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Liu M, Liu S, Mao Q, Zou Q, Cui Y, Wu J. Comparison of the efficacy and complications of tolterodine and α-adrenergic receptor blockers in improving ureteral stent-related symptoms: A systematic review and meta-analysis. PLoS One 2024; 19:e0302716. [PMID: 38701097 PMCID: PMC11068181 DOI: 10.1371/journal.pone.0302716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE We conducted a systematic evaluation of the therapeutic efficacy and complications of tolterodine and α-adrenergic receptor blockers in alleviating ureteral stent-related symptoms. METHODS Until August 2023, we conducted a comprehensive literature search on PubMed, Embase, Web of Science, and Cochrane Library to identify randomized controlled trials evaluating the efficacy and complications of tolterodine and α-adrenergic receptor blockers in treating ureteral stent-related symptoms. Two reviewers independently screened studies and extracted data. The scores from various domains of the Ureteral Stent Symptom Questionnaire (USSQ) were summarized and compared, and statistical analysis was performed using RevMan 5.4.0 software. RESULTS A total of 8 studies met the inclusion criteria for our analysis. These studies were conducted at different centers. All studies were randomized controlled trials, involving a total of 487 patients, with 244 patients receiving α-adrenergic receptor blockers and 243 patients receiving tolterodine. The results showed that tolterodine demonstrated significantly better improvement in body pain (MD, 1.56; 95% CI [0.46, 2.66]; p = 0.005) (MD, 0.46; 95% CI [0.12, 0.80]; p = 0.008) (MD, 3.21; 95% CI [1.89, 4.52]; p = 0.00001) among patients after ureteral stent placement compared to α-adrenergic receptor blockers at different time points. Additionally, at 4 weeks, tolterodine showed superior improvement in general health (MD, 0.15; 95% CI [0.03, 0.27]; p = 0.01) and urinary symptoms (MD, 1.62; 95% CI [0.59, 2.66]; p = 0.002) compared to α-adrenergic receptor blockers, while at 6 weeks, tolterodine showed better improvement in work performance (MD, -1.60; 95% CI [-2.73, -0.48]; p = 0.005) compared to α-adrenergic receptor blockers. Additionally, the incidence of dry mouth (RR, 4.21; 95% CI [1.38, 12.87]; p = 0.01) is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, there were no significant statistical differences between the two drugs in other outcomes. CONCLUSION This meta-analysis suggests that tolterodine is superior to α-adrenergic receptor blockers in improving physical pain symptoms after ureteral stent placement, while α-adrenergic receptor blockers are more effective than tolterodine in enhancing work performance. Additionally, the incidence of dry mouth is higher with the use of tolterodine compared to α-adrenergic receptor blockers. However, higher-quality randomized controlled trials are needed to further investigate this issue.
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Affiliation(s)
- Ming Liu
- Second Clinical Medical College, Binzhou Medical University, Yantai, Shandong, China
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Shangjing Liu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Qiancheng Mao
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Qingsong Zou
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Yuanshan Cui
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
| | - Jitao Wu
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China
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Policastro C, Dispagna M, Smith G, Byler T, Wiener S. Factors associated with unplanned clinical encounters for ureteral stent-related symptoms. World J Urol 2024; 42:74. [PMID: 38324162 DOI: 10.1007/s00345-024-04768-x] [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: 04/05/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND, INTRODUCTION AND AIM Ureteral stent-related symptoms (USRS) often result in unplanned phone calls and ER visits. We hypothesize that patient factors can be identified to predict these unplanned encounters. METHODS AND MATERIALS Retrospective analysis of indwelling ureteral stent placements from 2014 to 2019 at a single institution by CPT code was performed. Patient demographics, discharge medications, and clinical factors were evaluated using multiple logistic regression with respect to postoperative telephone and emergency room (ER) encounters for USRS. RESULTS Of 374 patients, 75 (20.1%) had one or more encounters for USRS: 48 (12.8%) called the clinic and 39 (10.4%) returned to the ER. Chronic opioid use was predictive of calls to clinic and ER visits (OR 3.21 [CI 1.42-6.97], p < 0.01 and OR 3.64 [CI 1.45-8.98], p < 0.01). Survival analysis stratified by history of chronic opioid use and discharge opioid prescriptions demonstrated that opioid naïve patients receiving opioids at discharge had unplanned encounters sooner and more often [Calls p = 0.025, ER p = 0.041]), whereas patients with chronic opioid use returned to the ER sooner and more frequently when prescribed additional opioids (Calls p = 0.4, ER p = 0.002). CONCLUSION Patients with a history of chronic opioid use may experience more intense USRS or have a lower threshold to seek medical care than opioid naïve patients and tend to bypass calling the clinic for the ER. Given that none of the studied medications reduced unplanned patient contact for USRS, urologists should consider upfront definitive management of urinary obstruction when appropriate.
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Affiliation(s)
- Connor Policastro
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Mauro Dispagna
- School of Medicine, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Garrett Smith
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Timothy Byler
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA
| | - Scott Wiener
- Department of Urology, SUNY Upstate Medical University, 750 E Adams St, CWB 2nd Floor, Syracuse, NY, 13210, USA.
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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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Jaworski P, Mello GF, Ferreira GM, Oliveira MH, Fraga RD. Mirabegron as effective as oxybutynin for ureteral stent symptoms. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1793-1797. [PMID: 34909951 DOI: 10.1590/1806-9282.20210711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Ureteral stents usually cause pain and lower urinary tract discomfort. This study aimed to compare the effect of mirabegron with oxybutynin in relieving ureteral stent-related symptoms over time. METHODS A prospective, longitudinal, randomized, single-blinded study was conducted. Patients who had a ureteral stent inserted after urolithiasis treatment were classified into two groups and received either oxybutynin 5 mg/day (Group O) or mirabegron 50 mg/day (Group M). The Ureteral Stent Symptoms Questionnaire (USSQ) was applied on the 3rd, 6th, and 15th postoperative days. Group domain scores were compared, and a mixed linear model was used to better assess score differences. RESULTS Ureteral Stent Symptoms Questionnaire scores were similar in both groups during all three postoperative days (p>0.05). A longitudinal analysis showed that global quality of life and general health improved over time, independently of the use of any of the medications (p<0.05), while urinary symptoms and body pain scores were lower over time in participants receiving oxybutynin. CONCLUSION Both mirabegron and oxybutynin are equivalent in relieving ureteral stent symptoms. Moreover, some stent symptoms seem to decrease over time despite the use of medication.
