Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Scott Department of Urology, Baylor College of Medicine, Houston, Texas.
J Urol. 2023 Nov;210(5):739-749. doi: 10.1097/JU.0000000000003616. Epub 2023 Jul 10.
Ureteral stents are commonly used for the treatment of ureteral obstruction, most often urolithiasis. Their use may be associated with significant bothersome symptoms and discomfort. Prior studies have examined the effects of various medication regimens on ureteral stent symptoms. This study utilized Bayesian network meta-analysis to analyze all available evidence on the pharmacological management of ureteral stent-related symptoms.
In December 2022 a systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines on randomized prospective studies on pharmacological management of ureteral stent-related symptoms reporting outcomes using the Ureteral Stent Symptom Questionnaire score on urinary symptoms and pain. The data were analyzed in Review Manager 5.3 and R Studio where a Bayesian network meta-analysis was performed. Treatments were ranked using surface under the cumulative ranking curve and mean difference vs placebo with 95% credible intervals.
A total of 26 studies were analyzed. These were used to build networks which were modeled to run 100,000 Markov Chain Montecarlo simulations each. Drug-class analysis revealed the most effective class for each domain: for urinary symptoms, sexual performance, general health, and work performance-combined α-blocker and anticholinergic and phosphodiesterase 5 inhibitors; for pain-combined anticholinergic and pregabalin. The following were the most effective drugs and dosages for specific symptoms: for urinary symptoms-combined silodosin 8 mg+solifenacin 10 mg; for pain-combined silodosin 8 mg+solifenacin 10 mg; for sexual performance-tadalafil 5 mg. Combined silodosin 8 mg+solifenacin 10 mg+tadalafil 5 mg has the best general health scores while solifenacin 10 mg had the best work experience scores.
This network meta-analysis demonstrated that the most effective drug therapy is different for each symptom domain. It is important to consider a patient's chief complaint and domains in order to ascertain the optimal medication regimen for each patient. Further iterations of this analysis can be strengthened by trials that directly compare more of these drugs instead of relying on indirect evidence.
输尿管支架常用于治疗输尿管梗阻，最常见的是尿路结石。它们的使用可能与明显的烦扰症状和不适有关。先前的研究已经研究了各种药物治疗方案对输尿管支架症状的影响。本研究利用贝叶斯网络荟萃分析来分析所有关于治疗输尿管支架相关症状的药理学管理的现有证据。
2022 年 12 月，根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南，对报告使用输尿管支架症状问卷评分的尿路症状和疼痛的输尿管支架相关症状的药理学管理的随机前瞻性研究进行了系统评价。使用 Review Manager 5.3 和 R Studio 分析数据，在那里进行了贝叶斯网络荟萃分析。使用排序概率曲线下面积和与安慰剂的平均差异以及 95%可信区间对治疗方法进行排名。
共分析了 26 项研究。这些研究用于构建网络，每个网络都进行了 100,000 次马尔可夫链蒙特卡罗模拟。药物类别分析显示了每个领域最有效的类别：对于尿路症状、性功能、一般健康和工作表现——联合 α-阻滞剂和抗胆碱能药和磷酸二酯酶 5 抑制剂；对于疼痛——联合抗胆碱能药和普瑞巴林。以下是特定症状的最有效药物和剂量：对于尿路症状——联合索利那新 8mg+索利那新 10mg；对于疼痛——联合索利那新 8mg+普瑞巴林；对于性功能——他达拉非 5mg。联合索利那新 8mg+索利那新 10mg+他达拉非 5mg 具有最佳的总体健康评分，而索利那新 10mg 具有最佳的工作体验评分。
这项网络荟萃分析表明，每种症状领域的最有效药物治疗方法不同。为了确定每个患者的最佳药物治疗方案，考虑患者的主要抱怨和领域非常重要。通过直接比较更多这些药物的试验可以加强这种分析的进一步迭代，而不是依赖间接证据。
