The Efficacy of Antimuscarinics Alone or in Combination with Alpha-Blockers for the Treatment of Ureteral Stent-Related Symptoms: A Systematic Review and Meta-Analysis

Abstract

Introduction and Aim: The purpose of this meta-analysis was to evaluate the efficacy of antimuscarinics alone or in combination with alpha-blockers for the treatment of ureteral stent-related symptoms. Methods: The databases MEDLINE, EMBASE, PubMed, the Cochrane Controlled Trial Register of Controlled Trials from 2000 to February 2016 were searched to identify randomized controlled trials that referred to the use of a combination of antimuscarinics and alpha-blockers for the treatment of ureteral stent-related symptoms. A systematic review and meta-analysis was conducted. Results: Seven publications involving 710 patients were included in the meta-analysis. In the analysis, we found significantly improved total International Prostate Symptom Score, quality of life, body pain and work performance score of the Ureteral Stent Symptom Questionnaire (USSQ) in the combination group compared with antimuscarinics alone (p = 0.00001, p = 0.00001, p = 0.00001 and p = 0.004, respectively). Antimuscarinics alone versus the control group showed significant improvement in urinary symptom, body pain and general health score of USSQ (p = 0.002, p = 0.00001 and p = 0.003, respectively). Conclusions: Our meta-analysis shows the beneficial effect of antimuscarinics alone in reducing stent-related symptoms. The combined use of antimuscarinics and alpha-blockers results in additive favorable effects in patients with ureteral stent-related symptoms compared with antimuscarinics monotherapy. The alpha-blockers may enhance the efficacy of the antimuscarinics, which is beneficial for the treatment of ureteral stent-related symptoms.

Comparison of safety and efficacy of silodosin, solifenacin, tadalafil and their combinations in the treatment of double-J stent- related lower urinary system symptoms: A prospective randomized trial

“…Numerous drugs had been tried to relieve these symptoms like alpha blockers, anticholinergics, phosphodiesterase inhibitors (PDE5Is) and analgesics. [6,7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] Silodosin is a highly selective alpha-1 adrenergic receptor antagonist which is used in the treatment of lower urinary tract symptoms (LUTS). Alpha-1 adrenergic receptors are densely found in the smooth muscle cells of the lower urinary tract, and silodosin relaxes them and improves the SRS, and various studies had also shown similar effect.…”

“…[13][14][15][16][17][18][19][20][21] Anticholinergics can also improve SRS by reducing the involuntary bladder contraction that occurs due to trigone irritation. [18][19][20][21][22][23][24][25] PDE5Is increase levels of cGMP that will lead to relaxation of the smooth muscle of ureter and reduces SRS. [6,26] The aim of our study was to evaluate the efficacy and safety of silodosin, solifenacin, tadalafil, and their combinations in reducing DJ stent-related LUTS.…”

“…Alpha-blockers, anticholinergics and their combinations can be used for the management of SRSs with good results. [13][14][15][16][17][18][19][20][21][22][23][24][25][26]30] Recently some studies have also shown the role of PDE5Is in SRS. [6,26] But most of these studies haven't used the most validated score (USSQ) with QOL score for the assessment of SRSs.…”

“…Anticholinergics alone and in combination with alpha-blockers have been found to be effective in patients with SRS but combination therapy is more effective than monotherapy. [18][19][20][21][22][23][24][25]30] PDE-5 inhibitors are FDA approved drugs for erectile dysfunction, LUTS due to prostatic hyperplasia, and…”

Risks of forgotten double-J ureteric stents after ureterorenoscopic lithotripsy in Taiwan: a nationwide population-based study

“…We hypothesized that less severe ureteric stent-related symptoms would result in the patients ignoring and forgetting about the presence of DJs inside their bodies, especially in cases in which the DJs were newly indwelled. Alpha blockers are reported to improve ureteric stent-related symptoms 9 ; therefore, we tested the association of postoperative prescriptions of alpha blockers with forgotten DJs. A T test, Fisher's exact test, and Pearson's chi square test were applied for statistical analysis.…”