The results of a meta-analysis published in the Journal of Urology confirm that alpha-blockers reduce pain and urinary symptoms and improve quality of life (QoL) in patients with indwelling ureteral stents.
The researchers note that ureteral stents are routinely used to resolve ureteral obstruction caused by various aetiologies; they are however associated with a reduction in quality of life in 45-80% of patients, mainly as a result of urinary symptoms (in about 78%) and/or pain (reported in about 80%). It is thought that the administration of a selective alpha blocker may prevent stent-related urinary symptoms and preserve sexual function and general health. The purpose of this systematic review and meta-analysis was to assess the efficacy of alpha blockers in patients with an indwelling ureteral stent, including the most recent evidence available.
The research team performed a search of MEDLINE, Embase and The Cochrane Library plus a hand search of conference proceedings from January 2000 to October 2010 to identify RCTs evaluating the effect of alpha-blockers versus control (placebo or no treatment) on symptoms and QOL in patients with a ureteral stent. Abstracts presented but not yet published were also included in the review (4 studies), and no language restriction was applied. A total of 12 RCTs evaluating tamsulosin (7 studies) and/or alfuzosin (5 studies) met the inclusion criteria; these involved 946 participants overall. Four trials (n=341) were placebo-controlled and reported the ureteral stent symptom questionnaire (USSQ) as an outcome measure; these were used for the quantitative meta-analysis. The other eight studies provided qualitative information.
The meta-analysis showed that alpha-blockers (alfuzosin in three studies and tamsulosin in one) were associated with a decrease in urinary symptoms (mean difference of -6.76 versus control; 95% CI -11.52 to -2.00; p=0.005), a decrease in pain (mean difference of -3.55; 95% CI -5.51 to -1.60; p=0.0004) and an improvement in general health (mean difference of -1.90; 95% CI -3.05 to -0.75; p=0.001), as assessed using the USSQ. There was however no evidence of a benefit in work (mean difference of 2.41; 95% CI -1.62 to 6.44; p=0.24) or sexual matters (mean difference of 0.20; 95% CI -1.06 to 1.45; p=0.33). Eight studies were not included in the meta-analysis, of which 7 showed a significant clinical decrease in urinary symptoms and pain.
In their discussion, the authors conclude that alpha-blockers significantly improve urinary symptoms and QOL in patients with a ureteral stent, and that their results support their use in routine clinical practice. They do however acknowledge the limitations of their study, including variation in ureteral stent types and procedures used, the considerable heterogeneity in the instruments used to measure outcomes (only 50% used the USSQ), the use of different treatment durations and outcome assessment timings, and the use of different alpha-blockers.