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Janane A et al, 2014: Usefulness of adjunctive alpha1-adrenergic antagonists after single extracorporeal shock wave lithotripsy session in ureteral stone expulsion

Janane A, Hamdoun A, Hajji F, Dakkak Y, Ghadouane M, Ameur A, Abbar M
Department of Urology, University Military Hospital Mohammed V. Rabat, Morocco


Abstract

INTRODUCTION: We evaluate the efficiency of α-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones.

METHODS: A total of 356 patients with solitary lower ureteral stones who underwent single ESWL sessions were divided into 2 groups. Group 1 received our standard medical therapy, and Group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during the treatment period. A computed tomography scan was systematically performed 3 months after ESWL.

RESULTS: In total, 82 of the 170 patients in Group 1 (48.2%) and 144 of the 186 patients in Group 2 (77.4%) (p = 0.002) were stone-free. Among the patients with stones 10 to 15 mm in diameter, the stone-free rate was 38.4% in Group 1 and 77.1% in Group 2 (p = 0.003). Average stone expulsion time was 10.6 days and 8.4 days in Groups 1 and 2, respectively. Ureteral colic occurred in 40 patients (23.5%) in Group 1, but only in 10 patients (5.3%) in Group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 5 of the 186 patients in Group 2 (2.6%).

CONCLUSION: Adjunctive therapy with α1-adrenergic antagonists after ESWL is more efficient than, and equally as safe as, lithotripsy alone to manage patients with lower ureteral stones. The adding of α-blockers is more reliable and helpful for stones with a large dimension, and can also decrease stone elimination time and episodes of ureteral colic.

Can Urol Assoc J. 2014 Jan-Feb;8(1-2):E8-E11. doi: 10.5489/cuaj.1261.
PMID:24454608[PubMed]
PMCID:PMC3896566

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Comments 1

Peter Alken on Monday, 17 March 2014 14:15

The patients were treated in the supine position but the route of shock wave application is not described in detail or discussed. The results compare well with those of Phipps et al.(Phipps S, Stephenson C, Tolley D. Extracorporeal shockwave lithotripsy to distal ureteric stones: the transgluteal approach significantly increases stone-free rates. BJU Int. 2013 Jan 29.) [reviewed in 2013] who compared supine transgluteal vs. prone SWL application. In their series "the proportions of patients who were stone-free after one treatment session within the prone and transgluteal treatment groups were 40 and 78%, respectively" They did not use a-blockers after treatment.

Peter Alken

The patients were treated in the supine position but the route of shock wave application is not described in detail or discussed. The results compare well with those of Phipps et al.(Phipps S, Stephenson C, Tolley D. Extracorporeal shockwave lithotripsy to distal ureteric stones: the transgluteal approach significantly increases stone-free rates. BJU Int. 2013 Jan 29.) [reviewed in 2013] who compared supine transgluteal vs. prone SWL application. In their series "the proportions of patients who were stone-free after one treatment session within the prone and transgluteal treatment groups were 40 and 78%, respectively" They did not use a-blockers after treatment. Peter Alken
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