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Sir,

We read with interest the article by Tadros et al. [1]. The authors must be commended for demonstrating such a simple proof of concept, identifying both the incidence of severe pain after ureteric stent removal, and its dramatic reduction after a single dose of a NSAID.

However, we would like clarification on the concomitant use of α1-antagonists in the patient cohort enrolled in this study. There is increasingly strong evidence alluding to an improvement in ureteric stent-related morbidity and quality of life in patients receiving this drug [2]. This therefore may be a confounding factor influencing both the incidence and severity of post-ureteric stent removal pain reported.

The authors comment on a paper by Beddingfield et al. [3] citing the ineffective use of α1-antagonists in decreasing analgesia requirements when ureteric stents are in situ. Whilst true, both this paper and a systematic review and meta-analysis by Yakoubi et al. [4] do however cite statistically significant reductions in stent-related pain.

Tadros et al. [1] have provided a much-needed insight into the role of NSAIDs in reducing pain after stent removal. However, with this understanding, it also opens further questions about the role of either prolonged or single use α1-antagonists in the reduction of pain after removal of ureteric stents.

References

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  2. References
  • 1
    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 2013; 111: 101105
  • 2
    Nazim SM, Ather MH. Alpha-blockers impact stent-related symptoms: a randomized, double-blind, placebo-controlled trial. J Endourol 2012; 26: 12371241
  • 3
    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: 170176
  • 4
    Yakoubi R, Lemdani M, Monga M, Villers A, Koenig P. Is there a role for α-blockers in ureteral stent related symptoms? A systematic review and meta-analysis. J Urol 2011; 186: 928934