee
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Ryan S Hsi
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Brandon M Haynes
- Department of Urology, University of Washington School of Medicine, Seattle, WA
| | - Jonathan D Harper
- Department of Urology, University of Washington School of Medicine, Seattle, WA.
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18
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Koprowski C, Kim C, Modi PK, Elsamra SE. Ureteral Stent-Associated Pain: A Review. J Endourol 2016; 30:744-53. [DOI: 10.1089/end.2016.0129] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christopher Koprowski
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Christopher Kim
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Parth K. Modi
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Sammy E. Elsamra
- Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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