sildenafil-citrate and Ureteral-Calculi

To evaluate the role of sildenafil in relieving ureteral stent symptoms.. A randomized controlled trial was conducted between March 2014 and November 2016. It included adult men who underwent unilateral ureteric stent after ureteroscopy. Patients who were taking PDE5-Is, alpha-blockers or anticholinergics, had contraindication to sildenafil or developed postoperative complications were not included. Eligible patients were randomized using sealed closed envelops to one of two groups (S and C). Patients in group S received sildenafil citrate 50 mg tablet once daily. Patients in group C were the control. All patients answered the ureteral stent symptom questionnaire (USSQ) after 2 weeks of stenting. Primary outcome was the difference in total USSQ score between both groups. Secondary outcomes were tolerability of the treatment and the difference in each domain of USSQ score.. After randomization, four patients (7.3%) in group C withdraw their consent because of severe symptoms and two patients (3.6%) in group S discontinued treatment because of headache and dizziness. Final analysis was performed for 46 and 48 patients in groups C and S, respectively. Total USSQ score and all domains (except work performance) were significantly lower in group S (P < 0.001). Dysuria and urgency were significantly more in group C (P = 0.012 and 0.007, respectively). Three patients in groups S (6.25%) experienced transient mild adverse effects (dyspepsia, flushing and rhinitis in one patient for each) but they continued sildenafil.. Sildenafil is an effective and well-tolerated treatment option for relieving ureteral stent-related symptoms in men. CLINICALTRIAL.. NCT02345980.

Topics: Adult; Dysuria; Hematuria; Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Nocturia; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Quality of Life; Sildenafil Citrate; Stents; Surveys and Questionnaires; Treatment Outcome; Ureter; Ureteral Calculi; Ureteroscopy; Urinary Incontinence, Urge

PDE5 inhibitors represent the gold standard in the medical therapy of erectile dysfunction (ED). Promising results have been published regarding further urological indications such as treatment of ureteral colic. The aim of the present study was to evaluate the functional effects of the PDE5 inhibitors sildenafil (SIL), vardenafil (VAR), and tadalafil (TAD) on tissue tension and cyclic nucleotide levels of human ureteral smooth muscle segments in vitro.. Relaxant responses of human ureteral smooth muscle were investigated in vitro using the organ bath technique. Cyclic nucleotides cAMP and cGMP were determined by specific radioimmunoassays.. Relaxing effects of ureteral muscle tension were observed in the rank order VAR>SIL>TAD. While only VAR significantly elevated cGMP levels 3.3-fold over control, no increase for cAMP levels was observed.. Our data provide evidence that cGMP is involved in the control of the normal function of the smooth musculature of the human ureter. Our findings suggest the potential of using selective inhibitors of PDE isoenzymes in the treatment of ureteral colic.

Topics: Aged; Carbolines; Colic; Cyclic AMP; Cyclic GMP; Dose-Response Relationship, Drug; Female; Humans; Imidazoles; Isometric Contraction; Male; Middle Aged; Muscle, Smooth; Organ Culture Techniques; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Purines; Radioimmunoassay; Sildenafil Citrate; Sulfones; Tadalafil; Triazines; Ureter; Ureteral Calculi; Ureteral Diseases; Vardenafil Dihydrochloride