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Affiliation(s)
- Paulo Jaworski
- Hospital Universitário Evangélico Mackenzie, Urology Department - Curitiba (PR), Brazil.,Universidade Presbiteriana Mackenzie - Curitiba (PR), Brazil
| | | | | | | | - Rogerio de Fraga
- Universidade Federal do Paraná, Urology Department - Curitiba (PR), Brazil
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Salih EM, Koritenah AK, Yehya M, Mourad MM. The efficacy of alpha-1A blocker (tamsulosin), antimuscarinic (solifenacin) and their combination in the management of double-J stent-related lower urinary tract symptoms: a randomized controlled study. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Background
The insertion of a double-J (DJ) stent is considered a routine and necessary urological procedure. It can cause lower urinary tract symptoms (LUTS). Pharmacologic management is one of many trials that were done to improve these symptoms, particularly the administration of alpha-1A blockers and antimuscarinics medications. This trial aimed to evaluate the efficacy of alpha-1A blocker (tamsulosin), antimuscarinic (solifenacin), and their combination in managing DJ stent-related LUTS.
Methods
This prospective, randomized, comparative, and nonblinded trial was conducted between November 2016 and October 2018. Eligible patients were between 18 and 50 years of both genders who underwent temporary retrograde unilateral Double-J stent fixation. Patients were randomized to four groups; group I was control (drug-free), group II received tamsulosin 0.4 mg, group III received solifenacin 5 mg, and group IV received the combination of tamsulosin and solifenacin. All patients completed the IPSS, QoL, and VAS questionnaires at both pre-insertion day of the stent and 2 weeks postoperatively; the data obtained were compared to all four groups.
Results
The study included 143 patients (78 males, 65 females). There was no statistically significant difference between the four groups regarding age, sex, side, and DJ placement indications. In comparison with the control group, there were statistically significant differences in all scores in favor of groups II, III, and IV. Compared to groups II and III, there were statistically significant differences in overall IPSS, QoL, and VAS scores in group IV. No significant differences were found between the tamsulosin and solifenacin groups.
Conclusion
The alpha-1A blocker (tamsulosin) or antimuscarinic (solifenacin) monotherapy effectively improves the DJ stent-related LUTS and the QoL of patients with no advantage with either drug. The combination therapy of both pharmacotherapies is significantly effective than drug monotherapy.
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Falahatkar S, Beigzadeh M, Mokhtari G, Esmaeili S, Kazemnezhad E, Amin A, Herfeh NR, Falahatkar R. The effects of pregabalin, solifenacin and their combination therapy on ureteral double-J stent-related symptoms: A randomized controlled clinical trial. Int Braz J Urol 2021; 47:596-609. [PMID: 33621009 PMCID: PMC7993956 DOI: 10.1590/s1677-5538.ibju.2020.0848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 11/20/2020] [Indexed: 01/16/2023] Open
Abstract
Background: Many medical therapies have been tested to deal with urinary stent-related symptoms (USRS). Several preventive and pharmaceutical methods have been already used for better compatibility of stents. However, the existing evidence for pharmacological treatment is still controversial. This study aims to evaluate the effects of pregabalin, solifenacin, and combination therapy on ureteral double-J stent-related symptoms following ureteroscopy and transureteral lithotripsy (TUL). Materials and methods: In a randomized controlled clinical trial, from November 2017 to March 2019, 256 patients who underwent ureteroscopy were enrolled. Patients were randomly divided into four groups including: group A received pregabalin 75mg BID (twice daily), group B received solifenacin 5mg orally once daily, group C received combination of pregabalin and solifenacin and the group D (control) given no drugs. Results: One hundred and fifty-one (58.9%) males and 101 (41.1%) females were enrolled in this study with a mean age of 43.47±7 (p=0.32, p=0.67). USSQ domains score such as urinary symptoms, pain, general condition, work performance, sexual matters and additional problems were significantly differenced during second and fourth week of follow-up among study groups (p <0.0001). In Tukey's multiple comparison test, urinary symptoms (p=0.735), pain (p=0.954) and sexual matters (p=0.080) in second week and work performance in forth week in group B was not significantly better than group D. Only group C in all indexes of USSQ showed significantly beneficial effects over group D (p <0.0001). Conclusion: Combination therapy of pregabalin and solifenacin has a significant effect on stent-related symptoms and is preferred over monotherapy of the respected medications.
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Affiliation(s)
- Siavash Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammadreza Beigzadeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Gholamreza Mokhtari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samaneh Esmaeili
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Atiyeh Amin
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nadia Rastjou Herfeh
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Galal E, Abdelhamid MH, Fath El-Bab T, Abdelhamid A. The role of mirabegron in relieving double-J stent-related discomfort: a randomized controlled clinical trial. Cent European J Urol 2021; 74:76-80. [PMID: 33976920 PMCID: PMC8097652 DOI: 10.5173/ceju.2021.0273.r2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/14/2021] [Accepted: 01/30/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to investigate the effect of 50 mg mirabegron once daily in relieving ureteral double-J (DJ) stent-related discomfort after ureteroscopy (URS) or retrograde intrarenal surgery (RIRS). Material and methods A total of 210 patients who underwent DJ ureteral stent insertion after URS or RIRS were randomized 1:1 to receive either no treatment (Group B) or mirabegron 50 mg once daily (Group A) during the stenting period. At time of stent removal, all patients were evaluated for stent-related symptoms using the Arabic translated and validated ureteral stent symptom questionnaire (USSQ). The severity of stent-related symptoms (SRS) was compared between the two groups. Results The mean age was 46.6 ±8.2 years in Group A and 44.7 ±9.4 (26-64) years in the control group (p = 0.13). The stone characteristics, stent size, and position were similar in both groups. Compared to the control group, the mirabegron group had significantly lower daytime frequency, nocturia and urgency (p = 0.028, p = 0.008 and p = 0.012, respectively). As for stent-related pain, Group A had significantly less flank and abdominal pain (p = 0.007 and p = 0.001, respectively). The mirabegron versus control group showed significant difference in mean analgesics use and quality of life (QoL) scores during the stenting period (p = 0.005 and p = 0.003, respectively). Three patients (2.9%) in Group A encountered minor adverse effects (two experienced dry mouth and one presented with constipation). Conclusions For patients with indwelling DJ stent, postoperative mirabegron 50 mg use was effective and well-tolerated for the treatment of lower urinary tract symptoms and stent-related pain.
