الفهرس 
THE URETER (ANATOMY-HISTOLOGY-NERUROPHYSIOLOGY)Only 14 pages are availabe for public view
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Abstract
After almost five decades of internal ureteral stenting, this endourological standard procedure is still associated with a
clear side-effect profile. Thus, ureteral stents should be
avoided whenever possible, and removed as soon as possible.
However, ureteral stenting remains unavoidable in a considerable number of our patients. In these cases, a proper stent length should be chosen, and patients should be informed
thoroughly about potential side-effects and treated with a1-blockers or antimuscarinics.
The mechanism of action of selective alpha A1 blocker Silodosin as medical treatment for ureteric stent related symptom is blockage of adrenergic receptors especially α1-adrenergic receptors in the detrusal muscle layer of bladder and intramural part of ureteric smooth muscle cells resulting in selective relaxation of the ureteric smooth muscle and therefore, decreases the pain with side effect as retrograde ejaculation and less CVS side effects as orthostatic hypotension.
While the mechanism of action of antimuscarinic selective m3 blocker Darifenacin as medical treatment for ureteric stent related symptom is to reduce the frequency of contractions by antagonizing parasympathetic control of the bladder; they also may alter bladder sensation during filling with side effects as xerostomia, blurred vision, and GI side effects such as constipation and dyspepsia. CNS-related antimuscarinic effects, including drowsiness, dizziness, and confusion, can occur and are particularly problematic in elderly patients but less likely as darifenacin is relatively selective for M3 receptors and therefore has minimal effects on M1 receptors in the CNS.
The aim of the present study was to analyze and compare the safety and efficacy of silodosin versus darifenacin versus combination of both drugs in the relief of ureteric stent related symptoms.
The present study was a prospective randomized comparative study, would be conducted on 100 patients admitted through the department of urology in Ain shams University Hospitals and Nasser institute hospital. The 100 patients were randomized divided into four groups. Each one was 25 patients, first group received Silodocin 8mg daily, the second group received Darifenacin 7.5 mg daily, the third group received Both drugs daily, the forth group did not receive either drugs
Follow-up was performed after two weeks and another follow up after six weeks by asking the patient about the grade of five symptoms (incomplete emptying, frequency, urgency, nocturia and pain) and side-effects of the drugs.
In this study, we found that the combination of Darifenacin and Silodosin or one of them only can significantly improve the ureteric stent related symptoms, It also showed significant improvement of these symptoms in favor of the combination of Silodosin and Darifenacin when compared with use of Silodosin only. Also, both drugs were safe with few side effects.