Tamsulosin, versus Tamsulosin in combination with Solifenacin versus Tamsulosin in combination with Trospium chloride for treatment of Double-J stent-related symptoms

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Tarek Osman Elsayed ◽  
Hisham Abd Elmajeed Fahim ◽  
Moustafa Gaber Menshawy Haroun
Keyword(s):  
Medical Treatment ◽  
University Hospital ◽  
Stent Insertion ◽  
Ureteroscopic Lithotripsy ◽  
Trospium Chloride ◽  
Once Daily ◽  
Daily Group ◽  
Double J Stent ◽  
Definitive Therapy ◽  
Mucosal Oedema

Abstract Background Stenting has been primarily used to treat urinary obstruction and the frequency of this use is increasing with the increase in ureteroscopic management. In cases of acute obstruction, a stent is used temporarily to stabilize the patient until definitive therapy. The stent is generally placed if there is accompanying ureteric injury or in those with a residual stone after ureteroscopic lithotripsy. Placing a ureteric stent after ureteroscopy with stone extraction is done by some urologists routinely to prevent possible stenosis or to decrease secondary pain caused by mucosal oedema. However, routinely placing a stent to prevent late complications or to relieve flank pain from a ureteric stricture or mucosal oedema after surgery is questionable. Stent-related symptoms are quite problem in nearly 80% of patients that has been implicated in short-term morbidities in terms of negative impact on the patients’ quality of life, body pains and hematuria. Various attempts had been made to minimize these symptoms but pharmacological treatment is the simplest and a noninvasive option. Numerous drugs had been tried to relieve these symptoms like alpha blockers, anticholinergics and analgesics. Objective To compare the efficacy of tamsulosin alone, tamsulosin in combination with solifenacin and tamsulosin in combination with trospium chloride in in the relief of Double-J stentrelated symptoms following uncomplicated ureteroscopic lithotripsy (URSL). Patients and Methods The present study was a prospective randomized comparative study conducted on 60 patients whith double-J stent inserted following uncomplicated ureteroscopic lithotripsy (URSL) in Ain Shams University Hospital and Karmouz Hospital over a period of 1 year. The patient were randomized into 3 equal groups (1:1:1 randomization): Group A:20 patients were treated by Tamsulosin (0.4 mg) alone once daily. Group B:20 patients were treated by Tamsulosin (0.4 mg) once daily in combination with Solifenacin (5 mg) once daily. Group C: 20 patients were treated by Tamsulosin (0.4 mg) once daily in combination with Trospium chloride (20 mg) twice daily. All patients were assessed 1 week postoperatively after Double-J stent insertion. Then, the patients were start the medical treatment and were assessed 3 weeks after starting the medical treatment. Results The study shows that the combination of the tamsulosin 0.4 mg/day and trospium chloride 20 mg twice/day are significantly superior to the tamsulosin 0.4 mg once alone / day and the combination of the tamsulosin 0.4 mg /day and the solifenacine 5 mg /day for the treatment of the LUTS in d.j stent cases except in the frecuncy the combination of tamsulosin 0.4 mg/day and the solifenacine 5 mg/day are signicantly superior. Also, the drugs are safe with mild few side effects. There were no significant differences regarding headache, dizziness, backache, myalgia and orthostatic hypotension. Conclusion The study show that the combination of the tamsulosin 0.4 mg/day and the trospium chloride 20 mg twice /day are significantly superior to the tamsulosin 0.4 mg once alone / day and the combination of the tamsulosin 0.4 mg /day and the solifenacine 5 mg /day for the treatment of the LUTS in d.j stent cases except in the frecuncy the combination of tamsulosin 0.4 mg/day and the solifenacine 5 mg/day are signicantly superior.

scholarly journals Comparative Study Between Holmium Laser versus Pneumatic Ureteroscopic Lithotripsy for Proximal Ureteric Stones Close to Pelvi-ureteric Junction (PUJ) -A Prospective Trial

2020 ◽  
Vol 23 (2) ◽  
pp. 188-192
Author(s):  
Harun Or Rashid ◽  
Md Shahidul Islam ◽  
SM Shameem Waheed ◽  
Md Abdur Rakib ◽  
Md Ashif Chowdhury ◽  
...  
Keyword(s):  
Laser Lithotripsy ◽  
Stent Insertion ◽  
Stone Size ◽  
Ureteroscopic Lithotripsy ◽  
Secondary Intervention ◽  
Upward Migration ◽  
Ho:Yag Laser ◽  
Double J Stent ◽  
Stone Free Rate ◽  
Free Rate

