Alpha-blockers may aid QoL after double-J stent

Berlin-The results of a recent study demonstrate that treatment with alpha-blockers has a positive effect on several debilitating symptoms associated with urination in patients receiving double-J stents, according to Greek researchers presenting their work at the European Association of Urology annual congress here.

Evangelos Mazaris, MD, and his team of researchers from the Second Department of Urology, Sismanoglio Hospital, University of Athens, conducted a study comparing the effects of the two alpha-blockers in order to assess the symptoms and quality of life in patients undergoing insertion of double-J stents.

The study comprised 150 patients (75 men, 75 women) who had unilateral urethral stone-related hydronephrosis, and had opted for conservative treatment with insertion of a double-J ureteral stent. Patients were prospectively randomized into three groups of 50 patients each. The patients in two treatment groups received alfuzosin (Uroxatral), 10 mg, and tamsulosin (Flomax), 0.4 mg, respectively, once a day for 4 weeks. A third group of patients served as the control group and did not receive an alpha-blocker. Four weeks after stent placement, all patients completed a validated ureteral stent symptom questionnaire (USSQ).

Another option

The possible treatments for stent side effects are either the administration of analgesics or stent removal. Dr. Mazaris said that the alpha-blockers work by effecting a relaxation of the lower urinary tract muscles as well as the area around the double-J stent. This is why such a clear improvement of the symptoms could be seen.

"The whole idea behind this study is that we are trying to show that these symptoms, as well as the morbidity seen after the insertion of double-J stents, are comparable to symptoms of benign prostatic hypertrophy. So that is why we started to use alpha-blockers. The results of this study clearly demonstrate the great benefits of alfuzosin as well as tamsulosin in our patients, but further studies are needed in order to refine the exact role of alpha-blockers in the management of stent-related symptoms," Dr. Mazaris explained.

P.J. Conort, MD, of the department of urology at Pitie-Salpetriere Hospital, Paris, and comoderator of the session, asked if parasympathomimetic drugs were tested and compared to the alpha-blockers in this special subset of patients.

"No, not yet, but we intend to," Dr. Mazaris replied. "The study is always ongoing and we plan on testing and comparing these drugs and their effects."

W.L. Strohmaier, MD, of the department of urology, Landkrankenhaus Coburg, Germany, asked Dr. Mazaris if he could explain the beneficial effect on patients' sexual function.

"My explanation actually is that the morbidity after the double-J stent insertion can inhibit or prohibit the people from functioning well in their sexual lives," he said. "So if we try to alleviate those symptoms or we try to improve those symptoms and the pain perceived from the stent insertion is less, then the sexual function will become far better. Another explanation I can offer you is that we noticed that alfuzosin especially had a beneficial effect on lowering retrograde ejaculation as well."