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Affiliation(s)
- Ehab Galal
- Minia University Hospital, Department of Urology, Minia, Egypt
| | | | | | - Amr Abdelhamid
- Minia University Hospital, Department of Urology, Minia, Egypt
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Leong JY, Steward JE, Healy KA, Hubosky SG, Bagley DH. Indwelling ureteric stents: Patterns of use and nomenclature. Arab J Urol 2020; 18:241-246. [PMID: 33312735 PMCID: PMC7717614 DOI: 10.1080/2090598x.2020.1761675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Objectives: To evaluate ureteric stenting practice patterns amongst a range of academic and community urologists, and to examine the nomenclature used to identify an indwelling ureteric stent from both our questionnaire and from a review of the literature. Subjects and methods: A 16-question, peer-reviewed online survey was distributed to members of the Mid-Atlantic American Urological Association. Responses were collected over a 1-month period. Questions included demographics, ureteric stenting practice patterns, and utilization of stenting nomenclature. Inappropriate use of nomenclature was defined as a mismatch between the visually depicted stents and the written description amongst urologists. Trends in ureteric stenting and nomenclature usage were tabulated and analyzed. Results: Of 863 members, 105 (12.2%) responded to the survey. There was a wide variety of practice settings, with the single-specialty group (44.2%) and academic/university (27.9%) being the two most common. Most providers used both cystoscopy and fluoroscopy to place stents (87.5%) as compared to fluoroscopy alone (12.5%). Most urologists (63.5%) removed stents with cystoscopy as compared to using a stent string (36.5%). While about half (51.0%) of the respondents left stents in situ for ≤3 months, many respondents (43.3%) felt comfortable with maximum dwell times of up to 6 months. The most commonly placed stent was the double pigtail stent (80.8%). However, most respondents inappropriately described this stent design as a Double J stent (72.1%). In the recent literature, 80% of articles clearly defined as using double pigtail stents, incorrectly identified their stent as a ‘Double J’. Conclusions: Variations in ureteric stenting practice patterns exist amongst community and academic urologists. Although most urologists utilize double pigtail ureteric stents, the majority inaccurately identified this stent design as a Double J. We propose use of the term ‘indwelling ureteric stent’ (IUS) unless describing any specific stent design.
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Affiliation(s)
- Joon Yau Leong
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - James E Steward
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Kelly A Healy
- Department of Urology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Scott G Hubosky
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Demetrius H Bagley
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
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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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Sali GM, Joshi HB. Ureteric stents: Overview of current clinical applications and economic implications. Int J Urol 2019; 27:7-15. [PMID: 31549458 DOI: 10.1111/iju.14119] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 09/01/2019] [Indexed: 12/16/2022]
Abstract
Ureteric stents are one of the most crucial tools used for various clinical conditions in the urological field. Placement of a ureteric stent, for short- or long-term use, remains one of the commonest urological interventional procedures. In the past few decades, ureteral stents have undergone notable technological advancements. However, an ideal stent without significant side-effects is yet to be engineered. Indwelling ureteric stents are often accompanied by physical distress to the patient and clinical complications, such as bacterial adhesion, encrustation, malpositioning, stent fracture and forgotten stent syndrome, that influence patients' health-related quality of life. In the market, different stent types are available, designed to reduce infections, and improve patient symptoms and tolerance. In this review, we have emphasized the recent developments that have taken place in stent design, size, materials and coating. This overview looks at current practices and problems related to stents, along with clinical and economic considerations. Few trial studies have been enumerated in the context of utilization of a ureteral stent symptom questionnaire and various stent models to compare their effects in patients.
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Szell T, Dressler FF, Goelz H, Bluemel B, Miernik A, Brandstetter T, Scherag F, Schoeb DS. In Vitro Effects of a Novel Coating Agent on Bacterial Biofilm Development on Ureteral Stents. J Endourol 2019; 33:225-231. [PMID: 30458115 DOI: 10.1089/end.2018.0616] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Tamas Szell
- Department of Urology, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - Franz Friedrich Dressler
- Department of Urology, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - Hanna Goelz
- Institute of Medical Microbiology and Hygiene, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - Benjamin Bluemel
- Institute of Medical Microbiology and Hygiene, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, Germany
| | - Thomas Brandstetter
- Laboratory for Chemistry and Physics of Interfaces, Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
| | - Frank Scherag
- Laboratory for Chemistry and Physics of Interfaces, Department of Microsystems Engineering (IMTEK), University of Freiburg, Freiburg, Germany
| | - Dominik Stefan Schoeb
- Department of Urology, Faculty of Medicine, Medical Center–University of Freiburg, Freiburg, Germany
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12
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Efficacy of Tadalafil on Ureteral Stent Symptoms: A Randomized Controlled Trial. Nephrourol Mon 2019. [DOI: 10.5812/numonthly.85523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Tae BS, Cho S, Jeon BJ, Choi H, Park JY, Cho SY, Lee KC, Bae JH. Does mirabegron relieve ureteric stent-related discomfort? A prospective, randomized, multicentre study. BJU Int 2018; 122:866-872. [DOI: 10.1111/bju.14416] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Bum Sik Tae
- Department of Urology; Korea University Ansan Hospital; Korea University College of Medicine; Ansan Korea
| | - Seok Cho
- Department of Urology; Inje University Ilsan Paik Hospital; Inje University School of Medicine; Goyang Korea
| | - Byung Jo Jeon
- Department of Urology; Korea University Ansan Hospital; Korea University College of Medicine; Ansan Korea
| | - Hoon Choi
- Department of Urology; Korea University Ansan Hospital; Korea University College of Medicine; Ansan Korea
| | - Jae Young Park
- Department of Urology; Korea University Ansan Hospital; Korea University College of Medicine; Ansan Korea
| | - Sung Yong Cho
- Department of Urology; Inje University Ilsan Paik Hospital; Inje University School of Medicine; Goyang Korea
| | - Keon-Cheol Lee
- Department of Urology; Inje University Ilsan Paik Hospital; Inje University School of Medicine; Goyang Korea
| | - Jae Hyun Bae
- Department of Urology; Korea University Ansan Hospital; Korea University College of Medicine; Ansan Korea
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Jian Z, Chen Y, Liu Q, Liao B, Yang T, Li H, Wang K. Combination of solifenacin and tamsulosin may provide additional beneficial effects for ureteral stent-related symptoms—outcomes from a network meta-analysis. World J Urol 2018; 37:289-297. [DOI: 10.1007/s00345-018-2404-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022] Open
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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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Maldonado-Avila M, Garduno-Arteaga L, Jungfermann-Guzman R, Manzanilla-Garcia HA, Rosas-Nava E, Procuna-Hernandez N, Vela-Mollinedo A, Almazan-Trevino L, Guzman-Esquivel J. Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms. Int Braz J Urol 2017; 42:487-93. [PMID: 27286111 PMCID: PMC4920565 DOI: 10.1590/s1677-5538.ibju.2015.0186] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 08/11/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction and objective Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms. Methods Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21. Results Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported. Conclusions Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.
