¬¬¬Tamsulosin And Sodium Diclofenac as An Effective Therapy To Reduce Pain After Ureteral Stent Removal: A Prospective, Double Blinded Randomized Placebo Controlled Trial Study
5 January 2019
Purpose: This study was conducted to determine the effects of tamsulosin and diclofenac sodium use on patients' pain perception after ureteral stents removal.
Materials and Methods: This study was a randomized control trial with double-blinded design. Eighty patients who underwent ureteral stent removal surgery at Kardinah Hospital, Tegal during January to March 2017 were divided into four groups. The experimental group was administered by analgesic for two days, (A) placebo tid, or (B) diclofenac sodium 50 mg bid, or (C) tamsulosin 0.2 mg sid, or (D) combination of tamsulosin and diclofenac sodium. Analgesic effects were assessed with the Visual Analog Scale (VAS). Relationships among variables were assessed using one-way ANOVA and post hoc tests.
Results: The surgical procedure for ureteral stent removal consisted of 48 (60%) male and 32 (40%) female. The average age of group A, B, C, and D were 51.0, 51.9, 47.6, and 47.3 years, and the average stent dwell times was 6.3 weeks. VAS values of the entire experimental group were lower than the control group on the first day until the second day after the stent removal procedure (p <0.05). In the experimental group, there was no difference between group B and C (p> 0.05). Group D showed better analgesic effects than group B and C (p <0.05). There were no severe side effects found in whole cases.
Conclusion: The result shows that combination therapy of diclofenac sodium and tamsulosin is better in reducing the pain after ureteral stent removal compared to the admission of a single placebo, tamsulosin, and diclofenac sodium therapy.
How to Cite
Joshi HB, Stainthorpe A, MacDonagh RP, Keeley FX, Timoney AG, Barry MJ. Indwelling ureteral stents: evaluation of symptoms, quality of life and utility. J Urol 2003; 169(3):1065-9. http://dx.doi.org/10.1097/01.ju.0000048980.33855.90
Theckumparampil N, Elsamra SE, Carons A, Salami SS, Leavitt D, Kavoussi A, et al. Symptoms after removal of ureteral stents. J Endourol 2015; 29(2):246-52.
Loh-Doyle JC, Low RK, Monga M, Nguyen MM. Patient experiences and preferences with ureteral stent removal. J Endourol 2015; 29(1):35-40.
Tyritzis SI, Stravodimos KG, Vasileiou I, Fotopoulou G, Koritsiadis G, Migdalis V, et al. Spinal versus General Anaesthesia in Postoperative Pain Management during Transurethral Procedures. ISRN Urol 2011; 895874:1-6. http://dx.doi.org/10.5402/2011/895874
Liu J, Zang YJ. Comparative study between three analgesic agents for the pain management during extracorporeal shock wave lithotripsy. Urol J 2013; 10(3):942-5.
Kara C, Resorlu B, Cicekbilek I, Unsal A. Analgesic efficacy and safety of nonsteroidal anti-inflammatory drugs after transurethral resection of prostate. Int Braz J Urol 2010; 36(1);49-54. http://dx.doi.org/10.1590/S1677-55382010000100008
Borda AP, Sonnek FC, Fontetne V, Papaioannou EG. Guidelines on Pain Management & Palliative Care. European Association of Urology 2014; 28-33.
Tadros NN, Bland L, Legg E, Olyaei A, Conlin MJ. A single dose of a non-steroidal anti-inflammatory drug (NSAID) prevents severe pain after ureteric stent removal: a prospective, randomised, double-blind, placebo-controlled trial. BJU Int 2012; 111(1):101-5.
Gangkak G, Teli RD, Yadav SS, Tomar V, Priyadarshi S, Aggarwal SP. A single oral dose of silodosin an d diclofenac sodium is effective in reducing pain after ureteric stent removal: a prospective, randomized, double blind placebo controlled study. Springerplus 2016; 5:23. http://dx.doi.org/10.1186/s40064-015-1662-7
Irfansyah. Effect of alpha blocker and anti cholinergic on ureteral stent related symptoms : A single-blind randomized clinical trial. [Tesis]. Universitas Gadjah Mada. 2016.
Yuri P, Ali Z, Rasyid N, Birowo P. Effect of ppemidic acid, phenazopyridine HCL, and sodium diclofenac on pain perception following endoscopic urological surgery: Double-blinde randomized-controlled trial. Acta medica indones 2016; 48(3):184-92.
Yesil S, Polat F, Ozturk U Dede O, Imamoglu M, Bozkirli. Effect of different analgesic on pain relief durung extracorporeal shock wave litotripsi. Hippokratia 2014; 18(2):107-9.
Damiano R, Autorino R, De Sio M, Giacobbe A, Palumbo IM, D'Armiento M. Effect of tamsulosin in preventing ureteral stent-related morbidity: a prospective study. J Endourol 2008; 22(4):651-6. http://dx.doi.org/10.1089/end.2007.0257
Deliveliotis C, Chrisofos M, Gougousis E, Papatsoris A, Dellis A, Varkarakis IM. Is there a role for alpha1-blockers in treating double-J stent-related symptoms. Urology 2006; 67(1):35-9. http://dx.doi.org/10.1016/j.urology.2005.07.038
Dellis A, Joshi HB, Timoney AG, Keeley FX. Relief of stent related symptoms: review of engineering and pharmacological solutions. J Urol 2010; 184(4):1267-72.
Gupta M, Patel T, Xavier K, Maruffo F, Lehman D, Walsh R, et al. Prospective randomized evaluation of periureteral botulinum toxin type A injection for ureteral stent pain reduction. J Urol 2010; 183(2):598-602. http://dx.doi.org/10.1016/j.juro.2009.10.021
Beddingfield R, Pedro RN, Hinck B, Kreidberg C, Feia K, Monga M. Alfuzosin to relieve ureteral stent discomfort: a prospective, randomized, placebo controlled study. J Urol 2009; 181(1):170-6. http://dx.doi.org/10.1016/j.juro.2008.09.026
Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K. Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol 2007; 14(8):749-53.
Michel MC, Vrydag W. Alpha1-, alpha2- and beta-adrenoceptors in the urinary bladder, urethra and prostate. Br J Pharmacol 2006; 147(Suppl 2):88-119.
Nakada SY, Jerde TJ, Bjorling DE, Saban R. Selective cyclooxygense-2 inhibitors reduce ureteral contraction in vitro: a better alternative for renal colic? J Urol 2000; 163(2):607-12. https://doi.org/10.1097/00005392-200002000-00059
Chaignat V, Danuser H, Stoffel MH, Z’brun S, Studer UE, Mevissen M. Effects of a non-selective COX inhibitor and selective COX-2 inhibitors on contractility of human and porcine ureters in vitro and in vivo. Br J Pharmacol 2008; 154(6):1297-307.
- Abstract Viewed: 280 times
- Just Accepted/5190 Downloaded: 55 times