Effects of α-Blockers, Antimuscarinics, or Combination Therapy in Relieving Ureteral Stent-Related Symptoms: A Meta-Analysis

PURPOSE: We evaluated the effects of α-blockers, antimuscarinics, or a combination of both in reducing ureteral stent-related symptoms. METHODS: The relevant studies were identified by searching MEDLINE, EMBASE and Cochrane Library Database from January 2000 to May 2014. Randomized controlled trials evaluating effects of α-blocker, antimuscarinic, and combination therapy for stent-related symptoms were included. Two reviewers independently screened studies and extracted data. RESULTS: A total of 13 articles were identified including 1408 patients. There were statistically significant differences in urinary symptom (-6.37; P<0.0001) and body pain index score (-7.03; P=0.0008) of the Ureteral Stent Symptom Questionnaire (USSQ), total International Prostate Symptom Score (IPSS) (-4.16; P=0.0006), Visual Analogue Pain Scale (VAPS) score (-2.48; P<0.00001), and quality of life (QoL) (-1.42; P=0.0009) in favor of the α-blocker group. Antimuscarinics alone vs the control group showed significant improvement in total IPSS (mean difference [MD]: -3.76; 95% confidence interval [CI], -5.08 to -2.43; P<0.00001) and QoL (MD: -0.82; 95% CI, -1.31 to -0.32; P=0.001). Compared with α-blockers monotherapy, combination therapy has significant lower total IPSS (MD: -3.74; 95% CI, -4.94 to -2.54; P<0.00001), VAPS (MD: -0.50; 95% CI, -0.89 to -0.11; P=0.01), and QoL (MD: -0.93; 95% CI, -1.30 to -0.55; P<0.00001). CONCLUSIONS: Our data showed the beneficial effect of α-blockers alone and antimuscarinics alone in reducing stent-related symptoms. Furthermore, we suggested significant advantages of combination therapy of α-blocker and antimuscarinic compared with α-blocker monotherapy. However, more high quality, randomized controlled trials are warranted to better address this issue, however.