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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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Ragab M, Soliman MG, Tawfik A, Abdel Raheem A, El-Tatawy H, Abo Farha M, Magdy M, Elashry O. The role of pregabalin in relieving ureteral stent-related symptoms: a randomized controlled clinical trial. Int Urol Nephrol 2017; 49:961-966. [DOI: 10.1007/s11255-017-1561-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 02/25/2017] [Indexed: 11/29/2022]
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Abdelkader O, Mohyelden K, Sherif M, Metwaly A, Aldaqadossi H, Shelbaya A, Khairy H, Elnashar A. Impact of Tamsulosin, Tolterodine and drug-combination on the outcomes of lower urinary tract symptoms secondary to post-ureteroscopy ureteral stent: A prospective randomized controlled clinical study. AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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20
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Betschart P, Zumstein V, Piller A, Schmid HP, Abt D. Prevention and treatment of symptoms associated with indwelling ureteral stents: A systematic review. Int J Urol 2017; 24:250-259. [DOI: 10.1111/iju.13311] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/11/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Patrick Betschart
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Valentin Zumstein
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Alberto Piller
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Hans-Peter Schmid
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
| | - Dominik Abt
- Department of Urology; St. Gallen Cantonal Hospital; St. Gallen Switzerland
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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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Randomized, double-blind, placebo-controlled trial to compare solifenacin versus trospium chloride in the relief of double-J stent-related symptoms. World J Urol 2017; 35:1261-1268. [DOI: 10.1007/s00345-016-1988-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/04/2016] [Indexed: 10/20/2022] Open
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Hekal IA. Drug treatment of bothersome lower urinary tract symptoms after ureteric JJ-stent insertion: A contemporary, comparative, prospective, randomised placebo-controlled study, single-centre experience. Arab J Urol 2016; 14:262-268. [PMID: 27900215 PMCID: PMC5122813 DOI: 10.1016/j.aju.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/06/2016] [Accepted: 08/20/2016] [Indexed: 11/30/2022] Open
Abstract
Objective To provide a guide for medication to alleviate bothersome lower urinary tract symptoms (LUTS) in patients after JJ ureteric stenting. Patients and methods Between June 2011 and June 2015, a prospective randomised placebo-controlled study was conducted on 200 consecutive cases of ureteric stones that required JJ stents. All patients had signed informed consent and JJ-stent placement confirmed by X-ray. The patients were randomised into five groups: A, solifenacin 5 mg; B, trospium chloride 20 mg; C, antispasmodic; and E, α-blocker; and a placebo group (D). A standard model was created to lessen patient selection bias. Eligible patients were enrolled and assessed for side-effects and bothersome LUTS using the validated Ureteric Stent Symptoms Questionnaire. Appropriate statistical analysis was carried out. Results In all, 150 male patients in the five groups were compared. LUTS were less in groups A and B (P < 0.05), while dry mouth was significantly reported in Group A. Individual comparisons with the placebo group showed a non-significant difference with Group C, while Group E had significant nocturia improvement. Selective comparison of two best groups (A and B) showed less frequency in Group B, while the other LUTS were less in Group A with comparable side-effects. Conclusions In symptomatic patients following JJ-stent insertion, anti-muscarinic medication, namely solifenacin 5 mg or trospium chloride 20 mg, was the best. The advantage of trospium over solifenacin is in the control of frequency rather than the other symptoms. Addition of an α-blocker (alfuzosin 10 mg) is valuable when nocturia is the predominant symptom.
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Affiliation(s)
- Ihab A Hekal
- Department of Urology, Mohammad Dossary Hospital, Al-Khobar, Saudi Arabia
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24
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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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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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Abdelaal AM, Al-Adl AM, Abdelbaki SA, Al Azab MM, Al Gamal KA. Efficacy and safety of tamsulosin oral-controlled absorption system, solifenacin, and combined therapy for the management of ureteric stent-related symptoms. Arab J Urol 2016; 14:115-22. [PMID: 27489738 PMCID: PMC4963155 DOI: 10.1016/j.aju.2016.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 12/28/2015] [Accepted: 01/12/2016] [Indexed: 12/04/2022] Open
Abstract
Objectives To evaluate the efficacy of solifenacin, tamsulosin oral-controlled absorption system (OCAS), and the combination of both drugs on JJ stent-related symptoms using the validated Arabic version of the ureteric stent symptom questionnaire (USSQ). Patients and methods In all, 260 patients who had undergone JJ stenting of the ureter for different endoscopic urological procedures were postoperatively randomly assigned into four equal groups. Patients in Group I received no treatment and served as the control group, Group II patients received tamsulosin OCAS 0.4 mg daily, Group III patients received solifenacin 5 mg daily, and Group IV patients received a combination of both drugs. Before stent removal, all patients completed the Arabic version of the USSQ. Results In all, 234 patients completed the study, comprised of 56 in Group I, 59 in Group II, 58 in Group III, and 61 in Group IV. Baseline characteristics and indications for JJ stenting were comparable in the four groups. There were highly significant differences in all items of the USSQ between the treatment groups and the controls, while Group II and III were comparable. The USSQ score was significantly lower in Group IV vs Groups II and III. Crossing of the distal curl of the stent to the midline had a significant positive correlation with the severity of the urinary symptoms, body pain, general health, and work performance in the medicated groups. Conclusions Combined therapy with tamsulosin OCAS 0.4 mg daily and solifenacin 5 mg daily is a safe and well-tolerated management for stent-related symptoms. However, stent position remains a significant factor affecting response to medical therapy and patients’ health-related quality of life.
