Presented by: Ana Sofia Araújo MD
Hospital de Braga

Introduction

Routine stenting after URS is not recommended but may be necessary and might increase postoperative morbidity and costs. Although no drugs have been licensed for this use, alpha-blockers can improve catheter tolerability. Mirabegron is a beta-3 adrenergic agonist approved for overactive bladder. Thus, we aim to compare mirabegron with tamsulosin for sexual and urinary catheter-related complaints after URS with double-J catheter placement. 

Materials

We conducted a prospective single-center study including 108 patients who underwent URS with double-J catheter placement and took tamsulosin or mirabegron between November 2022 and April 2023. Four validated questionnaires - International Consultation Incontinence Questionnaire Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), Female Sexual Function Index (FSFI), ICIQ-Male LUTS (MLUTS), International Index of Erectile Function (IIEF-5) and one subjective questionnaire were used. Statistical analysis was done with IBM^®SPSS^®, version 27.0. 

Results

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A total of 55 patients received mirabegron and 53 tamsulosin, including 55 women and 53 men. Patient and surgery aspects as well as median time to catheter removal were not statistically different between drugs for women and men (all p > 0.05). There were no differences in FLUTS/MLUTS dimensions (filling, voiding, incontinence), FLUTS/MLUTS total score, and bother between drugs. However, median bother and total scores were higher in the tamsulosin group (FLUTS-bother 47.0 vs 20.0 p=0.156 and FLUTS total score 20.0 vs 12.0 p=0.407; MLUTS-bother 22.0 vs 18.5 p=0.993 and MLUTS total score 8.0 vs 7.0 p=0.838). Women's median FSFI total score was 2.0 in both drug groups, indicating that the majority didn't have sexual intercourse. In men, about 1/3 of patients in both drug groups also didn’t try it. Of those who attempted, there were no differences (p=0.868) but mirabegron had a higher prevalence of no erectile dysfunction (ED) (34.6% vs 33.3%), and tamsulosin had a higher prevalence of some ED (33.3% vs 26.9%). The subjective questionnaire showed that although mirabegron patients reported more lumbar and suprapubic discomfort (67.3% vs 60.4% p=0.456, 65.5% vs 60.4% p=0.585 respectively), tamsulosin patients experienced more dysuria (30.2% vs 23.6% p=0.514) and haematuria (9.4% vs 5.5% p=0.806).

Conclusion

We conclude that mirabegron was not statistically distinct from tamsulosin in improving sexual and urinary catheter-related symptoms; in fact, in some variables, mirabegron has better results than tamsulosin. 

Funding

None

Co-Authors

Ricardo Rodrigues, MD
Hospital de Braga

Catarina Tinoco, MD
Hospital de Braga

Andreia Cardoso, MD
Hospital de Braga

Mariana Capinha, MD
Hospital de Braga

Luís Pinto, MD
Hospital de Braga

Paulo Mota, MD
Hospital de Braga

Carlos Oliveira, MD
Hospital de Braga

João Torres, MD
Hospital de Braga

Sara Anacleto, MD
Hospital de Braga

Jorge Ribeiro, MD
Hospital de Braga

Emanuel Dias, PHD
Hospital de Braga

Miguel Mendes, MD
Hospital de Braga

Mário Alves, MD
Hospital de Braga

Vera Marques, MD
Hospital de Braga