Objective: To compare the outcomes of ureteroscopic lithotripsy with pneumatic lithotripter versus Holium:Yttrium-Aluminum-Garnet (Ho:YAG) laser in the management of upper ureteric stones. Materials and methods: Patients who underwent ureteroscopic lithotripsy with pneumatic lithotripter or Ho:YAG laser for upper ureteric stones were reviewed. Patients with urinary tract infection, ,loss of follow-up, concurrent middle or lower third ureteral stones or acute renall failure were excluded. Patient age, stone size and burden (based on KUB or computerized tomography), stone upward migration, double J stent insertion rate, stone free rate and secondary intervention rate for residual stones were compared in both groups. Results: There were 70 patients with upper ureteric stones (35 in pneumatic group and 35 in laser group) meeting the study criteria. Patients’ age, gender, stone size and burden were similar in both groups. The Ho:YAG laser lithotripsy group had better stone free rate, less double J stent insertion rate and less upward migration and secondary intervention rate, sepsis as compared with pneumatic lithotripsy (94.2% vs. 60%; 85% vs. 100%; 5.7% vs 40%; 5.7% vs 34.2%; 2.8 vs 2.8 respectively, all p < 0.05). In patients with stones sizes 8-10 mm, Ho:YAG laser lithotripsy had significantly lower upward migration rate, lower double J stent insertion rate, higher stone free rate and less secondary intervention rate. Conclusions: Ho:YAG laser lithotripsy is better and much effective than pneumatic lithotripsy in the management of upper ureteric stones in terms of, stone free rate and secondary intervention rate for stones of sizes about 8 to 10 mm.Although the access of upper ureter is difficult but our small calibre (4.5 fr) ureteoscope and gentle manuevre have made the procedures safe and successful. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.188-192

scholarly journals THE COMPARISON OF CONSERVATIVE TREATMENT AND DOUBLE J STENT INSERTION IN GESTATIONAL HYDRONEPHROSIS

2018 ◽  
Vol 6 (2) ◽  
pp. 94-100
Author(s):  
Uğurkan Erkayıran ◽  
Bülent Köstü ◽  
Alev Özer
Keyword(s):  
Conservative Treatment ◽  
Pregnancy Outcomes ◽  
University Hospital ◽  
Control Group ◽  
Stent Insertion ◽  
Conservative Approach ◽  
Double J Stent ◽  
Significant Difference ◽  
Gestational Week ◽  
The Difference

Background: To compare the pregnancy outcomes of patents determined with gestational hydronephrosis and treated with a conservative approach or Double J Stent (DJS) application. Method: The study included 113 patients diagnosed with gestational hydronephrosis at a university hospital between January 2011 and January 2014. Of the 113 patients, DJS was applied to 51 and a conservative approach was applied to 62 patients. A comparison was made of the pregnancy outcomes in both treatment arms. Results: No significant difference was determined between the patients in the DJS application group and the patients in the conservative treatment group in respect of age, gravida, parity, gestational week at the time of diagnosis, gestational week at birth, and renal calyx diameter. Although a higher rate of births was determined in the first 24 hours and the first week after placement of DJS in DJS group compared to control group, the difference was not statistically significant. None of the patients in the control group required DJS insertion during the follow-up period. Conclusion: In patients with gestational hydronephrosis, if conservative treatment is first tried, if the patient cannot overcome the symptoms and complications are present, DJS should be inserted.

Efficacy of cystone versus tamsulosin in treatment of stent-related lower urinary tract symptoms

2021 ◽  
pp. 205141582110002
Author(s):  
Mohammad Ali Ghaed ◽  
Reza Rezaei ◽  
Amineh Shafeinia ◽  
Robab Maghsoudi
Keyword(s):  
Urinary Tract ◽  
Symptom Score ◽  
Lower Urinary Tract Symptoms ◽  
International Prostate Symptom Score ◽  
Lower Urinary Tract ◽  
Visual Analogue Score ◽  
Stent Insertion ◽  
Double J Stent ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Objective: Double-J stent is a common tool used in urological procedures that is inserted for 2–6 weeks, but it may induce abdominal and flank pain, incontinence and irritative urinary symptoms. Alleviation of such symptoms would be useful to improve the patients’ quality of life. Accordingly, in this study, the efficacy of cystone versus tamsulosin in the treatment of double-J stent-related lower urinary tract symptoms was determined. Materials and methods: In this randomised clinical trial, 128 patients who required double-J stent insertion after transureteral lithotripsy during 2018–2019 were enrolled. They were randomly assigned to receive either cystone, tamsulosin, both, or placebo. The international prostate symptom score and visual analogue score data were recorded at baseline, after 2 and 4 weeks across the groups. Results: The international prostate symptom score and visual analogue score factors were statistically different across the case groups receiving cystone, tamsulosin and both drugs versus placebo ( P=0.001). Two weeks after drug administration, the visual analogue score and international prostate symptom score were not statistically different in the tamsulosin, cystone and dual therapy groups; however, after 4 weeks the cystone group had the lowest symptoms. Conclusion: Both tamsulosin and cystone are efficient drugs which would relieve stent-related lower urinary tract symptoms. The administration of cystone with or without tamsulosin for 4 weeks may have the best result in reducing the visual analogue score and international prostate symptom score. Level of evidence: Level I, 1b, therapeutic study, randomised controlled trial

