A systematic review and meta-analysis of the efficacy and safety of mirabegron vs. tamsulosin in alleviating double-J catheter related symptoms.

Background: Currently, many clinicians use tamsulosin as a medication to alleviate symptoms following double J (DJ) stent insertion. With the emerging advantages of β-receptor agonists in relieving urinary tract spasms, the effectiveness of mirabegron in treating DJ stent-related symptoms has gained attention. Objective: To explore which medication, mirabegron or tamsulosin, is more effective in alleviating DJ stent-related symptoms. Methods: A literature search was conducted to identify randomized controlled trials (RCTs) that evaluated the use of mirabegron and tamsulosin in relieving DJ stent-related symptoms. Databases searched included PubMed, Web of Science, Cochrane Library, Embase, and CNKI, with the search cutoff date in June 2024. Inclusion criteria were patients who underwent percutaneous nephrolithotomy (PCNL) or ureteroscopy (URS) with DJ stent placement and were treated with either tamsulosin or mirabegron. Data extraction and quality assessment were performed using standardized methods, and a meta-analysis was conducted. Results: One of the Ureteral Stent Symptom Questionnaire (USSQ) indicators, Work Performance Index (WPI), showed a mean difference (MD) of -1.01 (95% CI: -1.91 to -0.11, p = 0.03, I 2 = 77%). For side effects: risk ratios (RR) = 0.34, (95% CI = 0.13 to 0.89, p = 0.03, I 2 = 0%). Conclusion: This study shows that mirabegron demonstrates better efficacy in terms of WPI and has fewer side effects overall, particularly for patients experiencing tamsulosin-related side effects such as hypotension or ejaculatory dysfunction. However, no significant differences were found between the two drugs in other aspects of the USSQ or in the IPSS. Further large-scale, high-quality RCTs with longer follow-up periods and comprehensive safety data are needed to confirm these findings and identify patient groups who may benefit most from mirabegron treatment. Systematic review registration: https://www.crd.york.ac.uk/prospero/, CRD420251083374.