Randomized Controlled Trial to Compare the Safety and Efficacy of Tamsulosin, Solifenacin, and Combination of Both in Treatment of Double-J Stent-Related Lower Urinary Symptoms
Purpose. We evaluated the effectiveness and safety of tamsulosin, solifenacin, and combination of both in reducing double-J stent-related lower urinary symptoms. Materials and Methods. A total of 338 patients with double-J ureteral stenting were randomly divided, postoperatively, into 4 groups. In group I ( ), no treatment was given (control group), group II ( ) received tamsulosin 0.4？mg daily, group III ( ) received solifenacin 10？mg daily, and group IV ( ) received a combination of both medications. Before insertion and 2 weeks after, all patients completed the International Prostate Symptom Score (IPSS), quality of life component of the IPSS (IPSS/Qol), Overactive Bladder Questionnaire (OAB-q), and Visual Analogue Pain Scale (VAPS) questionnaire. Results. The demographics and preoperative questionnaires scores of all groups were comparable. There were statistically significant differences in all scores in favour of groups II, III, and IV as compared to control group ( value < 0.005). Group IV showed statistically significant differences in total IPSS, QoL score, and OAB-q score as compared to groups II and III ( value < 0.001). Conclusions. Combined therapy of tamsulosin and solifenacin significantly alleviated lower urinary symptoms associated with double-J stents as compared to either medication alone. 1. Introduction The double-J stents are common tools and integral part used in endourologic practices. Double-J stents play a major role in a wide range of situations to prevent or to relieve ureteral obstruction [1, 2]. Despite the usefulness of double-J stent, some of the patients might encounter stent-related morbidities such as urinary tract infection (UTI), lower urinary tract symptoms (LUTS), stent-related body pain, and hematuria. These symptoms represent a prevalent problem with considerable effects on the quality of life, substantial general health, work performance, and sexual matters in both genders [3–5]. The pathophysiology of stent-related symptoms remains unclear. However, the pain and LUTS caused by stent placement has been attributed to lower ureter and bladder spasm due to local irritation of the stent [6]. Some previous studies indicated oral agents such as alpha-1-blockers and antimuscarinic agents to relieve LUTS associated with double-J ureteral stents [7–10]. Tamsulosin acts as a selective inhibitor of α-1a/1d-mediated contraction of the smooth muscles in distal ureter, bladder trigone, and bladder neck [11]. It is thought that relaxing these smooth muscles decreases bladder outlet resistance and voiding pressure, with
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