Georgiev MI et al, 2011: Efficacy of Tamsulosin Oral Controlled Absorption System After Extracorporeal Shock Wave Lithotripsy to Treat Urolithiasis
Georgiev MI, Ormanov DI, Vassilev VD, Dimitrov PD, Mladenov VD, Popov EP, Simeonov PP, Panchev PK
Department of Urology, University Hospital »Alexandrovska« Medical University Sofia, Sofia, Bulgaria
OBJECTIVE: To determine the efficacy of the tamsulosin oral controlled absorption system as an adjuvant therapy to extracorporeal shock wave lithotripsy (ESWL) for the expulsion of ureteral and renal stones.
METHODS: A consecutive sample of 248 patients with ureteral or renal stones who underwent ESWL in an academic hospital was included in a 12-week, prospective, open-label, randomized clinical trial. Of the 248 patients, 186, including 77 with ureteral stones (mean size 9 mm) and 109 with renal stones (mean size 13 mm) completed the study. After successful ESWL, the patients were randomized to standard medical care (corticosteroids and analgesics) or standard care plus the tamsulosin oral controlled absorption system 0.4 mg/d for 1 month. The stone clearance rate, interval to the elimination of stone fragments, incidence of renal colic, and the need for rehospitalization were assessed at 4, 8, and 12 weeks.
RESULTS: The stone clearance rate was significantly greater for the patients treated with tamsulosin than for those in the standard care group at 4 (73.4% vs 55.9%, respectively; P < .001) and 12 (91.3% vs 74.6%, respectively; P < .05) weeks. Tamsulosin treatment was also associated with a significantly lower interval to the elimination of stone fragments (P < .001), a significantly lower rehospitalization rate (P < .001), and a significantly lower proportion of patients with acute renal colic (P < .05) than standard care alone. No severe adverse events leading to treatment discontinuation were observed.
CONCLUSION: Adjuvant treatment with tamsulosin, in addition to standard treatment with steroids and analgesics, improved the outcome of ESWL.
Copyright © 2011. Published by Elsevier Inc.
Urology. 2011 Nov;78(5):1023-6. doi: 10.1016/j.urology.2011.01.073. Epub 2011 Sep 13
PMID: 21917304 [PubMed - in process]
It is of interest that the authors were able to demonstrate a significantly higher stone clearance in patients given tamsulosin. The faster fragment elimination also is in line with previous observations.
The problem in interpreting the results is, however, that none of the patients had renal stones located in the lower calyx. And it is not stated where the residual fragments were found at the start of the follow-up period (t=0). Neither was the result stratified in terms of stones in the kidneys and ureters. Moreover, the author's definition of "complete stone clearance" was "absence of fragments >3 mm on ultrasonography".
That »alpha«-receptor antagonists facilitate elimination of ureteral stones and stone fragments is reasonably well established from literature studies, but if this regimen also facilitates elimination of stone fragments from the kidney – which might be a clinically important effect - is not proven in this report.