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Affiliation(s)
| | - Ahmed M Al-Adl
- Department of Urology, Benha University, Benha, Egypt; Al Adwani General Hospital, Taif, Saudi Arabia
| | | | - Mohamed M Al Azab
- Department of Urology, Benha University, Benha, Egypt; International Medical Center, Jeddah, Saudi Arabia
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Sivalingam S, Streeper NM, Sehgal PD, Sninsky BC, Best SL, Nakada SY. Does Combination Therapy with Tamsulosin and Tolterodine Improve Ureteral Stent Discomfort Compared with Tamsulosin Alone? A Double-Blind, Randomized, Controlled Trial. J Urol 2016; 195:385-90. [DOI: 10.1016/j.juro.2015.08.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Sri Sivalingam
- Endourology and Minimally Invasive Surgery, Glickman Urological and Kidney Institute, Department of Urology, Cleveland Clinic, Cleveland, Ohio
| | - Necole M. Streeper
- Department of Urology, University of Pennsylvania Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Priyanka D. Sehgal
- Department of Urology, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Brian C. Sninsky
- Department of Urology, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Sara L. Best
- Department of Urology, University of Wisconsin School of Medicine, Madison, Wisconsin
| | - Stephen Y. Nakada
- Department of Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin
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Zhang P, Hu WL, Cheng B, Cheng L, Zeng YJ, Wang G. α 1-blockers for the reduction of ureteric stent-related symptoms: A systematic review and meta-analysis. Exp Ther Med 2015; 11:660-668. [PMID: 26893663 DOI: 10.3892/etm.2015.2942] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 10/21/2015] [Indexed: 11/06/2022] Open
Abstract
The present meta-analysis aimed to evaluate the current evidence for the use of α1-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, -2.18 to 5.47) 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 α1-blockers beneficially influence pain, urinary symptoms and the quality of life of patients with an indwelling ureteral stent.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Wan-Li Hu
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Bei Cheng
- Department of Anatomy and Embryology, School of Basic Medical Sciences, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Long Cheng
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Yang-Jun Zeng
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Gang Wang
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
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A Randomized Controlled Trial to Compare the Safety and Efficacy of Tadalafil and Tamsulosin in Relieving Double J Stent Related Symptoms. Adv Urol 2015; 2015:592175. [PMID: 26788054 PMCID: PMC4691600 DOI: 10.1155/2015/592175] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/17/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Objectives. To evaluate the safety and efficacy of Tadalafil and Tamsulosin in treating Double J stent related symptoms. Methods. In a prospective study, 161 patients with DJ related symptoms were randomized into 3 groups: Group A patients (54), Group B patients (53), and Group C patients (54). They were given Tadalafil, Tamsulosin, and placebo, respectively, at 1st week till removal of DJ stent at 3rd week. All patients completed Ureteral Stent Symptom Questionnaire (USSQ) at 1st week and at 3rd week. The statistical significant difference among groups was determined by the t-test, Kruskal-Wallis test and multivariate analysis were used to assess association of the variables within the three groups, and the level of significance was set at P < 0.05. Results. Tadalafil and Tamsulosin were comparable in relieving urinary symptoms, general health, and work performance (OR = 0.65, 1.8, and 0.92). But Tadalafil was more effective in relieving body pain, sexual problems, and additional problems than Tamsulosin (OR = 5.95, 19.25, and 2.69) and was statistically significant as P < 0.05. Conclusion. Tadalafil was as effective as Tamsulosin in relieving urinary symptom but more effective in relieving sexual symptoms and body pain.
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Kim DJ, Son JH, Jang SH, Lee JW, Cho DS, Lim CH. Rethinking of ureteral stent removal using an extraction string; what patients feel and what is patients' preference? : a randomized controlled study. BMC Urol 2015; 15:121. [PMID: 26653027 PMCID: PMC4675013 DOI: 10.1186/s12894-015-0114-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ureteral stent removal using an extraction string is advantageous because it can obviate an invasive cystoscopy, but there is a paucity of data on how patients feel about it, and how bothersome or beneficial it is. We performed this study to evaluate patients' preference for stent removal using an extraction string and which parameters could affect it. METHODS In total, 114 consecutive patients undergoing ureteral stent insertion after ureteroscopic stone removal (URS) for unilateral recurrent ureter stones were enrolled. Patients were randomized to a string group or a no string group. Stent removal was performed on the first visit within 7 days postoperatively. All patients were asked to complete the ureteral stent symptom questionnaire, to rate the degree of pain during stent removal using a visual analog scale (VAS) and to answer to questions regarding their preference. RESULTS No significant differences were found in domain total scores including urinary symptoms (p = 0.17), pain (p = 0.62), general health (p = 0.37), work performance (p = 0.41). However, regarding separate questions for 'dysuria' and 'difficulties with heavy physical activity', there were significant intergroup differences (p = 0.03 and p = 0.04, respectively). Particular, a significantly higher proportion of patients in the string group checked 'stoppage of sexual intercourse due to stent-related problems' than in the no string group (p = 0.03). VAS score on stent removal was significantly higher in the no string group than the string group (p = 0.005). Among the patients who remember the experience of an indwelling ureteral stent in the past, 85% (17/20) of the no string group answered 'No' to the question of 'difference between the methods used in this time and in the past'. On the contrary, 84.2% (16/19) answered 'Yes' to the same question in the string group. And, all 16 patients of the string group who noted differences between the methods preferred ureteral stent removal using an extraction string to the past method. CONCLUSIONS Despite of minor increased morbidity related to the extraction string, patients preferred ureteral stent removal using the extraction string after URS. The patients with the extraction string felt less pain on stent removal than flexible cystoscopic stent removal. TRIAL REGISTRATION KCT0001700 . The trial was registered in the Clinical Research Information Service (CRiS), Republic of Korea; registration date: 18/11/2015.
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Affiliation(s)
- Dae Ji Kim
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Jeong Hwan Son
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Seok Heun Jang
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Jae Won Lee
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Dae Sung Cho
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
| | - Chae Hong Lim
- Department of Urology, Bundang Jesaeng Hospital, 180 Seohyeon-rho Bundang-gu, Seongnam, 463-774, Republic of Korea.
