Methocarbamol vs Oxybutynin for Management of Pain and Discomfort S/P Ureteroscopy Procedure
Status:
Recruiting
Trial end date:
2022-09-01
Target enrollment:
Participant gender:
Summary
Stone disease is a common condition, affecting approximately 9% of Americans in 2007. It
causes great morbidity and is also a costly condition, estimated to cost the US healthcare
system approximately 3.79 billion dollars in 2007. Ureteroscopy (URS) is the most commonly
performed surgical treatment for upper tract stone disease. Ureteral stenting is a common
practice after ureteroscopy and placed in ~75% of cases to prevent ureteral edema and renal
obstruction. Unfortunately, ureteral stenting can be very painful and has been shown to
increase the rate of emergency room visits. Many strategies have been attempted to decrease
pain with ureteral stenting including modification of stent material and designs, but efforts
so far have been unsuccessful in decreasing stent-related morbidity. Stent-related morbidity
is hypothesized to be secondary to irritation of ureteral/bladder mucosa and muscle.
Analgesics such as alpha blockers and NSAIDs have been shown to reduce stent morbidity.
Anticholinergic drugs are also utilized as they decrease bladder spasms and, therefore, are
hypothesized to reduce stent irritation. However, the evidence for anticholinergics has been
conflicting. Anticholinergics also have a serious side effect profile including dry mouth,
dry eyes, constipation, urinary retention, blurred vision, and even dementia. Some authors
even hypothesize that these side effects may offset any purported benefits the
anticholinergics provide for stent-morbidity.
Methocarbamol is anti-spasmodic muscle relaxant that is believed to work by acting on central
neurons and possibly by blocking sodium channels. Given that anticholinergics have many side
effects and questionable efficacy, the investigators hypothesize that methocarbamol may
achieve superior analgesia for stent morbidity and stent-related bladder spasms.
Oxybutynin is used for the treatment of overactive bladder. The rationale is that the
oxybutynin relaxes the muscles in the bladder to help decrease problems of urgency and
frequent urination caused by the urinary stent irritation. Since anticholinergics have
multiple side effects, finding an equally efficacious alternative with less side effects is
highly desirable.
This study will evaluate the clinical and demographic factors of patients undergoing
ureteroscopy and treated postoperatively with methocarbamol vs. oxybutynin for stent-related
morbidity. Additionally, the study will aim to understand the postoperative outcomes and
complication rates of patients discharged with methocarbamol vs. oxybutynin after
ureteroscopy with a ureteral stent in place.