Mirabegron: A Novel and Promising Medical Expulsive Treatment for Ureteral Stones?

Ürkmez, Ahmet; Tokuç, Emre; Topaktaş, Ramazan; Şahin, Aytaç; Yüksel, Özgür Haki

doi:10.29271/jcpsp.2019.01.73

Cited by 8 publications

(10 citation statements)

References 10 publications

(16 reference statements)

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“…Previous studies have con rmed the presence of β1, β2, and β3 adrenoceptors in both smooth muscle and urothelial layers of the whole ureter. The ureter smooth muscle relaxation was reached by stimulating β-3 receptors which supported the potential role for mirabegron as a medical expulsive therapy [21].…”

Section: Discussionmentioning

confidence: 67%

Efficacy of Mirabegron in Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Updated Meta-analysis

Liu

Zhu

Huang

2022

Preprint

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The possibility of using mirabegron as a new medical expulsive therapy agent for ureteral stones has been studied owing to its relaxant effects on the ureteral smooth muscle. The objective of this study was to update the evidence regarding the efficacy of mirabegron in medical expulsive therapy for the management of ureteral calculi. We systematically searched PubMed, Cochrane library and Embase to collect the clinical trials from inception dates to August 2022. Meta-analysis and forest-plot figures were calculated with the software review manager v5.0. Six studies with 462 patients were eligible for inclusion. Mirabegron achieved significantly higher expulsion rate than control (pooled RR: 1.44, 95% CI: 1.12, 1.86; P = 0.004). A subgroup analyses showed that mirabegron has a significantly higher expulsion rate on stone sizes smaller than 5/6 mm (RR 1.4; 95% CI: 1.11–1.77; P = 0.005). The superior effect was not observed on stone sizes > 5/6 mm (RR 1.04; 95% CI: 0.80–1.35; P = 0.77). The pooled data showed no significant difference in the expulsion time between mirabegron and control group (MD: -0.53, 95% CI -5.77–4.71; P = 0.84). There was no significant difference between the mirabegron group and the control group in the episodes of renal colic (MD -0.18; 95% CI -0.39–0.02; P = 0.08). But patients receiving mirabegron had less analgesic consumption. No serious adverse events were reported with mirabegron treatment. This systematic review shows that mirabegron is an effective and safe medical expulsive therapy agent in patients with ureteral stones.

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Section: Discussionmentioning

confidence: 67%

Efficacy of Mirabegron in Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Updated Meta-analysis

Liu

Zhu

Huang

2022

Preprint

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“…Animal experiments have also demonstrated dilatation of the ureter and a decrease in ureteral intraluminal pressure with the use of mirabegron [12]. In addition, it has been reported to be an effective and safe medical expulsive treatment agent for the reduction of distal ureteral stones with a low rate of side effects [4,14]. Mirabegron reduces the disturbing symptoms related to stents by dilatation of the ureter and decreasing intraluminal pressure [15].…”

Section: Discussionmentioning

confidence: 99%

Can mirabegron facilitate ureteral access sheath placement during flexible ureterorenoscopy?

2020

Ann Clin Anal Med

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Aim: In this study, we aimed to demonstrate the effect of mirabegron on ureteral access sheath (UAS) placement during flexible ureterorenoscopy (f-URS). Material and Methods: The study enrolled 96 patients with renal stones who underwent fURS between October 2019 and March 2020. The patients were divided into 2 groups. Mirabegron treatment was administered 2 weeks before fURS in Group 1 (n = 41), and no mirabegron treatment was given in Group 2 (n = 55). All operations were performed by a single surgeon (MK). Demographic characteristics were recorded for each patient, including age, body weight, height, body mass index (BMI), stone characteristics, and perioperative data, including operation-fluoroscopy durations, stone-free rates, complications, and surgery success rates. Group data were compared, and p-values less than 0.05 were considered statistically significant. Results: No significant difference was detected between the groups in terms of age, sex, body mass index, number and size of stones, side of stones, density of stones, and renal hydronephrosis level. UAS placement in Group 1 was found to be statistically significant at the first attempt (without using a semi-rigid ureteroscope or balloon dilatation) compared with Group 2 (p=0.001) Discussion: The use of mirabegron may facilitate UAS placement during fURS with less operation time and fewer complications.

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“…6 Medical expulsive therapy provides smooth muscle relaxation to dilate the ureter and reduce edema and spasm, facilitating stone expulsion. 11 Recent advances in basic research provided a better understanding of ureteral function and pathophysiology which has helped in employing MET as a conservative treatment approach. 6 , 14 No doubt that proper analgesia is another important factor in this conservative management strategy.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that beta-3 adrenoreceptors (β3AR) are detected in the ureteral smooth muscles, mediating the adrenergic stimulation for ureteral relaxation. 11 Moreover, urothelium and the interstitial cells themselves express β3AR more than the ureteral smooth muscle. This indicates that β3AR takes part in the dynamics of the ureter.…”

Section: Introductionmentioning

confidence: 99%

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Mirabegron as a Medical Expulsive Therapy for 5-10 mm Distal Ureteral Stones: A Prospective, Randomized, Comparative Study

Sayed¹,

Moeen²,

Saada³

et al. 2022

Turkish Journal of Urology

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Objective: The aim of this study was to assess the efficacy and safety of mirabegron as a medical expulsive therapy in patients with distal ureteral stones of 5-10 mm size. Material and methods: A prospective, comparative study included 96 patients with radiopaque distal ureteral stones of 5-10 mm who were randomly allocated and treated by medical expulsive therapy in 2 groups from January 2019 to December 2020. Patients in group A received only ketorolac 30 mg/day for 5 days, then on demand. Patients in group B received mirabegron 50 mg/day for 4 weeks plus ketorolac 30 mg/day like in group A. The stone expulsion rate was the primary outcome. Results: There were no significant differences regarding age, gender, body mass index, laterality, degree of hydronephrosis, and stone size. After 4 weeks, stone expulsion rate was 52.1% for group A versus 89.6% for group B ( P < .001). The median (range) of time to stone expulsion was 14 (13-23) and 7 (3-16) days for groups A and B, respectively ( P = .004). The medians (range; interquartile range) of episodes of renal pain (1 (0-2; 1) vs. (0-2; 2); P < .001) and extra analgesic ampoules (1 (0-7; 4) vs. 0 (0-2; 0) vials; P < .001) were significantly higher in group A than those in group B, respectively. In multivariate analysis, only medical expulsive therapy ( P < .001) and stone size ( P < .001) were independent predictors of stone expulsion rate. Conclusion: Mirabegron is an effective and safe medical expulsive therapy agent in patients with 5-10 mm distal ureteral stones.

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Mirabegron: A Novel and Promising Medical Expulsive Treatment for Ureteral Stones?

Cited by 8 publications

References 10 publications

Efficacy of Mirabegron in Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Updated Meta-analysis

Efficacy of Mirabegron in Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Updated Meta-analysis

Can mirabegron facilitate ureteral access sheath placement during flexible ureterorenoscopy?

Mirabegron as a Medical Expulsive Therapy for 5-10 mm Distal Ureteral Stones: A Prospective, Randomized, Comparative Study

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