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A randomized controlled trial comparing alpha blocker (tamsulosin) and anticholinergic (solifenacin) in treatment of ureteral stent-related symptoms. World J Urol 2015; 34:963-8. [DOI: 10.1007/s00345-015-1704-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/30/2015] [Indexed: 10/22/2022] Open
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Kwon JK, Cho KS, Oh CK, Kang DH, Lee H, Ham WS, Choi YD, Lee JY. The beneficial effect of alpha-blockers for ureteral stent-related discomfort: systematic review and network meta-analysis for alfuzosin versus tamsulosin versus placebo. BMC Urol 2015; 15:55. [PMID: 26104313 PMCID: PMC4477492 DOI: 10.1186/s12894-015-0050-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 06/04/2015] [Indexed: 12/31/2022] Open
Abstract
Background This 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. Methods Relevant 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). Results One 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. Conclusion The alpha-blockers significantly decreased USS and BPS in comparison with placebo. Tamsulosin might be more effective than alfuzosin.
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Affiliation(s)
- Jong Kyou Kwon
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Cheol Kyu Oh
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
| | - Dong Hyuk Kang
- Department of Urology, Yangpyeong Health Center, Yangpyeong, South Korea.
| | - Hyungmin Lee
- Division of Epidemic Intelligence Service, Korea Centers for Disease Control and Prevention, Osong, South Korea.
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
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Abt D, Mordasini L, Warzinek E, Schmid HP, Haile SR, Engeler DS, Müllhaupt G. Is intravesical stent position a predictor of associated morbidity? Korean J Urol 2015; 56:370-8. [PMID: 25964838 PMCID: PMC4426509 DOI: 10.4111/kju.2015.56.5.370] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 03/18/2015] [Indexed: 12/02/2022] Open
Affiliation(s)
- Dominik Abt
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Elisabeth Warzinek
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | | | | | - Gautier Müllhaupt
- Department of Urology, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
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A critical assessment of the effects of tamsulosin and solifenacin as monotherapies and as a combination therapy for the treatment of ureteral stent-related symptoms: a 2 × 2 factorial randomized trial. World J Urol 2015; 33:1833-40. [DOI: 10.1007/s00345-015-1544-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022] Open
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Walker NAF, Bultitude MF, Brislane K, Thomas K, Glass JM. Management of stent symptoms: what a pain! BJU Int 2015; 114:797-8. [PMID: 25216234 DOI: 10.1111/bju.12534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zhou L, Cai X, Li H, Wang KJ. Effects of α-Blockers, Antimuscarinics, or Combination Therapy in Relieving Ureteral Stent-Related Symptoms: A Meta-Analysis. J Endourol 2015; 29:650-6. [PMID: 25491604 DOI: 10.1089/end.2014.0715] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE We evaluated the effects of α-blockers, antimuscarinics, or a combination of both in reducing ureteral stent-related symptoms. METHODS The relevant studies were identified by searching MEDLINE, EMBASE and Cochrane Library Database from January 2000 to May 2014. Randomized controlled trials evaluating effects of α-blocker, antimuscarinic, and combination therapy for stent-related symptoms were included. Two reviewers independently screened studies and extracted data. RESULTS A total of 13 articles were identified including 1408 patients. There were statistically significant differences in urinary symptom (-6.37; P<0.0001) and body pain index score (-7.03; P=0.0008) of the Ureteral Stent Symptom Questionnaire (USSQ), total International Prostate Symptom Score (IPSS) (-4.16; P=0.0006), Visual Analogue Pain Scale (VAPS) score (-2.48; P<0.00001), and quality of life (QoL) (-1.42; P=0.0009) in favor of the α-blocker group. Antimuscarinics alone vs the control group showed significant improvement in total IPSS (mean difference [MD]: -3.76; 95% confidence interval [CI], -5.08 to -2.43; P<0.00001) and QoL (MD: -0.82; 95% CI, -1.31 to -0.32; P=0.001). Compared with α-blockers monotherapy, combination therapy has significant lower total IPSS (MD: -3.74; 95% CI, -4.94 to -2.54; P<0.00001), VAPS (MD: -0.50; 95% CI, -0.89 to -0.11; P=0.01), and QoL (MD: -0.93; 95% CI, -1.30 to -0.55; P<0.00001). CONCLUSIONS Our data showed the beneficial effect of α-blockers alone and antimuscarinics alone in reducing stent-related symptoms. Furthermore, we suggested significant advantages of combination therapy of α-blocker and antimuscarinic compared with α-blocker monotherapy. However, more high quality, randomized controlled trials are warranted to better address this issue, however.
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Affiliation(s)
- Liang Zhou
- Department of Urology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Xiang Cai
- Department of Urology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Hong Li
- Department of Urology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
| | - Kun-Jie Wang
- Department of Urology, West China Hospital, Sichuan University , Chengdu, Sichuan, China
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Theckumparampil N, Elsamra SE, Carons A, Salami SS, Leavitt D, Kavoussi A, Motola J, Smith A, Okeke Z. Symptoms After Removal of Ureteral Stents. J Endourol 2015; 29:246-52. [DOI: 10.1089/end.2014.0432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nithin Theckumparampil
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
| | - Sammy E. Elsamra
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
| | - Akinwunmi Carons
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
| | - Simpa S. Salami
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
| | - David Leavitt
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
| | - Adriana Kavoussi
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
| | - Jay Motola
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
| | - Arthur Smith
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
| | - Zeph Okeke
- The Smith Institute for Urology, Hofstra North Shore–LIJ School of Medicine, New Hyde Park, New York
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El-Nahas AR, Elsaadany MM, Tharwat M, Mosbah A, Metwally AH, Hawary A, Keeley FX, Sheir KZ. Validation of the Arabic linguistic version of the Ureteral Stent Symptoms Questionnaire. Arab J Urol 2014; 12:290-3. [PMID: 26019964 PMCID: PMC4434880 DOI: 10.1016/j.aju.2014.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/06/2014] [Accepted: 08/09/2014] [Indexed: 12/02/2022] Open
Abstract
Objective To validate the Arabic version of the Ureteral Stent Symptoms Questionnaire (USSQ). Patients and methods The English version of the USSQ was translated into Arabic using a multi-step process by three urologists and two independent translators. The Arabic version was validated by asking 37 patients with temporary unilateral ureteric stents to complete the questionnaire at 2 weeks after stent insertion. The second group included 53 healthy individuals who agreed to complete the Arabic version of the questionnaire. The reliability of the Arabic version was evaluated for internal consistency using Cronbach’s α test. Domain structures were examined by interdomain (section) associations using Spearman’s correlation coefficient (r). The discrimination validity was evaluated by comparing the scores of patients with those of healthy individuals, using the Mann–Whitney test. Results Internal consistency was high for the sexual index and intermediate for urinary, pain and general health indices. There were good correlations of urinary symptoms with body pain (r = 0.596) and general health (r = 0.690). There was also a good correlation between body pain and general health (r = 0.681). For discrimination validity, there were significant changes in all domain scores when comparing patients with ureteric stents and healthy individuals (P < 0.001). Conclusion The Arabic version of the USSQ is a reliable and valid instrument that can be used to evaluate symptoms and health-related quality of life in Arabic patients with ureteric stents.
