Effect of mirabegron, tamsulosin, and tadalafil on quality of life in patients with indwelling ureteral (double-J) stents

OBJECTIVE: To evaluate and compare the efficacy of mirabegron, tamsulosin, and tadalafil in improving stent‐related symptoms and overall quality of life in urological patients following JJ stent insertion. METHODS: During the period from January 2022 to December 2022, 131 patients with ureteral double‐J stents were randomly assigned two days post‐insertion to receive either mirabegron (50 mg daily), tamsulosin (0.4 mg daily), or tadalafil (5 mg daily) for two weeks. Stent‐related symptoms and health‐related quality of life were assessed at baseline and at two weeks using the validated Ureteral Stent Symptom Questionnaire (USSQ). All groups completed follow‐up. RESULTS: The tamsulosin group showed the greatest improvement in total USSQ score (p= < 0.001), with significantly lower urinary symptoms, general health, and sexual function scores than the mirabegron and tadalafil groups. Specifically, sexual matter scores [median (IQR)] were lowest in the tamsulosin group [5 (1)] versus tadalafil [7 (3.2)] and mirabegron [16.5 (11)] (p=< 0.001). Differences in work performance and additional problem domains were not significant. Adverse effects were mild: dizziness/hypotension (∼6% tamsulosin), palpitations/headache (∼4% mirabegron), and flushing/dyspepsia/back pain (∼10% tadalafil). No serious events occurred, and no patient discontinued therapy. CONCLUSION: In conclusion, tamsulosin produced the most comprehensive symptom relief supporting its use as first‐line therapy for patients with indwelling JJ stents. Mirabegron demonstrated good safety and modest benefits in pain and storage symptoms, suggesting its use as a viable alternative for patients intolerant to standard treatments. Larger placebo‐controlled trials are needed to validate these findings.