Ateş F et al, 2012: Does the use of doxazosin influence the success of SWL in the treatment of upper ureteral stones? A multicenter, prospective and randomized study
Ateş F, Eryıldırım B, Oztürk MI, Turan T, Gürbüz C, Ekinci MO, Yıldırım A, Göktaş C, Senkul T, Sarıca K; AYTAG group
Department of Urology, GATA Haydarpasa Teaching Hospital, 34668, Uskudar, Istanbul, Turkey
The objective of the study is to investigate the effect of doxazosin, administered to the subjects who underwent SWL due to upper ureteral stones, on therapeutic outcomes. The study enrolled the patients with a radio-opaque stone ≥5 mm in upper ureter. Patients were randomized into two groups: the first group underwent SWL following the diagnosis and they were recommended to receive oral hydration. The second group underwent SWL after initiating alpha blocker (doxazosin controlled-release tablet 4 mg/day) and drug therapy was continued until that the patient has been stone free. Parameters of SWL procedure, Steinstrasse, pain score at admission, time to stone passage, the complications developed, the additional procedures that were administered and number of hospital visits done due to pain during the treatment were recorded. A total of 79 patients were enrolled to the study. The subjects evaluated included 35 patients, who received an alpha blocker and 44 patients who did not receive an alpha blocker. For both groups, the level of energy applied per SWL session, the diameter of the stone, the number of hospital visits done due to pain, pain score and the need for analgesia were found to be similar (p > 0.05). The group of doxazosin was more advantageous in terms of stone-free rate, the need for additional procedures and Steinstrasse (p < 0.05). In conclusion, the addition of doxazosin to SWL therapy administered for upper ureteral stones reduces Steinstrasse, and thereby, the need for additional procedures and increases post-treatment stone-free rate. A positive effect of doxazosin on the time to stone passage was not shown.
Urol Res. 2012 Oct;40(5):537-42. doi: 10.1007/s00240-011-0455-x. Epub 2012 Jan 7
PMID: 22228043 [PubMed - as supplied by publisher]
In the discussion the authors mention the missing data that would be nice to have: “The number of patients requiring additional treatment procedures was smaller in alpha blocker group. This suggests that stones must be fragmented into smaller pieces in alpha blocker group, but no such measurement was performed in this study. Further studies may be useful to focus on this issue.”