COMPARISON OF PHARMACOLOGY AGENTS EFFECT IN TREATING URETERAL STENT RELATED SYMPTOMS: SYSTEMATIC REVIEW & META-ANALYSIS OF RANDOMIZED CONTROLLED TRIAL¬

##plugins.themes.bootstrap3.article.main##

##plugins.themes.bootstrap3.article.sidebar##

PDF
Published 2024-01-04
Andi As'ad Mubarak Muhammad Ainul Mahfuz Abdul Aziz Muhammad Sopiyudin Dahlan

Abstract

Objective: We wish to update existing meta-analyses to assess the effectiveness of pharmacological agents against ureteral stent-related symptoms with better design of RCTs, as well as more valid and reliable measurement methods. Material & Methods: Relevant published articles up to February 2022 were obtained from PubMed, CENTRAL, Google Scholar, Science Direct, and DOAJ. All single-blind or double-blind RCTs with various comparisons using pharmacological agents and/or placebo in patients with ureteral stent-related symptoms, with outcome assessment using USSQ at week 1 and week 4 during stent placement was included in the study. Statistical parameter Mean Difference (MD) with 95% CI was used to measure effect size. The p value less than 0.05 indicates statistical significance. Results: Alpha blockers (2 studies, 85 samples) significantly reduced fourth week UIS compared to placebo (MD: – 5.46, 95% CI: – 7.47 to -3.46, I2 = 0%, P = < 0.001), and alpha blockers (2 studies, 42 samples) significantly reduced first week SIS compared to combination therapy (MD: – 0.82, 95% CI: – 1.56 to – 0.08, I2 = 0%, P = 0.03). The results of the meta-analysis of USSQ scores in other domains have no significant differences. Conclusion: Alpha blockers were better than placebo in reducing UIS due to ureteral stent in the fourth week of stent placement, and better than combination therapy in reducing SIS due to ureteral stent in the first-week post stenting. However, more RCTs are needed with larger samples and better designs to reach valid conclusions. Keywords: Stents, Randomized Controlled Trials as Topic, Single-Blind Method.


##plugins.themes.bootstrap3.article.details##

Keywords

Stents, Randomized Controlled Trials as Topic, Single-Blind Method

References

Zimskind PD, Fetter TR, Wilkerson JL. Clinical Use of Long-Term Indwelling Silicone Rubber Ureteral Splints Inserted Cystoscopically. J Urol. 1967 May; 97(5): 840–4.

Chew BH, Knudsen BE, Denstedt JD. The use of stents in contemporary urology. Curr Opin Urol. 2004 Mar; 14(2): 111–5.

Joshi HB, Okeke A, Newns N, Keeley FX Jr, Timoney AG. Characterization of urinary symptoms in patients with ureteral stents. Urology. 2002 Apr; 59(4): 511–6.

Joshi HB, Newns N, Stainthorpe A, Macdonagh RP, Keeley FX Jr, Timoney AG. Ureteral Stent Symptom Questionnaire: Development And Validation Of A Multidimensional Quality Of Life Measure. J Urol. 2003 Mar; 169(3): 1060–4.

Miyaoka R, Monga M. Ureteral stent discomfort: Etiology and management. Indian J Urol. 2009 12; 25(4): 455–60.

Haleblian G G, Kijvikai K, de la Rosettte J, Preminger G. Ureteral Stenting and Urinary Stone Management: A Systematic Review. J Urol. 2008 Feb; 179(2): 424–30.

Dellis A, Joshi HB, Timoney AG, Keeley FX Jr. Relief of Stent Related Symptoms: Review of Engineering and Pharmacological Solutions. J Urol. 2010 Oct; 184(4): 1267–72.

Deliveliotis K, Papatsoris AG, Skolarikos A, Mitsogiannis I, Tzannis K, Dellis AE. Management of stent-related symptoms with the use of α-blockers: A meta-analysis. Arab J Urol. 2020; 18(1): 14–21.

Zhang YM, Chu P, Wang WJ. PRISMA-combined a-blockers and antimuscarinics for ureteral stent-related symptoms. Medicine. 2017 Feb; 96(7): e6098.

Wang J, Zhang X, Zhang T, Mu J, Bai B, Lei Y. The role of solifenacin, as monotherapy or combination with tamsulosin in ureteral stent-related symptoms: a systematic review and meta-analysis. World J Urol. 2017 Nov; 35(11): 1669–80.

Gao Y, Liang H, Liu L, Gurioli A, Wu W. Comparison of Alpha-Blockers and Antimuscarinics in Improving Ureteral Stent-Related Symptoms: A Meta-Analysis. Urol J. 2019 Jun 17; 16(3): 307–11.

