The effect of intravesical stent length and Propiverine on ureteral stent related symptoms - Prospective controlled trial

Year 2023, , 30 - 37, 30.01.2023

Osman Can , Mustafa Erkoç , Eyyüp Danış , Muammer Bozkurt , Alper Ötünçtemur , Halil Lütfi Canat

https://doi.org/10.54233/endouroloji.1195139

Abstract

Objective: Ureteral double J stents are widely utilized in urolithiasis. Disturbing stent-related symptoms may occur while the stent is in location. Various medical agents and stent-related solutions were examined for this problem. However, a definite drug has still not been found. We aimed to research the effect of propiverine on stent-related symptoms.
Material and Methods: Patients who underwent ureteroscopic stone surgery between June 2020 and May 2022 were included in the study. While the control group was untreated, the treatment group received 45 mg of propiverine daily after 1 week of the operation. Stent-related symptoms were assessed by ureteral stent symptom questionnaire (USSQ) at the end of 1st week and 3rd week of surgery. In addition, the intravesical stent parts of all patients were quantitatively measured with a ruler during stent removal at the end of 3 weeks.
Results: A total of 177 patients were assessed in the study. Eighty-seven patients were control and 90 patients of them were treatment group. According to USSQ, urinary symptoms scores, body pain scores, general health scores, work performance scores, sexual health scores, additional problem scores, and global quality of life (QoL) scores were found to decrease in the treatment group (p<0.001 All domains). Intravesical stent length was found positive correlation with the urinary symptom score (1st week) of all patients.
Conclusion: Stent-related symptoms are more likely in patients with longer intravesical stent length. Propiverine successfully relieves stent-related symptoms.

Keywords

Propiverine, Stent related symptom, Double J stent, USSQ

Üreteral stent ilişkili semptomlara intravezikal stent uzunluğunun ve Propiverin’in etkisi- Prospektif kontrollü çalışma

Abstract

Amaç: Üreteral double J stentler taş hastalıklarında sıklıkla kullanılmaktadır. Stent normal lokalizasyonunda iken stent ilişkili rahatsız edici sempomlara neden olabilmektedir. Bu problem için çeşitli medikal ajanlar ve stent ilişkili çözümler araştırılmıştır. Ancak hala kesin bir ilaç bulunamamıştır. Biz stent ilişkili semptomlar üzerinde propiverinin etkisini araştırmayı amaçladık.
Gereç ve Yöntemler: Çalışmaya haziran 2020 ile mayıs 2022 tarihleri arasında üreteroskopik taş cerrahisi yapılan hastalar dahil edildi. Kontrol grubu tedavi almaz iken tedavi grubu operasyonun 1. haftasından sonra günlük 45 mg propiverin aldı. 1. ve 3. haftanın sonunda stent ilişkili semptomlar üreteral stent semptom anketi (USSQ) ile değerlendirildi. Ek olarak tüm hastaların 3. Hafta sonunda stent alınması sırasında intravezikal stent kısımları cetvel ile ölçüldü.
Bulgular: Çalışmada toplamda 177 hasta değerlendirildi. Bunlardan 87si kontrol grubunu oluştururken 90 hasta tedavi grubunu oluşturdu. USSQ skorlarına göre, üriner semptom skorları, vücut ağrı skorları, genel sağlık skorları, iş performansı skorları, cinsel sağlık skorları, ek problemler skoru ve global hayat kalitesi skoru tedavi gruplarında azalmış bulundu (p<0,001 tüm alanlarda). Tüm hastalarda intravezikal stent uzunluğu 1. hafta sonundaki üriner semptom skoru ile pozitif korele olarak bulundu.
Sonuç: Stent ilişkili semptomlar intravezikal stent boyu daha uzun olanlarda daha fazladır. Propiverin stent ilişkili semptomları başarılı şekilde rahatlatmaktadır.

