Role of Alpha-Blocker, Anti-Cholinergics and Combination Therapy in Treatment of Symptoms Related to DJ Stent

Abstract

In routine urological procedure ureteric DJ stents are important and basic tool. The history of DJ stenting is too old, Gustav simon in 1800s performed first DJ stenting following open cystostomy. Following his success, Zimskind et al in 1967 placed DJ stent endoscopically [1]. Later on it flourished as a important tool in endourology. With the passage of time, multiple changes were made in features & structure of DJ stent to ensure a good urinary drainage with lesser complications. In modern age of urology the uses of DJ stent have been expanded. Ureteric stents are now used in treatment of various diseases related to urinary tract. For example, to prevent ureteric obstruction postoperatively from mucosal oedema, mucosal erosion/damage following uretrorenoscopy for ureteric stone or other upper tract interventions, following ballon dilatation of ureteric stricture, following endopyelotomy / pyeloplasty, to relieve obstruction in pelvic malignancy etc. [2]. DJ stenting is now performed in routine endourological and open surgery for avoidance of ureteric obstruction [3]. Selective alpha blockers / anti- muscarinic are used in alleviating the symptoms due to DJ stent like urgency, frequency of urination and painful micturation. Objectives: To assess the role of α-blockers(tamsulosin) or anticholinergic(tolterodine) alone and in combination, in the management of DJ related symptoms. Material and Methods: Study Design: Randomized control Trial. Study Setting: Jinnah Hospital Lahore, Pakistan. Study Duration: Six months – One year. Data Collection and Analysis: All patients with DJ stent in situ were followed on weekly basis in outpatient department to assess the development of DJ related symptoms. A total of ninety  patients, who developed symptoms during their course of follow up were separated in three groups, group A, B & C, each comprising of 30 patients.  Group A, patients received 0.4 mg tamsulosin daily. Group B,  received 2mg tolterodine twice daily. Group C, received 0.4 mg tamsulosin daily&  2mg tolterodine twice daily. IPSS and VAPS score were compared within and in between groups at enrollment, during each follow up weeks and at the completion of study. The results were  compared between Group A, B (monotherapy) and group C (combination therapy).