Vicentini FC et al, 2011: Adjuvant Tamsulosin or Nifedipine After Extracorporeal Shock Wave Lithotripsy for Renal Stones: a Double Blind, Randomized, Placebo-controlled Trial

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Vicentini FC et al, 2011: Adjuvant Tamsulosin or Nifedipine After Extracorporeal Shock Wave Lithotri...

Vicentini FC et al, 2011: Adjuvant Tamsulosin or Nifedipine After Extracorporeal Shock Wave Lithotripsy for Renal Stones: a Double Blind, Randomized, Placebo-controlled Trial

Vicentini FC, Mazzucchi E, Brito AH, Chedid Neto EA, Danilovic A, Srougi M

Section of Endourology and Lithiasis, Department of Urology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil

Abstract

OBJECTIVE: To evaluate the effects of the adjuvant use of tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for nonlower pole kidney stones 5-20 mm in size.

METHODS: We conducted a randomized double-blind trial involving 136 patients with radiopaque kidney stones. The patients received daily treatment with 0.4 mg tamsulosin, 20 mg nifedipine retard, or placebo for ≤30 days after 1 session of extracorporeal shock wave lithotripsy. Success was defined as plain film radiography showing the patient was completely stone free or with asymptomatic stone fragments ≤4 mm in size at any time during the weekly follow-up.

RESULTS: The success rate was 60.5% (23 of 38) in the tamsulosin group, 48.6% (17 of 35) in the nifedipine group, and 36.8% (14 of 38) in the placebo group (P = .118). In the subgroup analysis, stones 10-20 mm had significantly greater success rates in the tamsulosin (13 of 21, 61.9%) and nifedipine (15 of 25, 60%) groups compared with the placebo group (6 of 23, 26.1%; P = .024), but not for stones 5-9 mm (P = .128). The number needed to treat was 2.9 for tamsulosin and 3 for nifedipine. Adverse events were more frequent in the nifedipine than in the placebo group (28.5% vs 2.6%, respectively, P = .009), but without a significant difference between the nifedipine and tamsulosin (28.5% vs 15.8%, P = .15) or the tamsulosin and placebo (P = .54) groups. No difference was found among the groups with regard to pain intensity, interval to clearance, or steinstrasse.

CONCLUSION: The stone-free rates after extracorporeal shock wave lithotripsy with adjuvant tamsulosin or nifedipine were significantly increased only for nonlower pole renal stones 10-20 mm in size compared with placebo. Nifedipine was associated with more adverse effects than placebo.

Urology. 2011 Nov;78(5):1016-21. doi: 10.1016/j.urology.2011.04.062. Epub 2011 Jul 29

PMID: 21802124 [PubMed - in process]

Comment

Like the paper by Zaytoun et al. in this review this is another report on the effects of medical expulsion therapy after SWL of non lower pole renal stones ≤ 20 mm.

	ESWL sessions	Stone free rate (%)	Mean fragment elimination time	Mean pain score	Median analgetic use
Vicentini	?	4 weeks
Tamsolusin		61	15,3 days	Ø no difference
Nifedipine		49	16	Ø no difference
placebo		37	17

Zaytoun	2,07	12 weeks
Tamsolusin +		92	5,3 weeks	X	X
Doxazosin +		90	6,8 weeks	X	X
+ = phloroglucinol		84	7,3 weeks

The table compares a few data of both papers. Statistically different results are indicated in bold. The story of the medical expulsion therapy goes on.

Peter Alken