Gul U et al, 2012: Do patients on alpha-blockers for the treatment of benign prostatic hyperplasia have better results after shock wave lithotripsy of urinary stones?
Gul U, Yaycioglu O Md Febu, Kuzgunbay B, Sariturk C, Kayra MV, Ozkardes H.
Baskent University, Urology, Adana, Turkey
PURPOSE: To investigate whether patients who are on alpha 1-AR antagonists for then treatment of benign prostatic hyperplasia (BPH) had better results after shock wave lithotripsy (SWL).
PATIENTS AND METHOD: We retrospectively reviewed the records of male patients older than 50 years and underwent SWL. Clinical characteristics including the use of alpha 1-AR antagonists for BPH were analyzed. Mann Whitney-U test was used for data not normally distributed and student's t test for data normally distributed. The categorical variables were analyzed by the Chi-square test. A multiple logistic regression analysis was used to analyze the associations of variables on successful treatment.
RESULTS: A total of 264 renal units were treated. Complete stone clearance was achieved in 167 RUs (63.3%) and 28 RUs (10.6%) had CIRF. In 69 RUs (26.1%) SWL failed. More patients were on alpha 1-AR antagonists for BPH in the successfully treated group (p=0.028). The multivariate analysis revealed that use of alpha 1-AR antagonists had significant effects on the success of SWL (p=0.047). SWL was performed to 34 RUs of 33 patients who were on alpha 1-AR antagonists and it was successful in 30 RUs (88.2%) In the remaining 230 RUs stone-free state was achieved in 165 RUs (71.7%) (p=0.028). Stone free rates were similar for patients on alfuzosine, tamsulosine, and doxazosine (p=0.310).
CONCLUSION: Patients who are being treated with alpha 1-AR antagonist agents for BPH have better results after SWL treatment, compared to patients not receiving alpha 1-AR antagonist. The improved results are independent of the type of alpha 1-AR antagonist.
J Endourol. 2012 Dec 13. [Epub ahead of print]
PMID: 23237326 [PubMed - as supplied by publisher]
The authors have retrospectively analysed their SWL results in patients who already were on a-receptor antagonists with those who were not and concluded that the success rate was significantly higher in the former group. The beneficial effect of a-receptor antagonists has been demonstrated in numerous studies but the fragment elimination from the kidneys remains to be demonstrated. It is of note, however, that in this report only 34 renal units were treated in patients who were on medication with a-receptor blocking agents. Treatment failures were defined as stones not satisfactorily disintegrated, but it seems unlikely that a-receptor antagonists have any effect of stone disintegration. Moreover, the result is considered in view of successful treatments, not stone-free renal units. It is thus not possible to elucidate to which extent ureteral stones contributed to the difference and in how many patients the a-receptor antagonists really increased fragment elimination from the kidneys. Studies of this kind are highly interesting and necessary, but it would be an advantage with a distinction between stone-free ureters/kidneys and those with residuals.