Does tamsulosin or mirabegron improve ureteral stent‐related symptoms? A prospective placebo‐controlled study

Abstract

Objective: The main objective of this study was to evaluate the efficacy of tamsulosin or mirabegron on ureteral stent-related symptoms. Patients and methods: This was a prospective, randomized, controlled, and singleblinded study. In total, 180 patients who had undergone ureterolithotripsy and ureteral stent insertion were included. Patients were randomly divided into three groups as follows: Group 1 was the control group taking placebo; group 2 was administered tamsulosin (0.4 mg) once a day; and group 3 received mirabegron (50 mg) once a day. The Turkish version of the ureteral stent symptom questionnaire was filled out after 4 weeks. Results: After excluding patients who were lost to follow-up, 161 patients were included in the final analysis. Analgesic usage doses were lower in the tamsulosin (5.1 ± 1.8) and mirabegron (4.5 ± 1.4) groups than in the control group (5.9 ± 2.1; P < .001). The urinary symptoms score was lower in tamsulosin group than it was in the control group (22.1 vs 27.8; P = .001); however, the other scores (body pain, general health, work performance, sexual matters, and other problems) were similar between the groups. Conclusions: Tamsulosin improves only urinary symptoms due to the ureteral stent and decreases the need for analgesics. Mirabegron has no effect on ureteral stentrelated symptoms, but it decreases analgesic need. K E Y W O R D S lower urinary tract symptoms, mirabegron, tamsulosin, ureteral stent 1 | INTRODUCTION Ureteral stents (USs) are widely used in urology practice to resolve obstruction, to help recovery of ureteric injury, or are routinely inserted after surgery. 1 However, about 80% of patients experience stent-related pain, and more than half of them have lower urinary tract symptoms (LUTSs; frequency, urgency, dysuria, and incomplete emptying). 2-4 For these patients, their working capacity decreases and sexual health deteriorates; thus, their quality of life is adversely affected due to pain and urinary symptoms. 5 Two main mechanisms are blamed for causing all these disorders: The first is high pressure transmitted to the renal pelvis during urination from the bladder by reflux; the second is a distal ureter (even whole ureter) and bladder spasms due to irritation from the US. 6,7 Tamsulosin is a selective inhibitor of alpha-1a (minimal 1d) adrenergic contraction; alpha-1a is present in the smooth muscles of the distal ureter, trigone, and bladder neck. 8 Tamsulosin has also long been used for pain and US-related symptoms. 9-12 Mirabegron is a beta-3 adrenergic receptor agonist that is currently available for treatment of overactive bladder symptoms. 13 Beta-3 adrenergic receptors

Effects of mirabegron on JJ stent‐related symptoms: A multicentric study

“…Yavuz et al reported the results of 180 patients regarding the changes on the ureteral stent symptom questionnaire 4 weeks after ureterolithotripsy plus ureteral stenting. They randomised the patients into three groups receiving placebo, tamsulosin and mirabegron (50 mg) once a day and found similar rates of urinary symptoms scores between the mirabegron and control patients (27.8 vs 24.5, P = .423) 21 . In contrast to that study, we compared the impact of mirabegron on changes of urinary symptoms scores in patients between postoperative first visit and at least 4 weeks after surgery.…”

“…19 once a day and found similar rates of urinary symptoms scores between the mirabegron and control patients (27.8 vs 24.5, P = .423). 21 In contrast to that study, we compared the impact of mirabegron on changes of urinary symptoms scores in patients between postoperative first visit and at least 4 weeks after surgery. For the first time in the literature, we showed that mirabegron monotherapy significantly decreased the SRS compared with pretreatment levels.…”

Effects of Mirabegron on JJ Stent-Related Symptoms: A Multicentric Study

“…Yavuz et al reported the results of 180 patients regarding the changes on the ureteral stent symptom questionnaire four weeks after ureterolithotripsy plus ureteral stenting. They randomized the patients into three groups receiving placebo, tamsulosin, and mirabegron (50 mg) once a day and found similar rates of urinary symptoms scores between the mirabegron and control patients (27.8 vs 24.5, p = 0.423) [21]. In contrast to that study, we compared the impact of mirabegron on changes of urinary symptoms scores in patients between postoperative first visit and at least four weeks after surgery.…”

The efficacy and safety of mirabegron in treating ureteral stent‐related symptoms: A systematic review and meta‐analysis

“…According to the inclusion criteria, five articles 14‐18 involving five RCT that compared mirabegron with placebo or blank control in treating ureteral stent‐related symptoms were included in the meta‐analysis (Figure 1). Baseline characteristics of the eligible studies are listed in Table 1.…”