I appreciate the letter from our colleagues Drs. Nair, Drinnan, and Symes from Brighton and Sussex University Hospitals. Their letter brings up an important question and an opportunity for clarification. I agree that α1-antagonists should be considered a confounding factor. However, this study  took place at a time when we did not prescribe patients an α1-antagonist postoperatively for either stent-related pain or to assist with stone passage. None of the patients in the study were receiving an α1-antagonist.
Currently, many of our patients are given tamsulosin postoperatively to help prevent stent-related pain. I do not know if this prevents severe pain after stent removal, but it certainly makes sense that it would help. It would be an interesting (and perhaps informative) study to compare an α1-antagonist to an NSAID in the prevention of pain after ureteric stent removal. While it may prove to be less needed in those patients taking an α1-antagonist concomitantly, given the low cost and safety of the NSAID, we simply give a single dose at the time of stent removal to every qualifying patient.