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Affiliation(s)
- Ahmed R El-Nahas
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed M Elsaadany
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Mohamed Tharwat
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Ahmed Mosbah
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amr H Metwally
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - Amr Hawary
- Urology Department, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Francis X Keeley
- Urology Department, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Khaled Z Sheir
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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Tehranchi A, Rezaei Y, Khalkhali H, Rezaei M. Effects of terazosin and tolterodine on ureteral stent related symptoms: a double-blind placebo-controlled randomized clinical trial. Int Braz J Urol 2014; 39:832-40. [PMID: 24456787 DOI: 10.1590/s1677-5538.ibju.2013.06.09] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Accepted: 08/15/2013] [Indexed: 11/22/2022] Open
Abstract
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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Affiliation(s)
- Ali Tehranchi
- Department of Urology, Urmia University of Medical Sciences, Urmia, Iran
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Sanguedolce F, Millán-Rodriguez F, Santillana-Altimira JM, Fantova-Alonso A, Sánchez-Martín FM, Angerri-Feu O, Martinez JML, Keeley FX, Joshi HB, Villavicencio-Mávrich H. The Spanish Linguistic Validation of the Ureteral Stent Symptom Questionnaire. J Endourol 2014; 28:237-42. [DOI: 10.1089/end.2013.0325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | - Oriol Angerri-Feu
- Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Francis X. Keeley
- Bristol Urological Institute, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | - Hrishi B. Joshi
- Urology Department, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, Wales
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Dellis AE, Keeley FX, Manolas V, Skolarikos AA. Role of α-blockers in the treatment of stent-related symptoms: a prospective randomized control study. Urology 2013; 83:56-61. [PMID: 24210570 DOI: 10.1016/j.urology.2013.08.067] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 07/29/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To properly use the Ureteric Symptom Score Questionnaire (USSQ) to evaluate, in a randomized control study, the effect of 2 different α-blockers in improving symptoms and quality of life in patients with indwelling ureteral stents. METHODS After institutional review board approval, 150 consecutive patients with a double-J ureteral stent inserted after extracorporeal shockwave lithotripsy (ESWL) or ureteroscopic stone treatment were randomly assigned to receive tamsulosin 0.4 mg, alfuzosin 10 mg, or placebo. The validated USSQ was completed 1 and 4 weeks after stent insertion and 4 weeks after stent removal. The Kruskal-Wallis test for independent samples for non-normally distributed ordinal variables, chi-square to compare proportions or differences, and 1-way analysis of variance (ANOVA) for independent samples to compare for differences in case of continuous variables were used for statistical analysis of the results. RESULTS Patients receiving α-blockers expressed an overall statistically significant lower urinary (P <.001), pain (P <.001 with stent in situ), and general health index (P <.002) scores. Sexual life and quality of life were also positively influenced. Quality of work was not influenced. No patients had to discontinue medication because of side effects or underwent stent removal before the due date. There was no difference in various outcomes between the 2 α-blockers. CONCLUSION Stent-related morbidity is a reality in the majority of patients. Simple medication, such as α-blockers, reduce stent-related symptoms and the negative impact on quality of life. It seems that stent-related symptom improvement is independent to the type of α-blocker.
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Affiliation(s)
- Athanasios E Dellis
- Second Department of Surgery, University of Athens, Aretaieion Hospital, Chalandri, Athens, Greece.
| | - Francis X Keeley
- Bristol Urological Institute, Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Victor Manolas
- First Department of Urology, University General Hospital of Athens, Laiko Hospital, Athens, Greece
| | - Andreas A Skolarikos
- Second Department of Urology, University of Athens, Sismanoglio Hospital, Northern Athens, Greece
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De S, Monga M, Knudsen B. Office-based stone management. Urol Clin North Am 2013; 40:481-95. [PMID: 24182971 DOI: 10.1016/j.ucl.2013.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As hospital resources are becoming strained, ambulatory surgical centers and day hospitals are being increasingly utilized. For the urologist, a working knowledge of local anesthetics and conscious sedation protocols are important, as many surgical kidney-stone procedures can be performed without general anesthetic. With any anesthesia, the key goal is to maximize patient comfort while minimizing respiratory depression and avoiding prolonged sedation. When using these medications, a working knowledge of emergency reversal, ventilation (bag mask/laryngeal mask airway/intubation), and cardiopulmonary resuscitation is recommended.
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Affiliation(s)
- Shubha De
- Endourology, The Cleveland Clinic, 9500 Euclid Avenue, Q10-1, Cleveland, OH 44195, USA
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Randomized controlled trial to compare the safety and efficacy of tamsulosin, solifenacin, and combination of both in treatment of double-j stent-related lower urinary symptoms. Adv Urol 2013; 2013:752382. [PMID: 24235970 PMCID: PMC3819880 DOI: 10.1155/2013/752382] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 09/07/2013] [Indexed: 11/17/2022] Open
Abstract
Purpose. We evaluated the effectiveness and safety of tamsulosin, solifenacin, and combination of both in reducing double-J stent-related lower urinary symptoms. Materials and Methods. A total of 338 patients with double-J ureteral stenting were randomly divided, postoperatively, into 4 groups. In group I (n = 84), no treatment was given (control group), group II (n = 85) received tamsulosin 0.4 mg daily, group III (n = 84) received solifenacin 10 mg daily, and group IV (n = 85) received a combination of both medications. Before insertion and 2 weeks after, all patients completed the International Prostate Symptom Score (IPSS), quality of life component of the IPSS (IPSS/Qol), Overactive Bladder Questionnaire (OAB-q), and Visual Analogue Pain Scale (VAPS) questionnaire. Results. The demographics and preoperative questionnaires scores of all groups were comparable. There were statistically significant differences in all scores in favour of groups II, III, and IV as compared to control group (P value < 0.005). Group IV showed statistically significant differences in total IPSS, QoL score, and OAB-q score as compared to groups II and III (P value < 0.001). Conclusions. Combined therapy of tamsulosin and solifenacin significantly alleviated lower urinary symptoms associated with double-J stents as compared to either medication alone.
