Eryildirim B et al, 2016: Medical Expulsive Therapy Following Shock Wave Lithotripsy in Ureteral Calculi: An Effective Approach for the Improvement of Health-Related Quality of Life.
Eryildirim B, Sahin C, Tuncer M, Sabuncu K, Tarhan F, Sarica K.
Training and Research Hospital, Urology Clinic, Istanbul, Turkey.
OBJECTIVE: To evaluate the possible effects of medical expulsive therapy (MET) on the health-related quality of life (HRQOL) of patients undergoing shock wave lithotripsy (SWL) for ureteric stones.
METHODS: Eighty patients treated with SWL for ureteric stones were included in this study. Patients were divided into 2 groups; Group 1 received medical therapy only for colic pain and Group 2 received MET in addition to medical therapy. Patients requiring DJ stenting and auxiliary measures after SWL procedure were excluded. The remaining 54 patients were further evaluated (Group 1: n = 26, Group 2: n = 28) and followed up during the 4-week period for analgesic requirement, number of renal colic attacks, emergency department (ED) visits and the HRQOL scores by using EQ-5D index and EQ-5D visual analogue scale (VAS) values.
RESULTS: During the 4-week follow-up period, cases undergoing SWL only required significantly higher amount of analgesics. In addition to the lower number of renal colic attacks and ED visits, EQ-5D index and EQ-5D VAS values also demonstrated higher mean values in patients undergoing SWL + MET.
CONCLUSION: In addition to the increased spontaneous stone passage rates, MET following SWL for ureteral calculi could increase the HRQOL scores by lowering the number of both renal colic attacks and ED visits along with decreased analgesic need.
Urol Int. 2016 Apr 23. [Epub ahead of print]
In a randomized comparative study the effect of MET after SWL for proximal ureteral stones, it was concluded that the stone-free rates without or with MET were 65.4% and 71.4%, respectively. The need of analgesic supplements was higher when MET was not given and the QoL-score better among MET-treated patients. The difference in QoL-score seems, however, to be of minor degree and it is difficult to know to which extent patients’ awareness/information of residuals affected that variable.
Nothing is mentioned in the article about the reason for residual stones, but it can be assumed that, in view of the definition of the proximal ureter. Treatment in supine position (shockwaves from the back) might have been less effective in some cases. The authors chose URS instead of repeat SWL for treating this group of patients.
Nevertheless these results indicate that alpha-receptor antagonists might have a place in the follow-up of patients treated with SWL because of ureteral stones. This report is thus an interesting contribution to the ongoing discussion on this issue.