Comparison of a once Daily with a twice Daily Subcutaneous Low Molecular Weight Heparin Regimen in the Treatment of Deep Vein Thrombosis

1998 ◽  
Vol 79 (05) ◽  
pp. 897-901 ◽  
Author(s):  
Bernard A. Charbonnier ◽  
Jean-Noël Fiessinger ◽  
J. D. Banga ◽  
Ernst Wenzel ◽  
Pascal d’Azemar ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Low Molecular Weight Heparin ◽  
Low Molecular Weight ◽  
Daily Regimen ◽  
Once Daily ◽  
Daily Group ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryBackground: Clinical trials have been performed to compare with standard heparin a once or a twice daily regimen of low-molecular-weight heparin but no direct comparison has been done between these two low-molecular-weight heparin regimens in terms of efficacy and safety with a long-term clinical evaluation.Methods: Patients with proximal deep vein thrombosis, confirmed by venography were randomly assigned to either nadroparin (10,250 AXa IU/ml) twice daily or nadroparin (20,500 AXa IU/ml) once daily for at least 5 days. Regimens were adjusted to bodyweight. Oral anticoagulants were started on day 1 or 2 and continued for 3 months. Patients were followed up for 3 months. The composite outcome of venous thromboembolism and death possibly related to pulmonary embolism was the primary measure of efficacy. Major bleeding was the principal measure of safety. The study was designed to show equivalence between the two regimens.Results: Recurrent thromboembolic events or death possibly related to pulmonary embolism were reported in 13 patients in the once daily group (4.1%) and in 24 patients of the twice daily group (7.2%): (absolute difference 3.1% in favor of the once daily regimen; 95% confidence interval -6.6%, +0.5%). Major bleeding episodes during nadroparin treatment occurred in 4 (1.3%) and 4 patients (1.2%) in the once and twice daily groups, respectively.Conclusions: A nadroparin regimen of one injection per day is at least as effective and safe as the same total daily dose divided over two injections for the treatment of acute deep vein thrombosis.

Use of long term aprepitant as a treatment for refractory nausea following oesophageal stent insertion – a case report

2021 ◽  
pp. 026921632110652
Author(s):  
Richard Shoulder ◽  
Joseph Taylor ◽  
Hilary Stiel
Keyword(s):  
Symptomatic Improvement ◽  
Nausea And Vomiting ◽  
Stent Insertion ◽  
Once Daily ◽  
Routes Of Administration ◽  
Delayed Nausea ◽  
Neurokinin 1 ◽  
Oral Diet ◽  
Oesophageal Stent

Background: Aprepitant, a substance P neurokinin-1 receptor antagonist, is licenced for the prevention of acute and delayed nausea and vomiting associated with highly and moderately emetogenic cancer chemotherapy. Case: A 33 year-old male with metastatic gastro-oesophageal cancer had multiple admissions for refractory nausea and vomiting following insertion of an oesophageal stent. Action: Mechanical issues with the stent, stent removal and central causes were excluded. Multiple anti-emetic agents were trialled in combination and with varying routes of administration without significant symptomatic improvement. Formulation: A trial of aprepitant was proposed as an off-licence therapy. Outcome: One hundred sixty-five milligrammes of aprepitant was given orally every 3 days and then up titrated to once daily with significant symptomatic improvement enabling the patient to tolerate an oral diet. The patient remained stable at 12 weeks and has been accepted into two clinical trials for potential further cancer treatment. Lessons: Aprepitant can be effective in refractory nausea and vomiting outside of emetogenic chemotherapy and safely used as a chronic treatment. The prevalence of refractory nausea and vomiting as a rare adverse outcome post-oesophageal stent insertion should be studied. What now? Further research of neurokinin-1 inhibitors for indications other than chemotherapy-induced nausea and vomiting is indicated.

scholarly journals Incidence of bacterial colonisation after indwelling of double-J ureteral stent

2016 ◽  
Vol 87 (4) ◽  
pp. 291 ◽  
Author(s):  
Hasan Riza Aydin ◽  
Lokman Irkilata ◽  
Mustafa Aydin ◽  
Selim Gorgun ◽  
Hüseyin Cihan Demirel ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
Early Period ◽  
Stent Insertion ◽  
Bacterial Colonisation ◽  
E Coli ◽  
Double J Stent ◽  
Aseptic Conditions ◽  
Tract Infections

