الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 99 |  |  |
| | | from | 99 | | |
Abstract
Ureteral stents provide drainage of the upper urinary tract, when obstruction of the ureter is present or anticipated. Indicated in relieving urinary obstruction, following or prior to ureterorenoscopy, Prophylactic before ESWL, Conservative Treatment of Upper Urinary Tract Trauma to reduces urinary leakage and the risk of strictures, Reconstructive Surgery of the Upper Urinary Tract and identifying the ureter before specific abdominal surgeries.
However, ureteral stents are associated with a clear side-effect profile. Patients are suffering from LUTS, such as frequency, urgency, dysuria, pain, and hematuria. Many factors related to stent characteristics can affect stent related symptoms as stent biomaterials, diameter, design, size and position of the stent.
To evaluate health related quality of life in patients with ureteral stents, We used the developed and validated ureteral stent symptom questionnaire (USSQ) with six sections covering urinary symptoms, body pain, general health, work performance, sexual matters, and additional problems.
Drugs still hold the key in reducing the morbidity related to the ureteral stents. In terms of monotherapy, Alpha blockers as well as Antimuscarinics are effective in reducing SRS. However, combination therapy reaches better outcomes than monotherapy alone. Tamsulosin and solifenacin are the 2 principal drugs used in our study.
Tamsulosin is a selective alpha -1 adrenoceptor antagonist that has super-selectivity for the α-1A and α-1D receptors relative to α-1B receptor. The α-1A and α-1D receptors are found in abundance in the prostate, prostatic capsule, prostatic urethra, bladder neck, bladder base and ureter. The α-1D is present in all portions of the ureter. Relaxation of the smooth muscle in the ureter, bladder neck and bladder base can alleviate spasms and reduce the discomfort associated with stent placement.
Solifenacin is a selective muscarinic receptor antagonist acts specifically at the M3 receptor site. selective mode of action gives solifenacin the potential to limit commonly experienced anticholinergic side effects as dry mouth, constipation and blurring of vision.
Relative to placebo, alpha antagonist alone, antimuscarinics alone have beneficial effect in reducing stent-related symptoms. Furthermore, there are significant advantages of combination therapy compared with monotherapy.
Our study is the first to be done comparing the effectiveness of double dose versus standard dose combination of tamsulosin and solifenacin using the standard USSQ questionnaire with baseline assessment one week post operative before medication and after 2 weeks of medication.
We noticed that after 2 weeks of medication, the double dose of tamsulosin with solifenacin was more effective for stent-related symptoms. there was significant difference in the score between the double dose and the standard dose.
Regarding side effects, they were more frequent among the double dose group with significant difference only in retrograde ejaculation and dry mouth. no difference between both groups regarding blurring of vision.
Our findings showed that double dose was better than standard dose in reducing stent related symptoms. Studies directed to assess ureteral stent discomfort and management remain a challenge since pain is the primary end-point, which can lead to subjective and variable conclusions and may be influenced by confounding variables such as BMI, age, and comorbidities. Further studies on a larger scale are needed to confirm this result.