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Abdelaal AM et al, 2016: Efficacy and safety of tamsulosin oral-controlled absorption system, solifenacin, and combined therapy for the management of ureteric stent-related symptoms.

Abdelaal AM, Al-Adl AM, Abdelbaki SA, Al Azab MM, Al Gamal KA.
Department of Urology, Benha University, Benha, Egypt; Al Adwani General Hospital, Taif, Saudi Arabia.
Department of Urology, Benha University, Benha, Egypt; International Medical Center, Jeddah, Saudi Arabia.

Abstract

OBJECTIVES: To evaluate the efficacy of solifenacin, tamsulosin oral-controlled absorption system (OCAS), and the combination of both drugs on JJ stent-related symptoms using the validated Arabic version of the ureteric stent symptom questionnaire (USSQ).
PATIENTS AND METHODS: In all, 260 patients who had undergone JJ stenting of the ureter for different endoscopic urological procedures were postoperatively randomly assigned into four equal groups. Patients in Group I received no treatment and served as the control group, Group II patients received tamsulosin OCAS 0.4 mg daily, Group III patients received solifenacin 5 mg daily, and Group IV patients received a combination of both drugs. Before stent removal, all patients completed the Arabic version of the USSQ.
RESULTS: In all, 234 patients completed the study, comprised of 56 in Group I, 59 in Group II, 58 in Group III, and 61 in Group IV. Baseline characteristics and indications for JJ stenting were comparable in the four groups. There were highly significant differences in all items of the USSQ between the treatment groups and the controls, while Group II and III were comparable. The USSQ score was significantly lower in Group IV vs Groups II and III. Crossing of the distal curl of the stent to the midline had a significant positive correlation with the severity of the urinary symptoms, body pain, general health, and work performance in the medicated groups.
CONCLUSIONS: Combined therapy with tamsulosin OCAS 0.4 mg daily and solifenacin 5 mg daily is a safe and well-tolerated management for stent-related symptoms. However, stent position remains a significant factor affecting response to medical therapy and patients' health-related quality of life. 

Arab J Urol. 2016 Feb 22;14(2):115-22. doi: 10.1016/j.aju.2016.01.004. eCollection 2016 Jun.

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Comments 1

Hans-Göran Tiselius on Tuesday, 24 January 2017 12:39

Stent insertion is an important part of modern endourology. For patients treated with SWL it is used to avoid steinstrasse when the stone volume is large, and to alleviate obstruction caused by fragments or stones in the ureter. Moreover, it is a useful safety step to decrease the risk of infection complications before SWL of stones that might contain bacteria.

The result in this study are thus of importance. Randomization was carried out as follows:

Group 1: no pharmacological treatment
Group 2: 0.4 mg of tamsulosin daily (-receptor antagonist)
Group 3: 5 mg of solifenacin daily (anti-cholinergic agent)
Group 4: combined administration of tamsulosin and solifenacin.

Interestingly the results of USSQ (ureteric stent symptom questionnaire) showed that both tamsulosin and solifenacin were better than no pharmacological treatment, but also that the combined therapy with tamsulosin and solifenacin was significantly better than the mono-therapy alternatives.

The presented result is a clinically useful lesson on how the stent treatment can be more comfortable or less uncomfortable for the patient.

One observation was that stents crossing the midline caused significantly more symptoms than those not crossing the midline. It is not mentioned why stents take that undesirable position. Careful insertion is recommended with attention paid to stent dimensions. But, although the stents chosen by the authors were adjusted to the individual patient’s measurements in terms of length and calibre, as many as 51 (22%) had stents crossing the midline!

Stent insertion is an important part of modern endourology. For patients treated with SWL it is used to avoid steinstrasse when the stone volume is large, and to alleviate obstruction caused by fragments or stones in the ureter. Moreover, it is a useful safety step to decrease the risk of infection complications before SWL of stones that might contain bacteria. The result in this study are thus of importance. Randomization was carried out as follows: Group 1: no pharmacological treatment Group 2: 0.4 mg of tamsulosin daily (-receptor antagonist) Group 3: 5 mg of solifenacin daily (anti-cholinergic agent) Group 4: combined administration of tamsulosin and solifenacin. Interestingly the results of USSQ (ureteric stent symptom questionnaire) showed that both tamsulosin and solifenacin were better than no pharmacological treatment, but also that the combined therapy with tamsulosin and solifenacin was significantly better than the mono-therapy alternatives. The presented result is a clinically useful lesson on how the stent treatment can be more comfortable or less uncomfortable for the patient. One observation was that stents crossing the midline caused significantly more symptoms than those not crossing the midline. It is not mentioned why stents take that undesirable position. Careful insertion is recommended with attention paid to stent dimensions. But, although the stents chosen by the authors were adjusted to the individual patient’s measurements in terms of length and calibre, as many as 51 (22%) had stents crossing the midline!
Tuesday, 25 June 2024