Research Frontier Patients with urinary frequency, urgency, and dysuria after indwelling double J tube? Try the combination of Mirabeiron and Solinacin!

Two drugs, miraberon and solifenacin, are "old friends" of urologists and are often used to treat patients with overactive bladder syndrome (OAB) (Previous article: Research Frontiers | Do you know? What are the effects of miraperion and solifenacin in women with OAB? ）
。 A prospective randomized clinical trial explored a new treatment model for two drugs, namely the treatment of double J ureteral stent tube-related OAB, and the efficacy and safety results of which are summarized below for readers
.

Double J ureteral stent tubes (double J tubes) have gradually become an integral part of minimally invasive urological surgery, but about 80% of patients experience stent-related symptoms such as urinary tract infection, OAB, pain or hematuria
.
The mechanism of double-J-tube-related OAB is different from other OABs in that it is due to lower ureteral and bladder spasm caused by stent tube stimulation, which has a negative impact
on the patient's quality of life, work ability, and sexual life.
Can combination therapy with miraberon and solifenacin relieve urinary tract symptoms in these patients? And how can I use it to achieve better results?

From August 2020 to July 2021, 219 patients with symptoms of double-J-tube-associated OAB were randomized into two groups, 109 patients in the combination treatment group received milabelon (50 mg, qd) and solifenacin (5 mg, qd), and 110 patients in the control group received solinacin (5 mg, qd) monotherapy
alone.
In addition, indomethacin suppositories are used as antispasmodic drugs in patients who cannot tolerate OAB symptoms, and all patients are advised to consume an adequate amount of water to ensure a daily urine output of 1500 ml
>.
The incidence of lower urinary tract symptoms (LUTS) at the 1st, 2nd, and 4th weeks of treatment and the scores of health-related quality of life (HRQol) and symptom distress in the Overactive Bladder Questionnaire (OAB-q
) were compared between the two groups.

There were no significant differences
in baseline general demographic and clinical features between the two groups.
Patients in the combination of mirabeiron and solinacin had the incidence of LUTS (urgency: 64.
5% vs 44.
9%, P=0.
028; urinary frequency: 62.
7% vs 48.
6%, P=0.
036; urinary incontinence: 56.
4% vs 40.
4%, P=0.
018) and urinary frequency 33.
6% vs 16.
5% at week 4 (urgency: 30.
9% vs 14.
7%, P=0.
004; urinary frequency: 33.
6% vs 16.
5%) at week 4 compared with the control group, compared with the control group, P=0.
003; urinary incontinence: 26.
4% vs 11.
9%, P=0.
007).

Table 1 Comparison of the incidence of LUTS in the two groups

The incidence of drug-related adverse events in the control group was higher than that in the combination treatment group, but the difference was not statistically significant (P>0.
05).

In addition, the OAB-q HRQol score at weeks 2 and 4 post-treatment was better in the combination group than in the control group (week 2: 77.
9 vs 76.
4, P=0.
020; week 4: 87.
9 vs 85.
6, P=0.
001), while the control group had a higher OAB-q symptomatic distress score than the combination group (week 2: 37.
6 vs 36.
4, P=0.
016; 26.
2 vs 24.
8, P=0.
003).

Table 2 Comparison of OAB-q HRQol and symptom distress scores between the two groups

Overall, the combination of milaviron and solifenacin was more effective than solinacin monotherapy in reducing symptoms of double-J-tube associated OAB and improving quality of life, without increasing the bothersome drug-related adverse effects
.
Based on these results, the investigators concluded that clinicians may consider combination therapy with miraberon and solifenacin when patients develop OAB after indwelling double J
tubes.
Future studies need to further quantify efficacy outcomes and explore drug mechanisms to confirm appeal conclusions
.

References:

Tang QL, Zhou S, Liu YQ, Wu J, Tao RZ.
Efficacy and safety of combination of mirabegron and solifenacin in patients with double-J stent related overactive bladder: a prospective study.
Sci Rep.
2022 Nov 7; 12(1):18844.
doi: 10.
1038/s41598-022-23795-5.
PMID: 36344629; PMCID: PMC9640653.