Effect of Antihistamine on Ureteral Stent-Related Symptoms: A Double-Blind Randomized Controlled Trial

Given evidence of antihistamine's efficacy in bladder pain syndrome and renal colic, we evaluated the effect of antihistamine on ureteral stent-related symptoms. We performed a double-blind, randomized controlled trial of adults undergoing unilateral ureteroscopy with stent placement for urolithiasis treatment. Coloplast Imajin silicone stents (Coloplast A/S, Humlebaek, Denmark) were used for all procedures. Alongside nonsteroidal anti-inflammatory medications for pain control, patients were randomly prescribed a 10-day course of either fexofenadine 180 mg oral daily (study arm) or placebo (control). The primary outcome was Ureteral Stent Symptoms Questionnaire urinary symptoms and pain scores with stent in situ immediately before stent removal; groups were compared using the Student t test. Higher scores represented increasing symptom severity. Of 73 patients (37 study arm, 36 control arm), mean age was 52-years-old, and the majority were male (60%). Mean stone burden (10 mm) and median time to stent removal (9 days) were similar between groups. With stent in situ, there were no differences in urinary symptoms or pain scores between study and control groups (28 vs 29, P = .85 and 14 vs 17, P = .25); moreover, there were no differences between arms in any Ureteral Stent Symptoms Questionnaire domain at this timepoint (P > .05). There were no differences between study and control groups in postdischarge narcotic analgesia use (5% vs 14%, P = .26), total number of office phone calls (5 vs 9, P = .61), or total number of Emergency Department visits (2 vs 3, P = .67). Postoperative antihistamines were well-tolerated but did not significantly reduce ureteral stent-related symptoms.