Comparison of the efficacy of alfuzosin and mirabegron on symptoms associated with Double-J stent placement after retrograde intrarenal surgery

Aims: This study aimed to evaluate the efficacy of alfuzosin, mirabegron, and their combination in terms of stone-free rates, residual fragments, stent-related pain, and lower urinary tract symptoms (LUTS) in patients undergoing Double-J (DJ) stent placement following retrograde intrarenal surgery (RIRS). Materials and Methods: A prospective, randomized, single-center trial was conducted between February 2022 and December 2023 at Gaziantep University. A total of 103 patients who underwent RIRS for unilateral renal stones measuring 1–2 cm followed by DJ stenting were enrolled. Patients were randomized into four groups: Group 1 (control group, no medication), Group 2 (alfuzosin 10 mg/day), Group 3 (mirabegron 50 mg/day), and Group 4 (combination therapy with alfuzosin and mirabegron). Pain and LUTS were assessed 30 days postoperatively using the Visual Analog Scale (VAS) and the Overactive Bladder-Validated 8 (OAB-V8) questionnaire. Results: The mean age was 43.55 ± 13.93 years. No statistically significant difference was found between groups with respect to stone-free rates, residual stones, pain, or LUTS (P > 0.05). Group 2 (alfuzosin) had the lowest mean VAS (1.69 ± 1.52) and OAB-V8 (13.5 ± 7.37) scores; however, these differences were not statistically significant when compared to the control group (P = 0.112 and P = 0.592, respectively). Residual stones were detected in 15.5% of patients, and stone size was identified as a significant predictor (P = 0.025). Conclusions: The use of alfuzosin and mirabegron, either alone or in combination, did not have a significant effect on stone-free rates, stent-related pain, and LUTS. Although lower pain and symptom scores were observed in the alfuzosin group, these findings should be interpreted with caution due to the lack of statistical significance. The relatively small sample size and single-center design represent important limitations of this study. Further large-scale, multicenter studies are warranted to clarify the potential role of these agents in the management of DJ stent-related symptoms.