Li Z, Cui Y, Chai Y, Zhang Y. The efficacy and safety of mirabegron in treating ureteral stent‐related symptoms: A systematic review and meta‐analysis. Low Urin Tract Symptoms. 2022 Jan;14(1):27–34.

Zhang DX, Sun K, Wang T, Wu G, Wang J J, Wu J et al. A meta-analysis of efficacy and safety of PDE5 inhibitors in the treatment of ureteral stent-related symptoms. Ann Palliat Med. 2021 Feb; 10(2): 1000–11.

Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021 Mar 29; 372: n160.

Higgins JPT, Savovic J, Page MJ, Elbers RG, Sterne JAC. Chapter 8: Assessing risk of bias in a randomized trial. In: Cochrane Handbook for Systematic Reviews of Interventions version 63 (updated February 2022)

Wang CJ, Huang SW, Chang CH. Effects of specific α-1A/1D blocker on lower urinary tract symptoms due to double-J stent: a prospectively randomized study. Urol Res. 2009 Jun; 37(3): 147–52.

Singh I, Tripathy S, Agrawal V. Efficacy of tamsulosin hydrochloride in relieving “double-J ureteral stent-related morbidity”: a randomized placebo controlled clinical study. Int Urol Nephrol. 2014 Dec; 46(12): 2279–83.

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. 2014 Jan; 83(1): 56–61.

Dellis AE, Papatsoris AG, Keeley Jr FX, Bamias A, Deliveliotis C, Skolarikos AA. Tamsulosin, Solifenacin, and Their Combination for the Treatment of Stent-Related Symptoms: A Randomized Controlled Study. J Endourol. 2017 Jan; 31(1): 100–9.

Maldonado-Avila M, Garduño-Arteaga L, Jungfermann-Guzman R, Manzanilla-Garcia HA, Rosas-Nava E, Procuna-Hernandez N et al. Efficacy of Tamsulosin, Oxybutynin, and their combination in the control of double-j stent-related lower urinary tract symptoms. Int Braz J Urol. 2016 Jun; 42(3): 487–93.

Hasbi BE, Palinrungi MA, Kholis K, Bakri S, Syahrir S, Kasim F. The Effectiveness Between Tamsulosin and Solifenacin Combined with Tamsulosin on Treatment of Ureteral Stent-Related Symptoms. Nusantara Medical Science J. 2021; 6(1): 1–17.

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 Feb; 195(2): 385–90.

Yavuz A, Kilinc MF, Aydin M, Ofluoglu Y, Bayar G. Does tamsulosin or mirabegron improve ureteral stent‐related symptoms? A prospective placebo‐controlled study. Lower Urinary Tract Symptoms. 2020 May 14; 13(1): 1–5.

Palinggi E, Palinrungi MA, Palinrungi AM, Seweng A, Kholis K, Syahrir A et al. Effectiveness of using Solifenacin compared to Mirabegron after double-J stent installation for treatment of lower urinary tract symptoms (LUTS). J Med Allied Sci. 2020; 10(2): 115–20.

Ilyas MRF, Kholis K, Palinrungi MA, Palinrungi AM, Seweng A, Syahrir S, et al. Comparative effectiveness of Tamsulosin and Tadalafil therapy in ureteral stents-related symptoms (uSRS). Medicina Clínica Práctica. 2021 Apr; 4: 100226.

Farshi Haghro A, Hajebrahimi S, Jabbari A, Sadeghi H, Babaei H. Efficacy of Tadalafil on Ureteral Stent Symptoms: A Randomized Controlled Trial. Nephro-Urol Mon. 2019 Feb 5; 11(1): e85523.

Gupta M, Patel T, Xavier K, Maruffo F, Lehman D, Walsh R, et al. Prospective Randomized Evaluation of Periureteral Botulinum Toxin Type A Injection for Ureteral Stent Pain Reduction. J Urol. 2010 Feb; 183(2): 598–602.

Jo JK, Kim JH, Kim KS, Chung JH, Kim YT, Choi HY et al. 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 Nov; 22(5): 858–65.

He F, Man LB, Li GZ, Liu N. Efficacy of α-blocker in improving ureteral stent-related symptoms: a meta-analysis of both direct and indirect comparison. Drug Des Devel Ther. 2016 May 26; 10: 1783–983.

Chen YB, Gao L, Jiang Q, Ran K, Luo RT. Tamsulosin Monotherapy Is Effective in Reducing Ureteral Stent- related Symptoms: A Meta-analysis of Randomized Controlled Studies. Curr Med Sci. 2019; 39(5): 707–18.

Section
Articles
Copyright Information
Department of Urology, Faculty of Medicine/Airlangga University