Madarshahian Daniel, Habeeb Abdulrasheed, Chandra-Segaran Nimeshan, Subramonian Kesavapilla, Patel Keval
Department of Urology University Hospitals Birmingham NHS Foundation Trust Birmingham UK.
Department of General Surgery University Hospitals Birmingham NHS Foundation Trust Birmingham UK.
BJUI Compass. 2025 Sep 11;6(9):e2485. doi: 10.1002/bco2.485. eCollection 2025 Sep.
Ureteral stent insertion, crucial for managing ureteral obstructions, often results in stent-related symptoms (SRSs) adversely affecting patient quality of life. This meta-analysis compares the effectiveness of tamsulosin or mirabegron versus placebo in alleviating these symptoms.
Following PRISMA guidelines, we systematically reviewed randomized controlled trials (RCTs) comparing mirabegron or tamsulosin to placebo in managing SRSs. Data sources included PubMed, Embase, Web of Science and CENTRAL, up to November 2023. The inclusion criteria focused on studies reporting on Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), quality of life (QoL) assessments, analgesic usage and adverse events. Meta-analysis employed a random-effects model, assessing heterogeneity and publication bias. For assessing the risk of bias in the included randomized trials, we employed the Cochrane Collaboration's tool. This protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42024511842).
Sixteen RCTs with 1635 patients met the inclusion criteria. Tamsulosin significantly improved body pain (MD -1.80; 95% CI -3.53 to -0.07; = 0.04), sexual function (MD -0.63; 95% CI -1.16 to -0.10; = 0.02) and improved quality of life score (MD -2.36; 95% CI -3.56 to -1.17; = 0.0001), while mirabegron was more effective in reducing urinary symptoms (MD -8.71; 95% CI -15.81 to -1.61; = 0.02), enhancing general health (MD -2.58; 95% CI -3.78 to -1.37; < 0.0001) and reducing analgesia use (MD -1.56; 95% CI -2.70 to -0.41; = 0.008). Both medications significantly reduced total International Prostate Symptom Score (Tamsulosin MD -8.4; 95% CI -15.63 to -1.22; = 0.02; Mirabegron MD -6.29; 95% CI -8.50 to -4.08; < 0.00001) without a significant rise in adverse events (tamsulosin OR 1.90; 95% CI 0.40-9.18; mirabegron = 0.42 and OR 0.93; 95% CI 0.30-2.88; = 0.89).
Tamsulosin and mirabegron effectively manage SRSs, with distinct benefits in different symptom domains. This suggests a potential for complementary therapeutic strategies. Future high-quality RCTs are needed to explore their combined efficacy.
输尿管支架置入术对于处理输尿管梗阻至关重要，但常常会导致与支架相关的症状（SRSs），对患者生活质量产生不利影响。本荟萃分析比较坦索罗辛或米拉贝隆与安慰剂在缓解这些症状方面的有效性。
遵循PRISMA指南，我们系统回顾了比较米拉贝隆或坦索罗辛与安慰剂治疗SRSs的随机对照试验（RCTs）。数据来源包括截至2023年11月的PubMed、Embase、Web of Science和CENTRAL。纳入标准聚焦于报告输尿管支架症状问卷（USSQ）、国际前列腺症状评分（IPSS）、生活质量（QoL）评估、镇痛药物使用及不良事件的研究。荟萃分析采用随机效应模型，评估异质性和发表偏倚。为评估纳入的随机试验中的偏倚风险，我们采用了Cochrane协作组的工具。本方案已在国际前瞻性系统评价注册库注册（注册号：CRD42024511842）。
16项RCTs（共1635例患者）符合纳入标准。坦索罗辛显著改善了身体疼痛（MD -1.80；95% CI -3.53至-0.07；P = 0.04）、性功能（MD -0.63；95% CI -1.16至-0.10；P = 0.02）并提高了生活质量评分（MD -2.36；95% CI -3.56至-1.17；P = 0.0001），而米拉贝隆在减轻尿路症状方面更有效（MD -8.71；95% CI -15.81至-1.61；P = 0.02），增强总体健康状况（MD -2.58；95% CI -3.78至-1.37；P < 0.0001）并减少镇痛药物使用（MD -1.56；95% CI -2.70至-0.41；P = 0.008）。两种药物均显著降低了国际前列腺症状总分（坦索罗辛MD -8.4；95% CI -15.63至-1.22；P = 0.02；米拉贝隆MD -6.29；95% CI -8.50至-4.08；P < 0.00001），且不良事件无显著增加（坦索罗辛OR 1.90；95% CI 0.40 - 9.18；米拉贝隆P = 0.42且OR 0.93；95% CI 0.30 - 2.88；P = 0.89）。
坦索罗辛和米拉贝隆可有效管理SRSs，在不同症状领域有不同益处。这提示了互补治疗策略的可能性。未来需要高质量的RCTs来探索它们的联合疗效。
