A combination of the antimuscarinic solifenacin and the alpha blocker tamsulosin may be the most effective treatment for ureteral stent-related symptoms, according to researchers.

Kunjie Wang, MD, PhD, of West China Hospital at Sichuan University, and colleagues conducted a network meta-analysis of 19 randomized controlled trials of 2036 patients investigating tamsulosin, alfuzosin, solifenacin, and the combination of tamsulosin and solifenacin.

According to results published in the World Journal of Urology, the combination of solifenacin and tamsulosin improved all 5 components of the ureteral stent symptom questionnaire over 1 to 2 weeks: urinary symptoms (86.2%), body pain (85.0%), general health (80.5%), work performance (72.0%), and sexual performance (84.4%).

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Except for pain, solifenacin was the most effective at relieving symptoms. Tamsulosin and alfuzosin relieved urinary symptoms (53.0 vs 48.7%) and body pain (61.9 vs 62.9%) to similar degrees.

Dr Wang’s team believes that solifenacin and tamsulosin have a “synergistic effect” on stent-related symptoms by concurrently inhibiting receptors on smooth muscle cells in the bladder neck, lower ureter, and detrusor.

Additional studies including other common drugs such as terazosin, doxazosin, and tolterodine are still needed.

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Jian Z, Chen Y, Liu Q, et al. Combination of solifenacin and tamsulosin may provide additional beneficial effects for ureteral stent‑related symptoms—outcomes from a network meta‑analysis. World J Urol. DOI: 10.1007/s00345-018-2404-6