What is the role of botulinum toxin (BTX) injection in the treatment of pain caused by ureteral stents?

Updated: Jun 19, 2018
  • Author: Anthony H Wheeler, MD; Chief Editor: Meda Raghavendra (Raghu), MD  more...
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The use of ureteral stents for ureteral obstruction and after ureteroscopy can result in substantially reduced patient quality of life due to pain, frequency and urgency. Gupta et al tested their theory that numerous stent-related symptoms may be caused by detrusor muscle spasm in and around the intramural ureter by evaluating the effect of BTX-A in patients with indwelling stents after ureteroscopy. [92] Fifty-one patients were enrolled in a prospective, randomized, single-blind study comparing BTX-A injections into 3 locations around the ureteral orifice (30 patients) compared with no injection after unilateral ureteral stent insertion (21 patients).

Pain and urinary symptoms after stent placement were evaluated using the Ureteral Stent Symptom Questionnaire, which was completed on postoperative day 7. In addition, patients were required to maintain a log of opioid analgesic use between stent placement and its removal. No complications or adverse events occurred during this study. A significant reduction was reported in the postoperative pain score between the patients treated with BTX-A and the control group (eg, 3.4 vs 6 [p = 0.02]). Postoperative opioid use was less in the BTX-A treatment group, who averaged 7.7 pills over 2.7 days compared with 24.7 pills averaged over 7 days in control patients (p = 0.03).

With respect to postoperative lower urinary tract symptoms, no significant difference was noted between cohorts using the individual index scores within the Ureteral Stent Symptom Questionnaire. Periureteral BTX-A injections appear to improve ureteral stent tolerability as referenced by patient report of reduced postoperative pain intensity and decreased opioid intake over a shorter period of time following stent placement.

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