title: PRISMA-combined α-blockers and antimuscarinics for ureteral stent-related symptoms: A meta-analysis.
abstract: BACKGROUND
  As a monotherpay, a-blockers and anti-muscarinics are both efficacy for ureteral stent-related symptoms (SRS). The aim of the study was to systematically evaluate their efficacy of a combination therapy for SRS.
  
  
  METHODS
  Relevant studies investigating α-blockers and/or anti-muscarinics for SRS were identified though searching online databases including PubMed, EMBASE, Cochrane Library, and other sources up to March 2016. The RevMan software was used for data analysis, and senesitivity analysis and inverted funnel plot were also adopted.
  
  
  RESULTS
  Seven randomized controlled trials (RCTs) and 1 prospective controlled trial including 545 patients were selected. Compared with α-blockers, the combination group achieved significant improvements in total International Prostate Symptom Score (IPSS) [-3.93 (2.89, 4.96), P < 0.00001], obstructive subscore [-1.29 (0.68, 1.89), P < 0.0001], irritative subscore [-2.93 (2.18, 3.68), P < 0.00001], and quality of life score [-0.99 (0.42, 1.55), P < 0.001]. Compared with antimuscarinics, there were also significant differences in total IPSS [-3.49 (2.43, 4.55), P < 0.00001], obstructive subscore [-1.40 (0.78, 2.01), P < 0.00001], irritative subscore [-2.10 (1.30, 2.90), P < 0.00001], and quality of life score [-1.18 (0.58, 1.80), P < 0.001] in favor of combination group. No significant difference was found in the visual analog pain score and the urinary symptoms score in Ureteral Stent Symptom Questionnaire (USSQ). No significant difference in complications was found.
  
  
  CONCLUSIONS
  Current analysis shows significant advantages of combination therapy compared with monotherapy of α-blockers or antimuscarinics alone mainly based on IPSS. More RCTs adopting validated USSQ as outcome measures are warranted to support the finding.
authors.affiliation: Department of Emergency, The First Hospital of Lanzhou University, Lanzhou, China.
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Zhang
authors.forename: Pei
authors.initials: P
authors.lastname: Chu
authors.forename: Wen-Jin
authors.initials: WJ
authors.lastname: Wang
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006417:Hematuria / Q000517:prevention & control; D006801:Humans; D018727:Muscarinic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000517:prevention & control; D011788:Quality of Life; D015607:Stents / Q000009:adverse effects*; D014513:Ureter; D014549:Urinary Incontinence / Q000188:drug therapy; D014552:Urinary Tract Infections / Q000517:prevention & control
chemical_list: D000317:Adrenergic alpha-Antagonists; D018727:Muscarinic Antagonists