Comparative Efficacy of Mirabegron vs Doxazosin for Ureteral Stent Dysfunction

Overview

This randomized, double-blind clinical trial compared mirabegron (50 mg/day) and doxazosin (4 mg/day) in alleviating ureteral stent-related symptoms (SRS), focusing on sexual dysfunction. Both drugs improved symptoms, but mirabegron showed superior efficacy in reducing pain during intercourse and sexual dissatisfaction.

Background

Ureteral stents are commonly used in minimally invasive urological procedures to facilitate urine drainage and prevent ureteral obstruction. However, stent-related symptoms (SRS) such as urinary urgency, pain, and sexual dysfunction affect up to 80% of patients, significantly impairing quality of life. Pharmacologic management with alpha-blockers like doxazosin and β3-adrenergic agonists like mirabegron has been employed to mitigate these symptoms. Prior to this study, no direct comparison of these agents for SRS had been conducted.

Data Highlights

Key Findings

• Both mirabegron and doxazosin significantly improved ureteral stent-related symptoms compared to baseline.
• Mirabegron demonstrated greater reduction in pain during sexual intercourse than doxazosin at stent removal and 2 weeks post removal.
• Sexual dissatisfaction scores improved more with mirabegron than with doxazosin.
• Both medications were well tolerated with no significant difference in adverse drug reactions.
• Age and sex were accounted for as covariates, confirming robustness of findings across subgroups.

Clinical Implications

Mirabegron may be preferred over doxazosin for managing ureteral stent-related sexual dysfunction due to its superior efficacy in reducing pain and dissatisfaction during intercourse. Both agents remain viable options for alleviating general SRS, but mirabegron's β3-adrenergic mechanism offers additional benefits. Clinicians should consider patient-specific factors and tolerability when selecting therapy.

Conclusion

This study provides the first direct comparison of mirabegron and doxazosin for ureteral stent symptom relief, highlighting mirabegron's enhanced efficacy in improving sexual function. These findings support mirabegron as a valuable pharmacologic option in managing stent-associated morbidity.

References

1. Joshi et al. 2003 -- Development and validation of the Ureteral Stent Symptoms Questionnaire (USSQ)
2. Clinical trial protocol and ethics approval -- Anning First People's Hospital, 2023