Management of stent-related symptoms with the use of α-blockers: A meta-analysis

Konstantinos Deliveliotis; Athanasios G Papatsoris; Andreas Skolarikos; Iraklis Mitsogiannis; Kimon Tzannis; Athanasios E Dellis

doi:10.1080/2090598X.2019.1690824

Management of stent-related symptoms with the use of α-blockers: A meta-analysis

Arab J Urol. 2019 Nov 14;18(1):14-21. doi: 10.1080/2090598X.2019.1690824. eCollection 2020.

Authors

Konstantinos Deliveliotis¹, Athanasios G Papatsoris¹, Andreas Skolarikos¹, Iraklis Mitsogiannis¹, Kimon Tzannis², Athanasios E Dellis^{3

4}

Affiliations

¹ 2nd Department of Urology, Sismanogleion General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
² Department of Clinical Therapeutics, University of Athens, National and Kapodistrian University of Athens Alexandra Hospital, Athens, Greece.
³ 1st Department of Urology, Laikon General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
⁴ 2nd Department of Surgery, Aretaieion Academic Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Abstract

Objectives: To assess the effectiveness of α-blockers at reducing stent-related morbidity compared to placebo using the Ureteric Symptom Score questionnaire (USSQ) at particular time points as originally set by the developers of the USSQ. Materials and methods: We conducted the study following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Eligible articles were identified by a search of the Medical Literature Analysis and Retrieval System Online (MEDLINE) database for the period from 1 January 2006 to 30 November 2018. The search strategy included specific keywords and only articles in English were considered eligible. A meta-analysis of randomised controlled trials was done according to methodological quality, placebo-control use, and USSQ completion at the time points of 1 and 4 weeks after insertion, and 4 weeks after stent removal. The mean differences with 95% confidence intervals were calculated for outcomes, with a P < 0.05 considered statistically significant. Results: In all, eight papers were included for analysis. At 1 week after stent insertion, α-blockers were associated with a significant decrease in the USSQ Urinary Index score (UIS), Pain Index score, General Health Index score (GHIS), Sex Index score, and Work Index score (WIS). At 4 weeks after stent insertion, α-blockers were associated with a significant decrease in the UIS, GHIS and WIS only, whilst at 4 weeks after stent removal, α-blockers were associated with a significant decrease in the UIS and GHIS. Conclusions: The oral administration of α-blockers or their combinations have been shown to relieve stent morbidity, especially during the early period of stenting. The use of selective agents can therefore be considered; however, there is still the need for uniformly designed multi-centre randomised studies. Abbreviations: MD: mean difference; QoL: quality of life; RCT: randomised controlled trial; SRS: stent-related symptoms; USSQ: Ureteric Symptom Score questionnaire.

Keywords: meta-analysis; stent-related symptoms; ureteric stent; Α-blockers.

Publication types

Review