Nephrology & Urology Xagena

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Ureteral stent-associated pain: alpha-blockers, anti-muscarinics and NSAIDs reduce symptoms

Ureteral stent-related pain is a well-known side effect of stent placement. To date, there is a paucity of resources that address this topic.

Stent pain pathophysiology is multifactorial and likely a result of mucosal irritation along with retrograde reflux of urine. While there is a consensus on the lack of association between stent length, diameter and stent-related flank pain, stents should be properly sized so as to prevent dislodgement.

Insufficient data exists comparing stent materials and durometry. Multiple drug-eluting stents are in development and have demonstrated promising early results.

Alpha-blockers have shown efficacious results and should be considered along with or in combination with anticholinergics and NSAIDs in the treatment of ureteral-stent related symptoms, with judicious consideration of their side effect profiles.

Periureteral botulinum toxin A injections are a promising novel treatment modality.

In conclusion, ureteral stent pain is common and multiple modalities have been studied and are in clinical use for its treatment. Care should be taken to avoid placement of stents if possible, with continual reassessment of indications to maintain stents in patients.
Relative heterogeneity among studies and small sample sizes makes creating specific evidence-based pain management recommendations challenging.
Alpha-blockers, anti-muscarinics and NSAIDs are all generally well tolerated and effectively reduce symptoms, but patient-specific factors must be the paramount consideration when choosing monotherapy or combination therapy. ( Xagena )

Koprowski C et al, J Endourol 2016; Epub ahead of print