Addition of anticholinergic to alpha-blocker ‘fails to provide any benefit’
Madison, WI—Adding an anticholinergic medication to an alpha-blocker does not appear to improve ureteral stent-related discomfort compared to monotherapy with an alpha-blocker alone, according to research presented by investigators from the University of Wisconsin, Madison.
The potential for the drug combination to improve stent-related subjective morbidity was evaluated in a prospective, randomized, double-blind study in which patients were assigned to treatment with tamsulosin (Flomax), 0.4 mg alone or with tolterodine ER (Detrol LA), 4 mg. Outcomes were assessed using the validated Urinary Stent Symptom Questionnaire (USSQ), which was completed on the day of surgery prior to stent placement, the day after stent placement, the morning of stent removal, and the day after stent removal.
Data were analyzed from a total of 80 patients who completed all assessments with a focus on mean scores for the urinary symptoms, activities of daily living, quality of life, and body pain domains. Compared to baseline, mean scores for all four domains were significantly worse on post-op day 1 in both treatment groups and then improved by the day of stent removal.
Between-group comparisons showed the mean activities of daily living score was significantly worse in the combination group on post-op day 1 compared to the monotherapy group. Otherwise, there were no significant differences between the two treatment groups in the mean scores for any of the domains at any time point, reported first author Necole M. Streeper, MD, endourology fellow at the University of Wisconsin School of Medicine and Public Health.
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Further research needed
“Patients with a ureteral stent often experience urinary symptoms that may be related to irritation caused by the presence of the distal coil in the bladder, and there is some previous evidence showing treatment with tamsulosin improves that discomfort. We hypothesized that adding an anticholinergic agent might be helpful as well, but in our study it failed to provide any benefit,” said Dr. Streeper, who worked on the study with Stephen Y. Nakada, MD, and colleagues.
“However, the worsening in symptoms, function, and quality of life in both groups after stent placement does suggest the need for further research to evaluate and improve stent-related discomfort.”
The study, which was presented at the 2014 AUA annual meeting in Orlando, FL, excluded patients who had a history of ureteral stent placement and those on existing anticholinergic medication. Appropriate stent placement was confirmed intraoperatively through fluoroscopy.
Patients in the study had a mean age of 50 years. Median duration of stent placement was 9.1 days in the combination group and 9.0 days in the monotherapy group. There was no significant relationship between stent duration and USSQ results.
Dr. Streeper noted that while patients were not asked to complete the USSQ on a daily basis, considering the mechanism of action of the anticholinergic medication and the expected time to onset of effect, any benefit from its use would most likely be observed just prior to stent removal.
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