Management of Ureteral Stent Discomfort in Contemporary Urology Practice.

INTRODUCTION

Ureteral stents are used ubiquitously in routine urological practice, and despite their long-standing clinical use, stent associated urinary symptoms and pain continue to be of significant concern for patients. Therefore, we reviewed contemporary randomized controlled trials and meta-analyses investigating the alleviation of urinary stent symptoms.

METHODS

A thorough search of randomized controlled trials and meta-analyses of pharmacotherapeutic means of alleviating urinary stent symptoms was conducted and reviewed. Efforts were made to evaluate the quality of studies based on methodology and tools used to assess symptoms.

RESULTS

Our search resulted in 16 published reports that fit our criteria. Of these randomized controlled trials 13 involved oral agents while 3 studies evaluated intravesical therapies. Specific pharmacological classes that were assessed included nonsteroidal anti-inflammatory drugs, anesthetics, alpha-antagonists, anticholinergics and paralytics. The majority of randomized controlled trials evaluated the role of alpha-antagonists, which ultimately produced the most compelling evidence of a reduction in stent associated lower urinary tract symptoms and pain. The randomized controlled trials involving anticholinergic agents have produced inconsistent results.

CONCLUSIONS

Stent associated symptoms are a significant source of dissatisfaction for patients undergoing urological procedures. Numerous agents have been studied and uroselective alpha-antagonists have most consistently demonstrated a significant reduction in symptoms.