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Park JH et al, 2013: A prospective randomized controlled trial of the efficacy of tamsulosin after extracorporeal shock wave lithotripsy for a single proximal ureteral stone

Park YH, Lee HE, Park JY, Lee SB, Kim HH
Department of Urology, Seoul National University College of Medicine, Seoul, Korea


Abstract

PURPOSE: The objective of this study was to evaluate the efficacy of tamsulosin on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with a single proximal ureteral stone.

MATERIALS AND METHODS: This prospective randomized controlled trial was performed on 88 patients with a single proximal ureteral stone. After consenting with a doctor, the patients were allocated to the treatment (tamsulosin 0.2 mg once a day) or control (no medication) group, and the efficacy of tamsulosin was evaluated. The primary outcome of this study was the stone-free rate, and the secondary outcomes were the period until clearance, pain intensity, analgesic requirement, and incidence of complications.

RESULTS: A stone-free state was reported in 37 patients (84.1%) in the treatment group and 29 (65.9%) in the control group (p=0.049). The mean expulsion period of the stone fragments was 10.0 days in the treatment group and 13.2 days in the control group (p=0.012). There were no statistically significant differences in aceclofenac requirement or pain score between the two groups. Only one patient in the treatment group experienced transient dizziness associated with medical expulsive therapy, and this adverse event disappeared spontaneously.

CONCLUSIONS: The results of this prospective randomized controlled trial of the efficacy of tamsulosin after ESWL for a single proximal ureteral stone suggest that tamsulosin helps in the earlier clearance of stone fragments and reduces the expulsion period of stone fragments after ESWL.

Korean J Urol. 2013 Aug;54(8):527-30. doi: 10.4111/kju.2013.54.8.527. Epub 2013 Aug 7
PMID:23956828 [PubMed] PMCID:PMC3742905

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Comments 1

Hans-Göran Tiselius on Wednesday, 02 October 2013 13:41

The advantage of using alpha-blocking agents to facilitate elimination of ureteral stones and fragments has been demonstrated in numerous studies and meta-analyses. In this prospective randomized trial the effect of tamsulosin was recorded following SWL of stone located in the proximal ureter. The stone-free rate was highest in the treatment group; 84% compared with 66%. Earlier expulsion was recorded when alpha blocking agents were given. This outcome can be predicted from previous experience because fragments in the proximal ureter sooner or later will pass the distal ureter where the effect of alpha-blocking agents is assumed to be most pronounced. The extent of stone disintegration is not mentioned in the article.

The conclusion that might be drawn from this, and also from other reports, is that alpha-blocking agents advantageously can be used following most SWL procedures irrespective of the initial stone location.

Hans-Göran Tiselius

The advantage of using alpha-blocking agents to facilitate elimination of ureteral stones and fragments has been demonstrated in numerous studies and meta-analyses. In this prospective randomized trial the effect of tamsulosin was recorded following SWL of stone located in the proximal ureter. The stone-free rate was highest in the treatment group; 84% compared with 66%. Earlier expulsion was recorded when alpha blocking agents were given. This outcome can be predicted from previous experience because fragments in the proximal ureter sooner or later will pass the distal ureter where the effect of alpha-blocking agents is assumed to be most pronounced. The extent of stone disintegration is not mentioned in the article. The conclusion that might be drawn from this, and also from other reports, is that alpha-blocking agents advantageously can be used following most SWL procedures irrespective of the initial stone location. Hans-Göran Tiselius
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