No reduction in ureteral stent-related symptoms, pain with naftopidil
A once-daily dose of the alpha blocker naftopidil did not significantly reduce double-J (DJ) ureteral stent-related discomfort and pain after ureteroscopy, a new study has found.
Participants who had indwelled retrograde DJ ureteral stents inserted after ureteroscopic surgery (URS, n=44) or retrograde intrarenal surgery (RIRS, n=48) were randomized to receive naftopidil 75 mg once daily (n=43) or placebo (n=49) during the stenting period. Evaluation was performed using the Ureteral Stent Symptom Questionnaire (USSQ) and International Prostate Symptom Score (IPSS).
Compared with placebo, participants in the naftopidil group had a lower overall USSQ urinary symptom score (29.23 vs 30.90; p=0.299) and overall USSQ body pain score (19.58 vs 22.28; p=0.286), though the results were not significant. [Sci Rep 2017;doi:10.1038/s41598-017-04505-y]
Patients on naftopidil also had lower scores for nocturia (2.30 vs 2.78; p=0.031) and urgency (1.86 vs 2.37; p=0.030) than those on placebo. The prevalence of inguinal pain was also lower among participants on naftopidil compared with placebo (14 percent vs 34.7 percent; p=0.026).
Preoperative IPSS scores decreased postoperatively in both the placebo group (from 9.33 to 9.17) and naftopidil group (from 9.35 to 8.81).
On multivariate analysis, the type of surgery (RIRS with ureteral access sheath [UAS]) predicted postoperative DJ-related pain (odds ratio, 2.736, 95 percent confidence interval, 1.095–6.834; p=0.031).
According to the researchers, RIRS typically entails the use of a large-diameter UAS, which could lead to a longer ureteral dilatation time that may eventually affect postoperative pain and urinary symptoms.
Alpha blockers have been shown to be beneficial in managing symptoms related to ureteral stenting such as frequency, urgency, dysuria, incomplete emptying, flank and suprapubic pain, and haematuria, all of which have been associated with morbidity and reduced quality of life. [J Urol 2003;169:1065-1069; J Urol 2008;179:424-430]
“Naftopidil has a higher selectivity for the [alpha-1D (α1D) adrenergic receptor], having approximately threefold and 17-fold higher potency for α1D than for α1A and α1B, respectively. Thus, there is a theoretical advantage in using naftopidil [for] DJ stent-related symptoms,” they said.
Given the relatively small number of participants and the researchers’ initial postulation that the type of surgery was unrelated to pain, a more comprehensive investigation is warranted to further evaluate the impact of naftopidil in reducing postoperative discomfort or pain in different surgical settings, noted the researchers.