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Ureteroscopy pp 351-359 | Cite as

Medical Therapy for Stent Discomfort

  • Zachariah G. Goldsmith
  • Michael E. Lipkin
  • Glenn M. PremingerEmail author
Chapter
Part of the Current Clinical Urology book series (CCU)

Abstract

Indwelling ureteral stents are associated with high rates of morbidity, including urinary frequency, urgency, and flank pain. These symptoms have been associated with increased narcotic requirement, decreased quality of life, and decreased attendance in the workplace. Methods to ameliorate stent-related morbidity are needed to provide comprehensive care following ureteroscopy with stent placement. The pathophysiology of stent discomfort is likely related to trigonal irritation, ureteral spasm, changes in stent position with ambulation, and vesicoureteral reflux. Ureteral contraction is mediated by intracellular calcium influx, and this process is regulated by alpha-stimulatory and beta-inhibitory adrenergic signaling. This system has served as the primary target for pharmacologic agents to reduce stent pain.

Alpha blockers (tamsulosin 0.4 mg daily) and alfuzosin (10 mg daily) have demonstrated efficacy in reducing stent morbidity in multiple randomized clinical trials as well as recent meta-analyses. Anticholinergic therapy (tolterodine ER 4 mg daily) has also been demonstrated to reduce stent-related morbidity in a randomized trial. Calcium channel blockers, phosphodiesterase inhibitors, and anti-inflammatories have shown promising effects in preclinical studies and other settings. Innovations in stent design (including drug-eluting ureteral stents) and intravesical therapies are likely to lead to improvements in stent-related morbidities.

Keywords

Stent Placement International Prostate Symptom Score Ureteral Stone Ureteral Stents Alpha Blocker 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Zachariah G. Goldsmith
    • 1
  • Michael E. Lipkin
    • 1
  • Glenn M. Preminger
    • 1
    Email author
  1. 1.Division of Urologic Surgery, Surgery DepartmentDuke University Medical CenterDurhamUSA

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