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Shahat A et al, 2016: Is Tamsulosin Effective after Shock Wave Lithotripsy for Pediatric Renal Stones? A Randomized, Controlled Study.

Shahat A, Elderwy A, Safwat AS, Abdelkawi IF, Reda A, Abdelsalam Y, Sayed M, Hammouda H.
Pediatric Urology Section, Urology Department, Assiut Urology and Nephrology Hospital, Assiut University, Assiut, Egypt.

Abstract

PURPOSE: We assessed the effect of tamsulosin as an adjunctive therapy after shock wave lithotripsy for pediatric single renal pelvic stones.
MATERIALS AND METHODS: A total of 120 children with a unilateral single renal pelvic stone were included in a prospective randomized, controlled study. All children were randomized to 2 equal groups. Group 1 received tamsulosin (0.01 mg/kg once daily) as adjunctive therapy after shock wave lithotripsy in addition to paracetamol while group 2 received paracetamol only. Stone clearance was defined as no renal stone fragments or fragments less than 3 mm and no pelvicalyceal system dilatation.
RESULTS: Our study included 69 boys and 51 girls with a median age of 3.5 years and a median stone size of 1.2 cm. There was no statistically significant difference between groups 1 and 2 in stone or patient criteria. Of the children 99 (82.5%) achieved stone clearance after the first session, including 50 in group 1 and 49 in group 2. All children in each group were cleared of stones after the second session. The overall complication rate was 14.2%. There was no statistically significant difference between single session stone clearance rates (p = 0.81) and complications rates (p = 0.432) in either group. On multivariate analysis using logistic regression smaller stone size (p = 0.016) and radiopaque stones (p = 0.019) were the only predictors of stone clearance at a single shock wave lithotripsy session. Tamsulosin therapy did not affect stone clearance (p = 0.649).
CONCLUSIONS: Tamsulosin does not seem to improve renal stone clearance. Smaller and radiopaque renal stones have more chance of clearance after shock wave lithotripsy for pediatric single renal pelvic stones.

J Urol. 2016 Feb 26. pii: S0022-5347(15)05235-0. doi: 10.1016/j.juro.2015.11.021. [Epub ahead of print]

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Comments 1

Hans-Göran Tiselius on Friday, 20 May 2016 07:36

In view of the considerable experience of the more powerful ureteral contractions in children than in adults, my immediate expectation would be that administration of tamsulosin would not result in any difference compared with that in controls.

The authors make a reservation for the results inasmuch as there were no placebo-treated children, but it is highly unlikely that paracetamol to any significant extent would affect stone clearance. The results also confirmed my assumption and fragment clearance was equal in the two groups of children.

One interesting feature of this report was the high occurrence of radiolucent stones (38/120= 32%). Moreover, the authors concluded that fragment clearance was better for radiopaque stones. No explanation is provided for this outcome, but the suspicion is that ultrasound localisation of stones was inferior to that of x-ray because the majority of radiolucent stones might have been composed of uric acid and followed with US.

The overall results of SWL in children was shown to be good and all children became stone-free after up to two SWL-sessions and 82.5% were stone-free after the first session!

The conclusion from this report is that http://storzmedical.com/images/blog/shahat.png -receptor antagonists have no place in children treated with SWL. In addition it recently has been questioned whether http://storzmedical.com/images/blog/shahat.png -receptor antagonists at all have any indication in the treatment of patients with stones.

In view of the considerable experience of the more powerful ureteral contractions in children than in adults, my immediate expectation would be that administration of tamsulosin would not result in any difference compared with that in controls. The authors make a reservation for the results inasmuch as there were no placebo-treated children, but it is highly unlikely that paracetamol to any significant extent would affect stone clearance. The results also confirmed my assumption and fragment clearance was equal in the two groups of children. One interesting feature of this report was the high occurrence of radiolucent stones (38/120= 32%). Moreover, the authors concluded that fragment clearance was better for radiopaque stones. No explanation is provided for this outcome, but the suspicion is that ultrasound localisation of stones was inferior to that of x-ray because the majority of radiolucent stones might have been composed of uric acid and followed with US. The overall results of SWL in children was shown to be good and all children became stone-free after up to two SWL-sessions and 82.5% were stone-free after the first session! The conclusion from this report is that [img]http://storzmedical.com/images/blog/shahat.png[/img] -receptor antagonists have no place in children treated with SWL. In addition it recently has been questioned whether [img]http://storzmedical.com/images/blog/shahat.png[/img] -receptor antagonists at all have any indication in the treatment of patients with stones.
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