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De Nunzio C et al, 2016: Tamsulosin or Silodosin Adjuvant Treatment Is Ineffective in Improving Shockwave Lithotripsy Outcome: A Short-Term Follow-Up Randomized, Placebo-Controlled Study.

De Nunzio C, Brassetti A, Bellangino M, Trucchi A, Petta S, Presicce F, Tubaro A.
Department of Urology, Sant'Andrea Hospital, "Sapienza", University of Rome , Rome, Italy.

Abstract

INTRODUCTION: The role of α-blockers after shockwave lithotripsy (SWL) is controversial. The aim of our study was to evaluate the effect of tamsulosin and silodosin after SWL for kidney stones.
METHODS: From 2012 onward, a consecutive series of patients undergoing SWL were prospectively enrolled and randomized by closed envelopes in three groups receiving tamsulosin 0.4 mg (A), silodosin 8 mg (B), and placebo (C) daily for 21 days after SWL. Anthropometrics, stone size, and location were recorded before SWL. Visual analogue scale (VAS) score was collected at 6, 12, and 24 hours after treatment to evaluate patients' discomfort. Stone-free rate was assessed 1 and 3 weeks postoperatively. Complications and medical treatment-related adverse events (AEs) were recorded. Differences in VAS score, stone-free rate, and complications were compared among the groups.
RESULTS: Overall, 60 patients were enrolled. Mean stone sizes were 10.28 ± 2.46 mm, 10.45 ± 1.73 mm, and 9.23 ± 2.04 mm in groups A, B, and C, respectively (p = 0.474). There was no significant difference between the three groups with regard to stone location. Comparable energy was used to treat patients from the three groups. The overall 3-week stone-free rate was 53%: 58% in the tamsulosin group, 47% in the silodosin group, and 55% in the placebo group (p = 0.399). No significant differences were observed in the VAS scores reported by the groups at 6 hours (p = 1.254), 12 hours (p = 0.075), and 24 hours (p = 0.490). Overall, 12 complications were reported: 11 patients (7 in group C and 4 in group B) needed analgesics for colic, and 1 patient (group B) was surgically treated for Steinstrasse. Tamsulosin was superior to placebo (p = 0.008) and silodosin (p = 0.021) in preventing complications; no difference between silodosin and placebo (p = 0.629) was noted.
CONCLUSIONS: Tamsulosin and silodosin are ineffective in increasing stone-free rate as well as early patients' discomfort after extracorporeal lithotripsy. 

J Endourol. 2016 May 11. [Epub ahead of print]

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Comments 1

Hans-Göran Tiselius on Sunday, 06 November 2016 11:43

Most studies on -receptor antagonists have shown positive effects on the passage of ureteral stones without or with preceding SWL. But also contradictory findings have been published.

The purpose of this randomized placebo-controlled study was to evaluate the effect of -receptor antagonists (Tamsulosin and Silodosin) administered after SWL of stones located in the kidney. In the relatively small groups (19-22 patients) no significant differences were recorded in terms of stone-free rates after 3 weeks (47-58%). The lowest value was recorded for patients treated with Silodosin. Neither was there any difference in pain experience up to 24h after SWL.

The authors concluded, however, that Tamsulosin was “significantly better” than placebo to reduce complications! Exactly how this effect was explained is, unfortunately, not further elucidated or discussed. It is likely, however, that this effect was entirely related to a reduced rate of episodes of acute stone colic classified by the authors as complications. Based on this latter observation it is possible that -receptor antagonists nevertheless might have a place in patients treated with SWL for stones in the kidney.

Most studies on -receptor antagonists have shown positive effects on the passage of ureteral stones without or with preceding SWL. But also contradictory findings have been published. The purpose of this randomized placebo-controlled study was to evaluate the effect of -receptor antagonists (Tamsulosin and Silodosin) administered after SWL of stones located in the kidney. In the relatively small groups (19-22 patients) no significant differences were recorded in terms of stone-free rates after 3 weeks (47-58%). The lowest value was recorded for patients treated with Silodosin. Neither was there any difference in pain experience up to 24h after SWL. The authors concluded, however, that Tamsulosin was “significantly better” than placebo to reduce complications! Exactly how this effect was explained is, unfortunately, not further elucidated or discussed. It is likely, however, that this effect was entirely related to a reduced rate of episodes of acute stone colic classified by the authors as complications. Based on this latter observation it is possible that -receptor antagonists nevertheless might have a place in patients treated with SWL for stones in the kidney.
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