Meta-analysis showing the beneficial effect of α-blockers on ureteric stent discomfort.

OBJECTIVES To evaluate the efficacy of alpha-blockers with respect to improving stent-related symptoms. Ureteric stents remain a source of marked discomfort and their placement is often required after certain ureteroscopic procedures or in the acute setting. This analysis identifies and reviews the several studies that have investigated the role of alpha-blockers after stent placement. MATERIALS AND METHODS Pubmed/Medline, EMBASE, CINAHL and Cochrane Library databases were scrutinized using standard MeSH headings. Randomized or controlled trials comparing alpha-blockers with control or standard therapy were included. In all studies, patients completed the Ureteral Stent Symptom Questionnaire (USSQ). The study data were independently reviewed by two assessors. RESULTS In total, five studies of varying quality were identified, including 461 patients receiving either tamsulosin or alfuzosin, or control. On meta-analysis, all five studies showed a reduction in USSQ urinary symptom score and body pain scores. There was mean reduction of 8.4 (95% CI, 5.6-11.1) in the urinary symptom score and 7.2 (95% CI, 2.511.8) in the body pain score. In three studies, the numbers of patients experiencing stent related pain were stated: 45% (51/114) of patients receiving an a blocker experienced painful episodes within the follow-up period defined for that study compared to 76% (88/116) in the control groups, which is equivalent to a relative risk of pain of 0.59 (95% confidence interval, 0.47-0.71). There were also reductions in other aspects of the USSQ, such as the general health score and sexual matters score, although these were not statistically significant or uniformly reported. CONCLUSION There is evidence that alpha-blockers provide an improvement in discomfort after placement of a ureteric stent.