Adults (>18 years) with ureteral stones undergoing ureteroscopic lithotripsy and ureteral stent placement
Care Setting
Urology clinical setting involving minimally invasive procedures and postoperative management
Key Highlights
Ureteral stents cause symptoms in up to 80% of patients, significantly impacting quality of life
Doxazosin (4 mg/day) and mirabegron (50 mg/day) are both used to alleviate stent-related symptoms
This randomized, double-blind clinical trial directly compares efficacy and side effects of mirabegron versus doxazosin
Guideline-Based Recommendations
Diagnosis
Confirm ureteral stones with imaging (CT or ultrasound) prior to stent placement
Use the validated Ureteral Stent Symptoms Questionnaire (USSQ) to assess symptom severity
Management
Initiate oral doxazosin 4 mg/day or mirabegron 50 mg/day after stent placement
Continue medication until 2 weeks after stent removal
Monitor for symptom relief focusing on urinary symptoms and sexual dysfunction
Monitoring & Follow-up
Assess USSQ scores at stent placement, removal, and 2 weeks post-removal
Record adverse drug reactions throughout treatment
Evaluate pain during intercourse and sexual dissatisfaction as primary outcomes
Risks
Potential side effects related to alpha-blockers and β3-agonists should be monitored
Sexual dysfunction is a significant concern associated with ureteral stents
Patient & Prescribing Data
Men and women over 18 years with ureteral stones requiring stenting
Both mirabegron and doxazosin are effective and safe for reducing ureteral stent symptoms; direct comparative efficacy and side effect profiles inform clinical choice
Clinical Best Practices
Employ randomized, double-blind methodology to minimize bias in treatment evaluation
Use standardized, validated questionnaires (USSQ) for consistent symptom assessment
Consider patient-reported sexual dysfunction outcomes when selecting pharmacologic therapy
Ensure adherence to medication regimen and follow-up assessments for optimal management
