Role of tamsulosin in patients undergoing ESWL for renal and ureteric stones
DOI:
https://doi.org/10.18203/2349-2902.isj20205881Keywords:
CISF, ESWL, Tamsulosin, Ureteric stoneAbstract
Background: To determine the effect of tamsulosin, as adjunctive medical therapy on the outcome of extracorporeal shock wave lithotripsy (ESWL) for solitary renal and ureteric calculi.
Methods: From January 2017 onwards, a prospective, randomized controlled study was conducted in patients with solitary renal or ureteral calculus measuring less than 20 mm undergoing ESWL. The study group (n=62) received 0.4 mg of tamsulosin daily till stone clearance or a maximum period of 12 weeks and control group (n=58) received ESWL only. Parameters assessed were stone size, composition, location, stone clearance, mean time to clearance, analgesic requirement, steinstrasse, need for hospitalization and/or auxiliary procedures.
Results: There was no difference between the 2 groups with regards to age, stone size, location or composition. The complete clearance rate for renal stones was 62.7% and 36.5% (p=0.004) and for ureteric stone was 89.4% and 58.8% (p=0.03) in study and control groups, respectively. The control group had a higher rate of clinically insignificant residual fragments (CISF i.e. <3 mm), 12.9% versus 35.4% (p=0.002). There was no significant difference in the mean time to stone clearance (p=0.07) or in the incidence of steinstrasse formation (p=0.12). The mean analgesic requirement (p=0.01), need for auxiliary procedures and hospitalization (p=0.03) was significantly was higher in the control group.
Conclusions: Tamsulosin increase the complete clearance rate and decrease the incidence of CISF. It also reduces analgesic requirement, need of additional procedures and hospitalization rate and might be useful as a routine adjunctive therapy following ESWL.
Metrics
References
Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi. J Urol. 1997;158:1915.
Porpiglia F, Destefanis P, Fiori C and Fontana D. Effectiveness of nifedipine and deflazocort in the management of distal ureteral stones. Urology. 2000;56:579.
Weiss RM. Physiology and pharmacology of the renal pelvis and ureter. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ, eds. Campbell’s Urology, 8th edn. Sec. III. Philadelphia: W Saunders Co; 2002:377-407.
Dellabella M, Milanese G and Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol. 2005;174:167.
Borghi L, Meschi T, Amato F, Novarini A, Giannini A, Quarentilli C et al. Nifedipine and methylprednisolone in facilitating ureteral stone passage: a randomized, double blind placebo controlled study. J Urol. 1994;152:1095.
Hussain Z, Inman RD, Elves AW, Shipstone DP, Ghiblawi S, Coppinger SW. Use of glyceryl trinitrate patches in patients with ureteral stones: a randomized, double-blind, placebo-controlled study. Urology. 2001;58:521.
Sigala S, Dellabella M, Milanese G, Fornari S, Faccoli S, Palazzolo F, et al. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn. 2005;24:142.
Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol. 2003;170:2202.
Ishigooka M, Nakada T, Hashimoto T, Iijima Y, Yaguchi H. Spinal substance P immunoreactivity is enhanced by acute chemical stimulation of the rat prostate. Urology. 2002;59:139.
Kinnman E, Nygards EB, Hansson P. Peripheral alphaadrenoreceptors are involved in the development of capsaicin induced ongoing and stimulus evoked pain in humans. Pain. 1997;69:79.
Gravina GL, Costa AM, Ronchi P, Galatioto GP, Angelucci A, Castellani D et al. Tamsulosin treatment increases clinical success rate of single extracorporeal shock wave lithotripsy of renal stones. Urology. 2005;66:24.
Porpiglia F, Destefanis P, Fiori C, Scarpa RM and Fontana D. Role of adjunctive medical therapy with nifedipine and deflazocort after shock wave lithotripsy of ureteral stones. Urology. 2002;59:835.
Resim S, Ekerbicer HC and Ciftci A. Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Urology. 2005;66:945.
Morita T, Wada I, Saeki H, Tsuchida S, Weiss RM. Ureteral urine transport: changes in bolus volume, peristaltic frequency, intraluminal pressure and volume of flow resulting from autonomic drugs. J Urol. 1987;137:132.
Fedullo LM, Pollack HM, Banner MP, Amendola MA, Van Arsdalen KN. The development of steinstrassen after ESWL: frequency, natural history, and radiologic management. Am J Roentgenol. 1988;151:1145.
Andersson KE, Forman A. Effects of calcium channel blockers on urinary tract smooth muscle. Acta Pharmacol Toxicol. 1986;58:193.
Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol. 2005;173:2010.
O’Leary MP. Tamsulosin, current clinical experience. Urology. 2001;58:42.
Delvecchio FC, Preminger GM. Management of residual stones. Urol Clin North Am. 2000;27:347-54.
Khaitan A, Gupta NP, Hemal AK, Dogra PN, Seth A, Aron M. Post- SWL, clinically insignificant Residual Stones: Reality or Myth? Urology 2002;59:20-4.
Beck EM, Riehle RA. The fate of residual fragments after extracorporeal lithotripsy monotherapy for infection stones. J Urol. 1991;145:6-10.
Osman MM, Alfano Y, Kamp S, Haecker A, Alken P, Michel MS, et al. 5-year-follow-up of patients with clinically insignificant residual fragments after extracorporeal shockwave lithotripsy. Eur Urol. 2005;47:860-4.