Comparative Study of Tamsulosin, Solifenacin and Combination Therapy in the Treatment of Double –J Stent Related Symptoms
Introduction: The double-J ureteral stent had been widely used during the endourologic surgery to relieve or prevent ureteral obstruction. Despite the usefulness of stents, however, patients experience various stent related symptoms, such as pain, frequency, and urgency etc.Several attempts to minimize stent-related symptoms have recently been reported. Pharmacologic management is one such trial, especially the prescription of selective alpha-1-blockers and antimuscarinic agents.
Aim: To evaluate the effectiveness of tamsulosin, solifenacin and combination of both drugs in relieving double-J stent related lower urinary tract symptoms.
Materials and Methods: A prospective study of patients with placement of double –J ureteral stent after retrograde ureteroscopy for urinary stone disease is to be conducted. All patients receive polyurethane double-J ureteral stents (5 Fr, 26 cm), which were removed at a mean of 2 weeks duration postoperatively. All patients are to be randomly assigned, post operatively, into 5 groups. Patients in Group I having symptoms receive no treatment and serve as the control group, Group II patients receive tamsulosin 0.4 mg daily, Group III patients receive solifenacin 5 mg daily, Group IV patients receive a combination of both drugs and group V patients being asymptomatic receive no treatment. At 1 day postoperatively and at 2 weeks, all patients complete International Prostate Symptom Score/Quality of Life (IPSS/QoL) and visual analogue pain scale (VAPS) questionnaires.
Results: A total of 168 patients were enrolled in the study, while 8 patients in group 5 being asymptomatic were not included in statistical analysis. There was a significant difference in the IPSS irritative score in group IV as compared to groups I and II but not with group III. There was a significant difference in the IPSS obstructive score and VAPS score in group IV as compared to group I and III, while it was not significant with group III. Group IV showed statistically significant differences in total IPSS, QoL score as compared to groups I, II and III
Conclusion: Combination therapy with tamsulosin and solifenacin should be strongly considered for patients who complain of stent-related symptoms. In the future, large-scale, prospective, and randomized study will be needed.