Keywords

Stent ilişkili semptom, Propiverin, Double J stent, USSQ

References

• Zimskind PD, Fetter TR, Wilkerson JL. Clinical use of long-term indwelling silicone rubber ureteral splints inserted cystoscopically. J Urol. 1967;97:840-844.
• Joshi HB, Newns N, Stainthorpe A, MacDonagh RP, Keeley FX, Timoney AG. Ureteral stent symptom questionnaire: Development and validation of a multidimensional quality of life measure. J Urol. 2003;169:1060-4.
• Ritter M, Krombach P, Knoll T, Michel MS, Haecker A. Initial experience with a newly developed antirefluxive ureter stent. Urol Res. 2012;40:349-53. 
• Dellis A, Joshi HB, Timoney AG, Keeley FX. Relief of stent related symptoms: Review of engineering and pharmacological solutions. Journal of Urology. 2010;184:1267-72.
• Park SC, Jung SW, Lee JW, Rim JS. The effects of tolterodine extended release and alfuzosin for the treatment of double-j stent-related symptoms. J Endourol. 2009;23:1913-7.
• Lee YJ, Huang KH, Yang HJ, Chang HC, Chen J, Yang TK. Solifenacin improves double-J stent-related symptoms in both genders following uncomplicated ureteroscopic lithotripsy. Urol Res. 2013;41:247-52.
• Huang W, Zong H, Zhou X, Wang T, Zhang Y. Efficacy and Safety of Propiverine Hydrochloride for Overactive Bladder in Adult: a Systematic Review and Meta-analysis. Indian Journal of Surgery. 2015;77:369-77. 
• Gotoh M, Yokoyama O, Nishizawa O. Propiverine hydrochloride in Japanese patients with overactive bladder: A randomized, double-blind, placebo-controlled trial. Int J Urol. 2011;18:365-73.  
• Zhu HL, Brain KL, Aishima M, Shibata A, Young JS, Sueishi K, et al. Actions of two main metabolites of propiverine (M-1 and M-2) on voltage-dependent L-type Ca2+ currents and Ca2+ transients in murine urinary bladder myocytes. J Pharmacol Exp Ther. 2008;324:118-27.
• Yoshida M, Homma Y, Inadome A, Yono M, Seshita H, Miyamoto Y, et al. Age-related changes in cholinergic and purinergic neurotransmission in human isolated bladder smooth muscles. Exp Gerontol. 2001;36:99-109.
• Giannarini G, Keeley FX, Valent F, Manassero F, Mogorovich A, Autorino R, et al. Predictors of morbidity in patients with indwelling ureteric stents: Results of a prospective study using the validated Ureteric Stent Symptoms Questionnaire. BJU Int. 2011;107:648-54.
• Movassaghi K, Shah SH, Cai J, Miranda G, Fernandez J, Duddalwar V, et al. Incisional and Parastomal Hernia following Radical Cystectomy and Urinary Diversion: The University of Southern California Experience. J Urol. 2016;196:777-81.
• Tanidir Y, Mangir N, Sahan A, Sulukaya M. Turkish version of the Ureteral Stent Symptoms Questionnaire: linguistic and psychometric validation. World J Urol. 2017;35:1149-1154.  
• Haleblian G, Kijvikai K, De La Rosette J, Preminger G. Ureteral stenting and urinary stone management: A systematic review. Journal of Urology. 2008;179:424-30. [Crossref]
• Hao P, Li W, Song C, Yan J, Song B, Li L. Clinical evaluation of double-pigtail stent in patients with upper urinary tract diseases: Report of 2685 cases. J Endourol. 2008;22:65-70.  
• Koprowski C, Kim C, Modi PK, Elsamra SE. Ureteral stent-associated pain: A review. Journal of Endourology. 2016;30:744-53.  
• Pais VM, Smith RE, Stedina EA, Rissman CM. Does Omission of Ureteral Stents Increase Risk of Unplanned Return Visit? A Systematic Review and Meta-Analysis. J Urol. 2016;196:1458-1466.
• Lamb AD, Vowler SL, Johnston R, Dunn N, Wiseman OJ. Meta-analysis showing the beneficial effect of α-blockers on ureteric stent discomfort. BJU Int. 2011;108:1894-902. [Crossref]
• Yakoubi R, Lemdani M, Monga M, Villers A, Koenig P. Is there a role for α-blockers in ureteral stent related symptoms? A systematic review and meta-analysis. J Urol. 2011;186:928-34.
• Shalaby E, Ahmed AF, Maarouf A, Yahia I, Ali M, Ghobish A. Randomized controlled trial to compare the safety and efficacy of tamsulosin, solifenacin, and combination of both in treatment of double-J stent-related lower urinary symptoms. Adv Urol. 2013;2013:752382.
• Park J, Yoo C, Han DH, Shin DW. A critical assessment of the effects of tamsulosin and solifenacin as monotherapies and as a combination therapy for the treatment of ureteral stent-related symptoms: a 2 × 2 factorial randomized trial. World J Urol. 2015;33:1833-40.
• Liu Q, Liao B, Zhang R, Jin T, Zhou L, Luo D, et al. Combination therapy only shows short-term superiority over monotherapy on ureteral stent-related symptoms - outcome from a randomized controlled trial. BMC Urol. 2016;16:66.
• Joshi HB, Okeke A, Newns N, Keeley FX, Timoney AG. Characterization of urinary symptoms in patients with ureteral stents. Urology. 2002;59:511-6.
• Hekal IA. Drug treatment of bothersome lower urinary tract symptoms after ureteric JJ-stent insertion: A contemporary, comparative, prospective, randomised placebo-controlled study, single-centre experience. Arab J Urol. 2016;14:262-268.
• Canda AE, Turna B, Cinar GM, Nazli O. Physiology and pharmacology of the human ureter: Basis for current and future treatments. Urologia Internationalis. 2007;78:289-98.
• Rane A, Saleemi A, Cahill D, Sriprasad S, Shrotri N, Tiptaft R. Have stent-related symptoms anything to do with placement technique? J Endourol. 2001;15:741-5.
• Lingeman JE, Preminger GM, Goldfischer ER, Krambeck AE. Assessing the Impact of Ureteral Stent Design on Patient Comfort. J Urol. 2009;181:2581-7.
• Fischer KM, Louie M, Mucksavage P. Ureteral Stent Discomfort and Its Management. Current Urology Reports. 2018;19:64.