Mirabegron Role in Urolithiasis Management: What you should Know

Abstract

The purpose of the present study was to develop a narrative review of the available evidence of mirabegron efficacy in three scenarios: as a medical expulsive therapy; as a medical treatment to increase a successful access to stones before ureteroscopy, and management of double-J stent-related symptoms. Only two original studies have evaluated its use as a medical expulsive therapy, with contradictory results in terms of stone expulsion rate; however, both demonstrated a better pain control in the mirabegron group. One randomized controlled trial (RCT) found a higher successful access to ureteral stones when mirabegron was administered 1 week before the ureteroscopy. And two RCTs demonstrated its efficacy in diminishing discomfort related with double-J stent. There is a promising role for the use of mirabegron in the arsenal of urolithiasis treatment, even as a medical expulsive therapy, before ureteroscopy surgery, to increase the successful access to the stones and after the placement of ureteral catheter to reduce the related symptoms. However, larger-scaled prospective double-blinded RCTs are needed before it can be used with these purposes in the clinical scenario.

Resumen

El propósito de este trabajo fue desarrollar una revisión narrativa de la literatura describiendo la evidencia disponible sobre la eficacia del mirabegrón en tres escenarios: como terapia médica expulsiva, como tratamiento médico antes de la ureteroscopia para incrementar el acceso exitoso al cálculo, y en el manejo de los síntomas asociados con el uso de catéter doble J. Solo dos estudios originales han evaluado su uso como terapia médica expulsiva, con resultados contradictorios en términos de tasa de expulsión del cálculo; sin embargo, ambos demostraron mejor control del dolor en el grupo de mirabegrón. Un estudio aleatorizado multicéntrico encontró un aumento en el acceso exitoso al cálculo durante la ureteroscopia cuando el mirabegrón era administrado una semana antes del procedimiento. Adicionalmente, dos estudios aleatorizados controlados demostraron eficacia del medicamento para disminuir los síntomas relacionados con el catéter doble J. El uso del mirabegrón como parte del arsenal del tratamiento para urolitiasis tiene un rol prometedor, tanto en la terapia médica expulsiva como antes de la ureteroscopia, para aumentar la posibilidad de acceder exitosamente al cálculo, y en pacientes con catéter doble J, para disminuir los síntomas asociados. Sin embargo, se requiere estudios más grandes, prospectivos, doble ciegos y aleatorizados antes de que podamos utilizarlo con estos fines en un escenario clínico.

Keywords

mirabegron - medical expulsive therapy - urolithiasis - ureteroscopy - ureteral catheter - double-J catheter

Palabras clave

mirabegrón - terapia médica expulsiva - urolitiasis - ureteroscopia - catéter ureteral - catéter doble J

Publication History

Received: 27 January 2020

Accepted: 17 June 2020

Article published online:
14 August 2020

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