A Comparative Analysis of Mirabegron versus Tolterodine for the Management of Irritative Symptoms Caused by Ureteral Stents

Background: The use of ureteral stents is a common practice in the management of urinary tract obstruction. However, the presence of a stent often leads to irritative lower urinary tract symptoms (LUTS), significantly impacting the patient's quality of life. Traditional management with anticholinergics is limited by side effects, whereas beta 3 agonists like Mirabegron offer a potentially more tolerable alternative. Objective: To compare the efficacy and tolerability of Mirabegron versus Tolterodine in the management of irritative symptoms associated with ureteral stents. Methods: This prospective randomized controlled trial was conducted at the Department of Urology and Renal Transplant, Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, from January 2019 to August 2020. A total of 104 patients who had undergone ureteral stent placement were randomized into two groups: Mirabegron (52 patients) and Tolterodine (52 patients). Inclusion criteria included individuals aged 18 years or older without prior LUTS history. The primary outcome measured was the change in the International Prostate Symptom Score (IPSS) Irritative score from baseline to post-treatment. Data analysis was conducted using SPSS version 25, with paired and unpaired t-tests for within and between-group comparisons, respectively. Results: The mean age in the Mirabegron group was 29.44 ± 6.25 years, and 28.23 ± 5.97 years in the Tolterodine group. Pre-treatment IPSS Irritative scores were 9.19 ± 3.72 for Mirabegron and 9.88 ± 3.5 for Tolterodine. Post-treatment, scores reduced to 3.27 ± 1.34 in the Mirabegron group and 4.13 ± 1.47 in the Tolterodine group. The change in IPSS Irritative score was 5.92 ± 2.46 for Mirabegron and 5.75 ± 2.10 for Tolterodine, with no significant difference between groups (p > 0.05). Conclusion: Mirabegron is as effective as Tolterodine in reducing irritative LUTS in patients with ureteral stents, with a comparable side effect profile. These findings support Mirabegron as a viable alternative for patients experiencing LUTS due to ureteral stents.