Editorial Comment: The effects of pregabalin, solifenacin and their combination therapy on ureteral double-J stent-related symptoms: A randomized controlled clinical trial

Siavash Falahatkar ¹, Mohammadreza Beigzadeh ¹, Gholamreza Mokhtari ¹, Samaneh Esmaeili ¹, Ehsan Kazemnezhad ¹, Atiyeh Amin ¹, et al.

Int Braz J Urol. May-Jun 2021;47(3):596-609.

COMMENT

Ureteral stents are frequently used in urology practice, particularly following ureteroscopy for urinary stone treatment (¹). However, urinary stent-related symptoms are among the most bothersome symptoms affecting patient's quality of life (², ³). Stent-related symptoms are usually worse during the first four days after surgery, with a peak of medication use on day 1 after placement (⁴). Sometimes, these symptoms are so limiting that the patient usually refers the treatment for urinary stone as stent placement. Stent composition, design and size, and medical therapies have been studied to mitigate patient's suffering.

Some strategies have been proved to reduce stent-related symptoms. Silicone composed stents are associated with less patient discomfort (⁵, ⁶). A novel intraureteral stent placement was associated with less discomfort than conventional stent placement (⁷). Other studies found that stent-related patient symptoms increase with the diameter of the stents. Therefore, smaller diameter stents should be preferred (⁸, ⁹). Stent-related symptoms may be significantly mitigated with drug monotherapy or combination of beta-3 adrenergic receptor agonist, alpha-blockers and anticholinergic (¹⁰–¹⁶).

Falahatkar et al. studied the effects of pregabalin, solifenacin and their combination therapy on urinary stent-related symptoms in a randomized controlled clinical trial (¹⁷). Patients were randomly allocated into four groups: pregabalin 75 mg BID (N=64), solifenacin 5 mg once a day (N=64), pregabalin 75 mg BID and solifenacin 5 mg once a day (N=64), and no medication (N=64). Ureteral Symptom Score Questionnaire (USSQ) was used to compare groups at 2 and 4 weeks after discharge from hospital (¹⁸). Authors reported significant beneficial effects in all indexes of USSQ only for combined pregabalin and solifenacin therapy over control group. Reported side effects were mild for all studied groups. Lack of a placebo arm and application of USSQ only at 2 and 4 weeks after discharge from hospital are some of the limitations of this study.

Urinary stent-related symptoms should not be overlooked and could be relieved by an adequate stent selection and a combination of postoperative medical therapy.

REFERENCES

• ¹
  Muslumanoglu AY, Fuglsig S, Frattini A, Labate G, Nadler RB, Martov A, et al. Risks and Benefits of Postoperative Double-J Stent Placement After Ureteroscopy: Results from the Clinical Research Office of Endourological Society Ureteroscopy Global Study. J Endourol. 2017;31:446-51.
• ²
  Bosio A, Alessandria E, Dalmasso E, Peretti D, Agosti S, Bisconti A, et al. How bothersome double-J ureteral stents are after semirigid and flexible ureteroscopy: a prospective single-institution observational study. World J Urol. 2019;37:201-7.
• ³
  Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX Jr, Timoney AG, Barry MJ. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol. 2003;169:1065-9; discussion 1069.
• ⁴
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• ⁵
  Wiseman O, Ventimiglia E, Doizi S, Kleinclauss F, Letendre J, Cloutier J, et al. Effects of Silicone Hydrocoated Double Loop Ureteral Stent on Symptoms and Quality of Life in Patients Undergoing Flexible Ureteroscopy for Kidney Stone: A Randomized Multicenter Clinical Study. J Urol. 2020;204:769-77.
• ⁶
  Gadzhiev N, Gorelov D, Malkhasyan V, Akopyan G, Harchelava R, Mazurenko D, et al. Comparison of silicone versus polyurethane ureteral stents: a prospective controlled study. BMC Urol. 2020;20:10.
• ⁷
  Yoshida T, Inoue T, Taguchi M, Matsuzaki T, Murota T, Kinoshita H, et al. Efficacy and Safety of Complete Intraureteral Stent Placement versus Conventional Stent Placement in Relieving Ureteral Stent Related Symptoms: A Randomized, Prospective, Single Blind, Multicenter Clinical Trial. J Urol. 2019;202:164-70.
• ⁸
  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;34:368-72.
• ⁹
  Nestler S, Witte B, Schilchegger L, Jones J. Size does matter: ureteral stents with a smaller diameter show advantages regarding urinary symptoms, pain levels and general health. World J Urol. 2020;38:1059-63.
• ¹⁰
  Sahin A, Yildirim C, Yuksel OH, Urkmez A. Treatment of ureteral catheter related symptoms; mirabegron versus tamsulosin/solifenacin combination: A randomized controlled trial. Arch Esp Urol. 2020;73:54-9. English, Spanish.
• ¹¹
  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;122:866-72.
• ¹²
  Dellis AE, Papatsoris AG, Keeley FX Jr, 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;31:100-9.
• ¹³
  Zhang L, Li J, Pan M, Han W, Liu S, Xiao Y. Doxazosin oral intake therapy to relieve stent - related urinary symptoms and pain: a prospective, randomized, controlled study. Int Braz J Urol. 2016;42:727-33.
• ¹⁴
  Maldonado-Avila M, Garduno-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;42:487-93.
• ¹⁵
  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.
• ¹⁶
  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. 2013;39:832-40.
• ¹⁷
  Falahatkar S, Beigzadeh M, Mokhtari G, Esmaeili S, Kazemnezhad E, Amin A, et al. 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.
• ¹⁸
  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;169:1060-4.

Publication Dates

• Publication in this collection
  11 Mar 2022
• Date of issue
  Mar-Apr 2022