Objective: To determine the bacterial colonisation after double-J stent use and the risk factors for bacteriuria linked to the stent. Materials and Methods: A total of 102 patients (61 men and 41 women, mean age 47.5 ± 14.16) were examined. The stents were removed under aseptic conditions, and a urine culture was obtained before the removal of the stents. After the stents were removed, the upper, central and lower sections were separated, and washing water was sent through the stent. Results: Bacterial colonisation was found in 29.4% (30 of 102) of the stents. The most frequently observed microorganisms were determined as staphylococcus, coagulase negative (8 of 30) and E. coli (5 of 30). The washing fluid used to clean the interior of the catheter produced pathogens in 8 patients (7.8%), and these pathogens were observed to be the same microorganisms that colonised the outside of the stent. There was no statistical difference between the patients with colonisation and those without in terms of age, gender, duration of stenting and reason for stent insertion. Conclusions: Though stent colonisation does not always entail symptomatic urinary tract infections, as shown in our study, the pathogens in the urine culture are the same as those colonising the stent, confirming the reality that colonisation is the main factor in these events. Additionally, according to our study, significant colonisation may be found in the first 3 weeks, contrary to the literature, causing us to consider that urinary tract infections may develop even in the early period.

Efficacy of Celecoxib in Treating Symptoms of Viral Pharyngitis: A Double-Blind, Randomized Study of Celecoxib versus Diclofenac

2002 ◽  
Vol 30 (2) ◽  
pp. 185-194 ◽  
Author(s):  
LLM Weckx ◽  
JE Ruiz ◽  
J Duperly ◽  
GA Martínez Mendizabal ◽  
MBG Rausis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Adverse Events ◽  
Randomized Study ◽  
Specific Inhibitor ◽  
Symptomatic Treatment ◽  
Double Blind ◽  
Once Daily ◽  
Daily Group ◽  
Throat Pain

This study compared the efficacy and safety of the cyclooxygenase-2 specific inhibitor celecoxib with the conventional non-steroidal anti-inflammatory drug diclofenac in the symptomatic treatment of viral pharyngitis. Adult patients from 27 study centers in Latin America were treated with oral doses of celecoxib 200 mg once daily or 200 mg twice daily, or diclofenac 75 mg twice daily for 5 days in a double-blind, randomized study. The primary efficacy assessment was ‘Throat Pain on Swallowing’ on day 3. In addition, secondary quality-of-life assessments were performed on days 3 and 5. All adverse events and treatment-emergent signs and symptoms were recorded. Data from 313 patients were evaluable for efficacy (105 celecoxib 200 mg once daily, 107 celecoxib 200 mg twice daily, 101 diclofenac 75 mg twice daily). The upper 95% confidence limits for the visual analog scale of ‘Throat Pain on Swallowing’ on day 3 for celecoxib 200 mg once daily relative to diclofenac 75 mg twice daily, and celecoxib 200 mg twice daily relative to diclofenac 75 mg twice daily were 9.26 and 7.83, respectively. All secondary efficacy and quality-of-life measures were clinically similar for the three treatment groups, and no statistically significant differences were detected. The incidences of treatment-emergent adverse events and withdrawals due to adverse events were similar for all groups, but numerically higher among patients taking diclofenac than celecoxib. More patients in the diclofenac group reported gastrointestinal complaints (7.3%) compared with those in the celecoxib groups (4.3% in the celecoxib 200 mg once-daily group and 3.4% in the celecoxib 200 mg twice-daily group). In conclusion, 5 days of treatment with celecoxib 200 mg once daily is as effective as diclofenac 75 mg twice daily in the symptomatic treatment of viral pharyngitis. Celecoxib 200 mg once daily is also as effective as celecoxib 200 mg twice daily in this condition.

scholarly journals Renal Parenchyma Perforation and Hematoma Formation following Double-J Stent Insertion in a Solitary Functioning Kidney: An Unusual Complication

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Michael S. Nomikos ◽  
Zacharias Chousianitis ◽  
Christos Georgiou ◽  
Chrysostomos Georgellis ◽  
Panagiotis Rikas ◽  
...  
Keyword(s):  
Left Kidney ◽  
Stent Insertion ◽  
Unusual Complication ◽  
Hematoma Formation ◽  
The Past ◽  
Double J Stent ◽  
Noncontrast Computed Tomography ◽  
Functioning Kidney ◽  
Collecting System

Double-J ureteral stent insertion is a common urological procedure performed for the relief of ureteral obstruction or as a part of other endourological procedures. Several complications have been reported in the past. A case of a 62-year-old woman who was stented due to hydronephrosis of her solitary functioning left kidney and had renal perforation and retroperitoneal hematoma formation is presented. She was managed conservatively with blood transfusion and double-J stent repositioning in the collecting system the fifth postoperative day. Follow-up noncontrast computed tomography (CT) of the abdomen was performed the first and third months after stent placement which showed stabilization of the hematoma.

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