Effect of mirabegron, tamsulosin, and tadalafil on quality of life in patients with indwelling ureteral (double-J) stents.

OBJECTIVE

To evaluate and compare the efficacy of mirabegron, tamsulosin, and tadalafil in improving stent-related symptoms and overall quality of life in urological patients following JJ stent insertion.

METHODS

During the period from January 2022 to December 2022, 131 patients with ureteral double-J stents were randomly assigned two days post-insertion to receive either mirabegron (50 mg daily), tamsulosin (0.4 mg daily), or tadalafil (5 mg daily) for two weeks. Stent-related symptoms and health-related quality of life were assessed at baseline and at two weeks using the validated Ureteral Stent Symptom Questionnaire (USSQ). All groups completed follow-up.

RESULTS

The tamsulosin group showed the greatest improvement in total USSQ score (P ≤ .001), with significantly lower urinary symptoms, general health, and sexual function scores than the mirabegron and tadalafil groups. Specifically, sexual matter scores [median (IQR)] were lowest in the tamsulosin group [5 (1)] versus tadalafil [7 (3.2)] and mirabegron [16.5 (11)] (P ≤ .001). Differences in work performance and additional problem domains were not significant. Adverse effects were mild: dizziness/hypotension (∼6% tamsulosin), palpitations/headache (∼4% mirabegron), and flushing/dyspepsia/back pain (∼10% tadalafil). No serious events occurred, and no patient discontinued therapy.

CONCLUSION

In conclusion, tamsulosin produced the most comprehensive symptom relief supporting its use as first-line therapy for patients with indwelling JJ stents. Mirabegron demonstrated good safety and modest benefits in pain and storage symptoms, suggesting its use as a viable alternative for patients intolerant to standard treatments. Larger placebo-controlled trials are needed to validate these findings.