Impact of Tamsulosin, Tolterodine and drug-combination on the outcomes of lower urinary tract symptoms secondary to post-ureteroscopy ureteral stent: A prospective randomized controlled clinical study

Objectives: To compare the role of alpha-blocker (Tamsulosin) monotherapy, anticholinergic (Tolterodine) monotherapy or combination of both drugs versus analgesics in improving post-ureteroscopy (URS) lower urinary tract symptoms related to double-J ureteral stent.Patients and methods: Between January 2009 and June 2013, 160 consecutive patients with ureteric stones were included in this study at 2 tertiary care centers’. Patients were randomized into 4 groups; group A (n = 40) received 0.4 mg Tamsulosin once a day, group B (n = 40) received 4 mg Tolterodine once a day, group C (n = 40) received Tamsulosin 0.4 mg and Tolterodine 4 mg once a day and group D (n = 40) as a control group, received placebo once a day. All patients received analgesics on demand. Pre-treatment evaluation was done followed by among-groups comparison after 14 days including ureteral stent symptom questionnaire (USSQ) [Urinary symptom index (USI), pain symptom index (PSI), general health index (GHI), work perform index (WPI), need for pain killer (PK), need for analgesia, visual analogue scale (VAS) for pain and quality of life (QOL)]. Side effects were recorded and compared.Results: Out of 160 patients, 153 patients (40, 38, 37 and 38 patients in groups A, B, C and D, respectively) completed the study with a mean age of 34.3 ±7.6 (20–50) years. All groups were comparable in terms of age, gender, stone size and stone location, USSQ items and QOL. After 14 days, the USSQ and QOL were significantly lower in group A, B and C in comparison with group D (p < 0.05). Patients in group C had significantly much improvement than those of groups A and B (p < 0.05).Conclusion: Combination of alpha blockers (Tamsulosin) and Anticholinergics (Tolterodine) seems to significantly improve post-URS lower urinary tract symptoms secondary to ureteral stents with lower need for analgesia and better quality of life. Adverse effect of used drugs mentioned as transient and tolerated by the patients without need for auxiliary medication.Keywords: Anticholinergics; α-Adrenergic blockers; Ureter stent; Ureteroscop