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Lee YJ, Huang KH, Yang HJ, Chang HC, Chen J, Yang TK. Solifenacin improves double-J stent-related symptoms in both genders following uncomplicated ureteroscopic lithotripsy. Urolithiasis 2013; 41:247-52. [DOI: 10.1007/s00240-013-0554-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
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Abstract
This article reviews the data on pharmacologic treatment of kidney stone disease, with a focus on prophylaxis against stone recurrence. One of the most effective and important therapies for stone prevention, an increase in urine volume, is not discussed because this is a dietary and not a pharmacologic intervention. Also reviewed are medical expulsive therapy used to improve the spontaneous passage of ureteral stones and pharmacologic treatment of symptoms associated with ureteral stents. The goal is to review the literature with a focus on the highest level of evidence (ie, randomized controlled trials).
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Affiliation(s)
- Brian H Eisner
- Department of Urology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
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Park J, Shin DW, You C, Chung KJ, Han DH, Joshi HB, Park HK. Cross-Cultural Application of the Korean Version of Ureteral Stent Symptoms Questionnaire. J Endourol 2012; 26:1518-22. [DOI: 10.1089/end.2012.0235] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Daejeon, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
| | - Changhee You
- Department of Urology, College of Medicine, Hallym University, Chuncheon, Korea
| | - Kyung Jin Chung
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hrishi B. Joshi
- Department of Urology, University Hospital of Wales, United Kingdom
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Is there a role for α-blockers in ureteral stent related symptoms? A systematic review and meta-analysis. J Urol 2011; 186:928-34. [PMID: 21791359 DOI: 10.1016/j.juro.2011.04.061] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Indexed: 12/30/2022]
Abstract
PURPOSE We evaluated the efficacy of α-blockers to improve ureteral stent related morbidity and quality of life. MATERIALS AND METHODS We performed a search of MEDLINE®, Embase™ and The Cochrane Library plus a hand search of conference proceedings from January 2000 to October 2010 to identify randomized, controlled trials comparing treatment for ureteral stent symptoms with α-blockers. Two reviewers independently screened studies and extracted data. Trial methodological quality was assessed by The Cochrane Collaboration quality assessment tool. Placebo randomized, controlled trials with the ureteral stent symptom questionnaire as the outcome were eligible for meta-analysis. Meta-analysis was done using the mean difference to determine the aggregate effect size. RESULTS A total of 12 randomized, controlled trials including 2 α-blockers in a total of 946 patients were eligible, including 4 (33%) presented only as an abstract at a urological meeting and 4 (33%) eligible for meta-analysis. Meta-analysis using a random effects model showed that α-blockers were associated with a significant decrease in urinary symptoms (MD -6.76, 95% CI -11.52 to -2.00, p=0.005), a significant decrease in pain (MD -3.55, 95% CI -5.51 to -1.60, p=0.0004) and significant improvement in general health (MD -1.90, 95% CI -3.05 to -0.75, p=0.001). However, they were not associated with a benefit in work (MD 2.41, 95% CI -1.62 to 6.44, p=0.24) or sexual matters (MD 0.20, 95% CI -1.06 to 1.45, p=0.33). Eight studies were not included in the meta-analysis, of which 7 showed a significant clinical decrease in urinary symptoms and pain. CONCLUSIONS 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.
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Lim KT, Kim YT, Lee TY, Park SY. Effects of tamsulosin, solifenacin, and combination therapy for the treatment of ureteral stent related discomforts. Korean J Urol 2011; 52:485-8. [PMID: 21860770 PMCID: PMC3151637 DOI: 10.4111/kju.2011.52.7.485] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/29/2011] [Indexed: 11/28/2022] Open
Abstract
Purpose To 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 Methods A 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. Results In 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. Conclusions Combination 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.
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Affiliation(s)
- Kyoung Taek Lim
- Department of Urology, Hangyang University College of Medicine, Seoul, Korea
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Lamb AD, Vowler SL, Johnston R, Dunn N, Wiseman OJ. Meta-analysis showing the beneficial effect of α-blockers on ureteric stent discomfort. BJU Int 2011; 108:1894-902. [PMID: 21453351 DOI: 10.1111/j.1464-410x.2011.10170.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? Ureteric stents cause significant discomfort and this is probably related to ureteric smooth muscle spasm and trigonal irritation. Alpha-adrenoceptor antagonists reduce smooth muscle activity and are already widely used in medical expulsive therapy to aid passage of ureteric calculi. This meta-analysis incorporating five randomized controlled trials provides evidence that alpha-adrenoceptor antagonists reduce stent-related pain and storage symptoms as assessed by the Ureteric Stent Symptoms Questionnaire (USSQ). OBJECTIVES • To evaluate the efficacy of α-blockers with respect to improving stent-related symptoms. • Ureteric stents remain a source of marked discomfort and their placement is often required after certain ureteroscopic procedures or in the acute setting. This analysis identifies and reviews the several studies that have investigated the role of α-blockers after stent placement. MATERIALS AND METHODS • Pubmed/Medline, EMBASE, CINAHL and Cochrane Library databases were scrutinized using standard MeSH headings. • Randomized or controlled trials comparing α-blockers with control or standard therapy were included. • In all studies, patients completed the Ureteral Stent Symptom Questionnaire (USSQ). • The study data were independently reviewed by two assessors. RESULTS • In total, five studies of varying quality were identified, including 461 patients receiving either tamsulosin or alfuzosin, or control. • On meta-analysis, all five studies showed a reduction in USSQ urinary symptom score and body pain scores. There was mean reduction of 8.4 (95% CI, 5.6-11.1) in the urinary symptom score and 7.2 (95% CI, 2.5-11.8) in the body pain score. • In three studies, the numbers of patients experiencing stent related pain were stated: 45% (51/114) of patients receiving an α-blocker experienced painful episodes within the follow-up period defined for that study compared to 76% (88/116) in the control groups, which is equivalent to a relative risk of pain of 0.59 (95% confidence interval, 0.47-0.71). • There were also reductions in other aspects of the USSQ, such as the general health score and sexual matters score, although these were not statistically significant or uniformly reported. CONCLUSION • There is evidence that α-blockers provide an improvement in discomfort after placement of a ureteric stent.
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Affiliation(s)
- Alastair D Lamb
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK.
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