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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.

Copyright © 2011 Elsevier Inc. All rights reserved.
Urology. 2011 Nov;78(5):1016-21. doi: 10.1016/j.urology.2011.04.062. Epub 2011 Jul 29
PMID: 21802124 [PubMed - in process]

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Comments 1

Peter Alken on Monday, 19 September 2011 15:56

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.

/images/blog/VincentiniFC2011klein.jpg

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

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. [img]/images/blog/VincentiniFC2011klein.jpg[/img] 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
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