Abstract
BACKGROUND: Ureteral stent insertion, crucial for managing ureteral obstructions, often results in stent-related symptoms (SRSs) adversely affecting patient quality of life. This meta-analysis compares the effectiveness of tamsulosin or mirabegron versus placebo in alleviating these symptoms. METHODS: Following PRISMA guidelines, we systematically reviewed randomized controlled trials (RCTs) comparing mirabegron or tamsulosin to placebo in managing SRSs. Data sources included PubMed, Embase, Web of Science and CENTRAL, up to November 2023. The inclusion criteria focused on studies reporting on Ureteral Stent Symptom Questionnaire (USSQ), International Prostate Symptom Score (IPSS), quality of life (QoL) assessments, analgesic usage and adverse events. Meta-analysis employed a random-effects model, assessing heterogeneity and publication bias. For assessing the risk of bias in the included randomized trials, we employed the Cochrane Collaboration's tool. This protocol was registered at the International Prospective Register of Systematic Reviews (registration number: CRD42024511842). RESULTS: Sixteen RCTs with 1635 patients met the inclusion criteria. Tamsulosin significantly improved body pain (MD -1.80; 95% CI -3.53 to -0.07; p = 0.04), sexual function (MD -0.63; 95% CI -1.16 to -0.10; p = 0.02) and improved quality of life score (MD -2.36; 95% CI -3.56 to -1.17; p = 0.0001), while mirabegron was more effective in reducing urinary symptoms (MD -8.71; 95% CI -15.81 to -1.61; p = 0.02), enhancing general health (MD -2.58; 95% CI -3.78 to -1.37; p < 0.0001) and reducing analgesia use (MD -1.56; 95% CI -2.70 to -0.41; p = 0.008). Both medications significantly reduced total International Prostate Symptom Score (Tamsulosin MD -8.4; 95% CI -15.63 to -1.22; p = 0.02; Mirabegron MD -6.29; 95% CI -8.50 to -4.08; p < 0.00001) without a significant rise in adverse events (tamsulosin OR 1.90; 95% CI 0.40-9.18; mirabegron p = 0.42 and OR 0.93; 95% CI 0.30-2.88; p = 0.89). CONCLUSIONS: Tamsulosin and mirabegron effectively manage SRSs, with distinct benefits in different symptom domains. This suggests a potential for complementary therapeutic strategies. Future high-quality RCTs are needed to explore their combined efficacy.