The first indwelling endoluminal ureteral stent was described over 30 years ago and has since become a routine and indispensable urologic tool. However, the side effects and patient morbidity associated with ureteral stents are not insignificant.
Efforts have been made to utilize validated questionnaires for the assessment of stent relayed symptoms mainly to aid in developing a more tolerable stent material and design. In a recent study by C. Deliveliotis and colleagues from Athens, Greece, the ability of alfuzosin to alleviate stent-related symptoms was examined. The study is published in the January 2006 issue of Urology.
The authors hypothesized that a selective alpha1-blocker, such as alfuzosin, might influence stent-related symptoms because the latter mimic the lower urinary tract symptoms due to benign prostatic hyperplasia. In the study, 100 patients, 50 men and 50 women, with a mean age of 54.2 years, with unilateral ureteral stone-related hydronephrosis who underwent insertion of a double-J ureteral stent were prospectively randomized into two groups. The patients in group 1 received 10 mg of alfuzosin once daily for 4 weeks, while patients in group 2 received a placebo. All patients were given this time to spontaneously pass their stones which were less than 10 mm at presentation. During the stenting period, analgesic use was recorded and the patients completed the validated Ureteral Stent Symptom questionnaire 4 weeks after stent insertion
Analysis of results revealed that of the 100 patients, 69 had spontaneous expulsion of the calculus, and 31 opted for ESWL (16 patients) or ureteroscopic stone extraction (5 patients). The mean urinary symptom index was significantly less in patients taking alfuzosin. Urinary frequency, urgency, and nocturia were present significantly less in group 1, and urge incontinence was marginally less. However, non-urge incontinence, incomplete bladder emptying, and dysuria were not significantly influenced by alfuzosin. Both groups reported similarly mixed (equally satisfied and dissatisfied) feelings about living their life with a stent.
Stent-related pain was more frequently reported in patients in group 2 than in group 1 (66% versus 44%), but the overall intensity as identified on the visual analog scale was similar between the two groups. However, the mean pain index was significantly less in patients taking alfuzosin (14.6 versus 16.6). Both groups were similar in days off of work and in the ability to engage in sexual activity. Less pain with sexual activity was reported in the alfuzosin group and this was significant. The mean global quality-of-life score with the stent in situ was similar in both groups of patients.
In summary, the placement of indwelling ureteral stents has become routine in the management of a variety of urinary tract diseases. The ideal stent is not yet available, and stent-related symptoms are frequently reported. The administration of a selective alpha1-blocker, such as alfuzosin, improves stent-related urinary symptoms and pain. In addition, it was demonstrated that patients’ sexual function and general health were better preserved. These conclusions might have implications in terms of patient counseling and routine clinical practice.