WCE 2018: Are α-Blockers Better Compared to β3-Agonists for the Treatment of Stent Related Symptoms?

Paris, France (UroToday.com) Ureteral stent related symptoms are an unfortunate complication of stent placement, which can negatively affect a patient’s quality of life. The ureteral stent symptom questionnaire (USSQ) was developed and validated to measure the severity of these symptoms and addresses the domains of urinary symptoms, pain, general health, work performance, sexual matters and additional problems. Several medications such as alpha blockers and beta 3 agonists have been demonstrated efficacy in the treatment of symptoms after placement of ureteral stent. Dr. Kimon Tsirkas et al. conducted a randomized controlled study comparing the efficacy of alpha blockers and beta blockers for treating stent related symptoms.

Seventy five patients were evenly and randomly distributed into 1 of three arms – alpha blocker administration (tamsulosin OCAS, alfuzosin 10mg or silodosin 8mg), beta 3 agonist (mirabegron 50mg), or placebo. Medication administration began 2 days after stent placement and ended 4 weeks after placement. USSQ scores at 1 and 4 weeks after stent placement, and 4 weeks after stent removal were compared between arms. Patients in the alpha-blocker and beta agonist arms experienced significantly lower overall scores in the domains of urinary symptoms (p < .001), pain (p < .001), and general health (p < .001). The two medication arms also had lower scores for sexual health, quality of life, and work performance but these differences did not reach significance. Alpha blockers proved to be more efficacious than beta 3 agonists in the domains of urinary symptoms (p = .05) and pain (p = .03), and 2 patients on beta 3 agonist therapy had to discontinue treatment due hypertension dysregulation. No other side effects or adverse events were reported.

The authors of this study show that treatment with either alpha blockers or beta 3 agonists decreases stent related morbidity over placebo, and alpha blockers seem to be slightly better for this purpose. The study is still ongoing, and Tsirkas et al. hope to test whether or not combination therapy with these two drug classes can further improve these symptoms than either alone.

Presented by: Kimon Tsirkas, MD, Department of Urology, General Hospital of Athens G.N.A. “G. Gennimatas”, Athens, Greece

Authors: Athanasios Dellis, Athanasios Papatsoris, Konstantinos Spyropoulos, Konstantinos Nastos, Charalambos Deliveliotis, Andreas Skolarikos

Written By: Max Towe at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France