The Beneficial Effects of Alpha-Blockers, Antimuscarinics, Beta 3-Agonist, and PDE5-Inhibitors for Ureteral Stent-Related Discomfort: A Systematic Review and Meta-Analysis from KSER Update Series

Abstract

Background and Objectives: Ureteral stents are widely used in the field of urology but can cause varying degrees of side effects. This study utilized a network meta-analysis to evaluate stent-related discomfort (SRD) in patients with alpha-blockers (alfuzosin, tamsulosin, and silodosin), antimuscarinics (solifenacin), beta 3-agonists (mirabegron), and phosphodiesterase 5-inhibitors (tadalafil) versus a placebo. Materials and Methods: Relevant randomized controlled trials (RCTs) from 2006 to 2021 were identified from electronic databases, including PubMed, EMBASE, and the Cochrane Library. The following identifiers were included to assess the urinary symptom score (USS): participants (patients with ureteral stents), interventions (patients who took medication for stent discomfort), and outcomes (comparisons of the Ureteric Stent Symptoms Questionnaire (USSQ)). We also executed an independent quality assessment using the Scottish Intercollegiate Guidelines Network (SIGN). Results: A total of 16 RCTs were identified, and they included 1865 patients. Compared with the placebo, mirabegron (mean difference (MD): -3.87; 95% confidence interval (CI): -10.6-2.35), tadalafil (MD: -4.47; 95% CI: -10.8-1.63), and silodosin (MD: -4.02; 95% CI: -12-4.01) did not show significant differences to the placebo, whereas others did. Alfuzosin, mirabegron, silodosin, solifenacin, and tadalafil were not inferior to tamsulosin in terms of the USS using Bayesian analyses. In the random effect model, P-score tests showed that solifenacin possessed the highest P-score (p = 0.8484); tamsulosin was the second highest (p = 0.7054). As a result of the rank-probability test, solifenacin was also ranked highest in terms of USS, and tamsulosin was ranked second. Conclusions: Compared with the placebo, solifenacin, tamsulosin, and alfuzosin significantly decreased the USS. In our study, solifenacin may be considered the most effective medication for SRD.

Keywords: network meta-analysis; stents; urolithiasis.

Figure 1

Study flow chart.

Figure 2

Network plots for included studies. A total of 16 RCT articles were identified, including 1865 patients. RCT; randomized controlled trial.

Figure 3

Funnel plots of (A) alfuzosin, (B) mirabegron, (C) solifenacin, (D) tadalafil, and (E) tamsulosin. There was little publication bias in the funnel plots.

Figure 4

Risk of bias for eight RCTs. The risk of bias for each item is presented as a percent across all included studies. RCT: randomized controlled trial.

Figure 5

Risk of bias for eight RCTs. +, no bias; –, bias; ?, bias unknown. RCT: randomized controlled trial [10,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30].

Figure 6

Pairwise meta-analysis of alfuzosin, mirabegron, silodosin, solifenacin, tadalafil, and tamsulosin. The USS of alfuzosin, mirabegron, silodosin, solifenacin, tadalafil, and tamsulosin was lower than that of the placebo. USS: urinary symptom score [10,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30].

Figure 7

Net heat plot for inconsistency. Net heat plot shows little inconsistency within the whole network. PLA, placebo; ALF, alfuzosin; MIR, mirabegron; SOL, solifenacin; TAD, tadalafil; TAM, tamsulosin.

Figure 8

Network meta-analysis of each medication for USS; Compared with (A) placebo, (B) alfuzosin, (C) mirabegron, (D) silodosin, (E) solifenacin, (F) tadalafil, and (G) tamsulosin. Compared with the placebo, mirabegron (MD: −3.87, 95% CI: −10.6 to 2.35), tadalafil (MD: −4.47, 95% CI: −10.8 to 1.63), and silodosin (MD: −4.02, 95% CI: −12 to 4.01) did not show significant differences, whereas others did. All medications had insignificant differences, except for the placebo, compared with solifenacin. Alfuzosin, mirabegron, silodosin, solifenacin, and tadalafil were not inferior to tamsulosin in the USS using Bayesian analyses. MD, mean difference; USS, urinary symptom score; CI, confidence interval.

Figure 9

The rank-probability test. In the rankogram, solifenacin also had the highest rank for USS, followed by tamsulosin. USS, urinary symptom score.