DJ ureteral stenting has become a routine practice for every urologist. The main advantages of stenting are preventing ureteral obstruction, permitting ureteral healing, and preventing ureteral stricture.
Despite its useful effects, short-term use of a double-J stent is associated with mild complications. In contrast, the complications became more severe in long-term usage, particularly when placed for more than 6 months. Patients usually complain of various stent-related symptoms, such as frequency, urgency, dysuria, incomplete emptying, flank pain, suprapubic pain, incontinence, and hematuria. These symptoms negatively affect the patient’s activities, work performance, and QoL . The pathogenesis of the DJ stent-related LUTS has not been verified. Multiple theories were proposed to describe these symptoms’ mechanisms; it might be due to smooth muscle spasm in the lower ureter, irritation of nerve endings located in the trigone of urinary bladder submucosa, and bladder instability [11,12,13].
Trials to overcome the DJ stent-related LUTS included using the suitable length of the stent, appropriate placement of upper and lower coils, changing stent material from polyurethane to silicone or other polymers, changing the coating substance or stent design. Pharmacologic management is one of many trials to improve those problems; many medical drugs have been tested, such as anticholinergics, analgesics, and alpha-blockers.
In this trial, we aimed to evaluate the efficacy of alpha-1A blocker (tamsulosin), antimuscarinic (solifenacin), and their combination in the management of DJ stent-related LUTS, using IPSS, QoL, and VAS questionnaires.
Our analysis found that, relative to the control group, both alpha-1A blocker (tamsulosin) and antimuscarinic (solifenacin) monotherapy improved patients’ DJ stent-related LUTS using IPSS, QoL, and VAS questionnaires. However, their combination was much better than either drug alone. These results were consistent with other studies; Lim et al. conducted a retrospective study that stated that combined treatment with tamsulosin and solifenacin improved LUTS more than in the other groups (control, tamsulosin, and solifenacin monotherapy) .
In a prospective, randomized, and controlled study by Shalaby et al., combined treatment with tamsulosin and solifenacin was confirmed to be substantially better than either drug alone in relieving the DJ stents-related LUTS . EL-Nahas et al. indicated that in patients with DJ stents, tamsulosin alone or solifenacin alone could improve the QoL by reducing LUTS related to DJ stents. Solifenacin has shown better efficacy than tamsulosin. They did not study the efficacy of combined treatment .
A meta-analysis performed by Zhou et al. proved a substantial advantage of combined treatment of alpha-blockers and antimuscarinics compared with alpha-blockers monotherapy. Also, they stated a beneficial effect of alpha-blockers alone and antimuscarinics alone in relieving the ureteric stent-related LUTS. After all, higher quality, randomized controlled trials have been recommended to deal with this subject .
Liu et al. reported that in the first few days, combination therapy was affected quicker than monotherapy. Based on this analysis, the combination treatment was suggested for patients with severe symptoms at the start . Another study by Dellis et al. reported that tamsulosin and solifenacin monotherapy or combined treatment relieve the DJ stent-related LUTS and improve the QoL .
In contrast, Lee et al., a prospective randomized study using a combined treatment of tamsulosin and tolterodine, informed no statistically significant difference compared to placebo. The combined treatment showed no benefit when compared to tamsulosin alone. In their view, the DJ stent’s correct positioning was more important than pharmacotherapy for relieving the DJ stent-related LUTS .
Also, Park et al. have performed randomized clinical trials to test the effectiveness of tamsulosin, solifenacin and combined treatment in relieving DJ stent-related LUTS. They concluded that neither tamsulosin nor solifenacin positively affected relieving the DJ stent LUTS .
Another study reported that anticholinergic (tolterodine) was not different from anti-inflammatory, spasmolytic, and alpha-blockers regulating DJ stent-related LUTS . In contrast to this result, a prospective randomized controlled study by Park et al. stated that the anticholinergic (tolterodine ER) and alpha-blocker (alfuzosin) relieving the DJ stent-related urinary symptoms .
The heterogeneity due to differences in surgical procedures was the key drawback of our report. For instance, post-ureteroscopy DJ placement leads to less pain and hematuria than post-PNL.