A recent study indicated that stent on string (SOS) is a great alternative following ureteroscope (URS), particularly for patients without intraoperative complications, and they are typically inserted as a routine based on surgeon preference. These stents decrease pain, cost, dwell time, risks, and the suffering associated with prolonged stenting, and most patients are satisfied to remove them at home. While their use is currently limited in endourology practices, they are expected to become the standard for routine URS in the future. The findings of this study were published in the Journal of Endourology.

An extensive systematic review was carried out across several databases, utilizing the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. This review targeted studies published in English that involved patients of all age groups with SOS after undergoing ureteroscopy (URS) for the management of stone disease. A total of 22 studies (20 involving adults and 2 involving pediatric patients) were included from the 1210 records identified, including 8382 patients. Among these patients, 3427 (40.9%) had stent on string inserted and 434 (11%) were in the pediatric age group.

Study results showed that SOS presents several advantages, and when compared with stents without strings (SWOSs), they were implanted for a shorter period, with no significant differences in complications such as urinary tract infection or urinary symptoms. Moreover, SOS showed notable cost savings, decreased pain upon removal, and a high incidence of successful home removal, with more than 90% of patients indicating their readiness to remove their SOSs at home. However, it is important to consider the minor risk of stent dislodgment when deciding on SOS placement post-URS.

The above study demonstrated that SOS is an excellent option after URS, especially for patients who do not experience intraoperative complications. Surgeons typically insert these stents based on their preference as part of routine practice. The use of these stents reduces cost, pain dwell time, risks, and the discomfort associated with prolonged stenting. Many patients are happy to have them removed at home. The use of SOS is currently limited in endourology, it is anticipated that they will become the gold standard for routine ureteroscope in the future.

According to a recent study, the addition of Pentoxifylline to tamsulosin has shown promising results in alleviating the lower urinary symptoms experienced by patients with benign prostatic hyperplasia (BPH). This combination therapy is well-tolerated and has demonstrated superior treatment outcomes compared to tamsulosin alone. The findings of this study were published in the journal, Lower Urinary Tract Symptoms.

A total of 60 patients diagnosed with BPH were included in this randomized clinical trial. The participants were divided into two groups: intervention (Pentoxifylline + tamsulosin) and control (placebo + tamsulosin). Throughout the study, the patients were assessed for international prostate symptom score (IPSS), maximum urinary flow rate (Q_max) using uroflowmetry, quality of life (QoL), and post-void residual volume (PVR) through abdominal sonography at the beginning of the trial and after 12 weeks.

Patients who were administered the combination therapy exhibited significantly improved results in terms of prostate symptoms and improvement of quality of life (IPSS: -36.6%; QoL:       -45.3%) when compared to patients who solely received tamsulosin (IPSS: -21.2%; QoL: -27.7%). Additionally, the combination therapy yielded a significantly higher improvement in maximum urinary flow rate and residual volume (Q_max: +42.5%; PVR: -42.6%) compared to monotherapy (Q_max: +25.1%; PVR: -26.1%).

It can be concluded that the addition of Pentoxifylline to tamsulosin is effective in reducing the lower urinary symptoms in patients with BPH.

According to a recent study, in men with benign prostatic hyperplasia (BPH)/ lower urinary tract symptoms (LUTS) who are unwilling to continue combination therapy, they may be presented with either α1-adrenergic receptor blocker (AB) or 5α-reductase inhibitor (5ARI) withdrawal if there is a minimum improvement of seven points in International Prostate Symptom Score-total (IPSS-T) and a reduction of at least 20% in prostate volume (PV). This research findings were published in the journal, The Prostate.

This randomized trial included 222 patients with BPH/LUTS who experienced a minimum seven-point improvement[S.1]  in IPSS-T and a ≥ 20% decrease in PV after commencing combination therapy. Patients were randomly assigned to continued-combination, AB-withdrawal, and 5ARI-withdrawal groups in a 1:1:1 ratio. Various parameters such as IPSS, EuroQol-five-dimensional questionnaire (EQ-5D-5L), overactive bladder symptom score, EuroQol-visual analog scale (EQ-VAS), PV, postvoid residual urine (PVR), maximal flow rate, and prostate-specific antigen level were assessed every 6 months over a 24-month period and the predictors of IPSS-T deterioration were evaluated.

At month 24, 27.8% of patients in the AB-withdrawal group and 26.4% in the 5ARI-withdrawal group experienced a deterioration of ≥2 points in IPSS-T. Among the patients, 5.6% and 5.7% necessitated the reintroduction of the previously withdrawn medication. EQ-VAS showed improvement in the continued combination group at month 24 compared to baseline (p = 0.028). The AB-withdrawal group displayed enhancements in EQ-VAS, EQ-5D-5L, and PVR at month 24 (all p < 0.005), while the 5ARI-withdrawal group demonstrated improvement in IPSS-S (p = 0.011). Diabetes was associated with a decrease in IPSS-T at the 24-month mark (p = 0.020)

Therefore, for men diagnosed with BPH experiencing LUTS who are unwilling to continue combination therapy may be offered the choice of either discontinuing AB or 5ARI treatment. This option is available if there is a minimum improvement of seven points in the IPSS-T and a reduction of at least 20% in PV.

A new study demonstrated that patients who have been catheterized due to acute urinary retention secondary to benign prostatic hyperplasia (AUR Secondary to BPH) may experience spontaneous voiding after catheter removal if they are treated with silodosin, regardless of the duration of catheterization. However, side effects tend to increase with longer periods of catheterization. This study’s findings were published in the journal, Urologia.

The study included 260 patients who experienced acute urinary retention secondary to benign prostatic hyperplasia. The patients underwent catheterization and were subsequently allocated at random to receive either 8 mg of silodosin for a period of three days or seven days. After the treatment period, the catheter was removed, and the success of voiding unaided was evaluated.

Out of the 260 men who were treated, 74 men who were on a 3-day silodosin regimen and 88 patients who were on a 7-day silodosin regimen did not require re-catheterization on the day of outcome of trial without catheter (TWOC) (57% and 68% respectively). In the group of participants who underwent the 3-day silodosin regimen, 16.2% experienced complications like acute urinary tract infection, urinary leakage, hematuria, or catheter blockage. On the other hand, in the group that received the 7-day silodosin treatment, 48.5% reported similar issues.

Therefore, silodosin treatment demonstrated positive outcomes in patients who have undergone catheterization as a result of AUR secondary to BPH. Irrespective of the duration of catheterization, these patients can spontaneously void after the removal of the catheter if they are treated with silodosin. It is important to consider that the likelihood of experiencing side effects tends to increase with longer periods of catheterization.