STONE DISEASE

Effects of specific alpha-1A/1D blocker on lower urinary tract symptoms due to double-J stent: a prospectively randomized study
Wang CJ, Huang SW, Chang CH
Division of Urology, Department of Surgery, Saint Martin De Porres Hospital, Chiayi, Taiwan, ROC
Urol Res. 2009; 37: 147-52

• The aim of our study was to evaluate the effect of tamsulosin in improving symptoms in patients with indwelling double-J ureteral stents. This prospective study lasted from April 2006 to March 2008. All the patients with symptomatic lower ureteral stones with < 15 mm diameter were enrolled, and were prospectively randomized (random numbers table) into two groups. A total of 154 patients, with insertion of a double-J ureteral stent after ureteroscopic stone removal. In group 1, 75 patients were enrolled and received placebo for 2 weeks. Group 2 included 79 patients who received 0.4 mg of tamsulosin, once daily for 2 weeks. All patients completed the validated ureteral stent symptom questionnaire (USSQ) and quality of life of international prostate symptom scale (IPSS) for evaluating the symptoms of double-J stents and quality of life after double-J stent insertion and removal, respectively. The analysis of the questionnaire at W1 revealed a significant difference in the main score index of urinary symptoms, body pain and general health between groups 1 and 2. When comparing W1 evaluation with that of W4 after double-J removal, both groups showed significant worsening of urinary symptoms, body pain, general health and work performance, except sexual performance. The mean score of quality of life in IPSS was 4.21 in group 1 and 1.6 in group 2. Tamsulosin can improve a subset of stent-related urinary symptoms and quality of life effectively and may be applied in routine clinical practice.

• Editorial Comment
  
  This is a well designed, implemented and analyzed study that lends support to prior studies suggesting the efficacy of alpha-blockers in the management of ureteral stent discomfort. Patients receiving tamsulosin had less urinary symptoms and body pain and better general health and quality of life than those on placebo. Remarkably, only 3% of patients in the tamsulosin group required narcotics, compared to 33% in the placebo group. Urinary symptoms were less in both men and women treated with tamsulosin irrespective of age. Improvement in body pain was noted primarily in patients > 50 years of age.
  Alpha-blockers may alleviate stent discomfort by decreasing ureteral spasm, decreasing trigone sensitivity, decreasing voiding pressures or decreasing resting ureteral pressure and peristalsis.
  Though previous studies have suggested return to normal activities at two weeks following ureteroscopy, it is possible that a small subset of patients may not have reached “baseline” by the 4-week time point following ureteroscopy. Administering this questionnaire at 2-3 months may have been a more reliable baseline, albeit logistically more challenging.

Dr. Manoj Monga
Professor, Department of Urology
University of Minnesota
Edina, Minnesota, USA
E-mail: endourol@yahoo.com