Pharmacological treatment of bladder stent symptoms

Ureteric stenting is a ubiquitous procedure, but it is associated with symptoms that affect psychological well-being and quality of life. While many factors are linked to worse symptomatology, some innovative modifications to the stent's structure, as well as treatments, have been studied to reduce their clinical impact. Pharmacotherapy is a well-evaluated treatment modality derived from the treatment of lower urinary tract symptoms not related to stents.

This review focuses on these pharmacological treatments. Several drug classes have been trialed to treat stent-related symptoms. Most of these studies investigated adrenoceptor modulators (both alpha-blockers and beta-3 agonists), muscarinic receptor antagonists, phosphodiesterase-5 inhibitors, as well as novel pharmacological modalities. Most trials and subsequent meta-analyses support treatment over placebo and controls, and some drugs are better at treating certain symptom domains, such as phosphodiesterase-5 inhibitors working on sexual issues. Furthermore, a combination therapy with alpha-blockers and muscarinic receptor antagonists appears to be superior to monotherapy with either of them. Treatments are also well tolerated.

However, initiating pharmacotherapy should be part of a shared decision-making approach that balances the severity of symptoms and the duration the stents will remain in situ against potential side effects.