Kyarimov IA. et al., 2026: Efficacy and safety of α1-adrenergic blockers after extracorporeal shock wave lithotripsy in pediatric kidney stones.

Kyarimov IA, Zorkin SN, Galuzinskaya AT, Bayazitov RR, Shakhnovskiy DS.
Pediatr Surg Int. 2026 Mar 4;42(1):136. doi: 10.1007/s00383-026-06353-2

Abstract

Purpose: The development of effective medical expulsive therapy (MET) following extracorporeal shock wave lithotripsy (ESWL) for pediatric urolithiasis is crucial for enhancing stone fragment clearance. This study aimed to evaluate the efficacy and safety of alpha-1 adrenergic blockers (tamsulosin and silodosin) in children after ESWL.

Methods: A prospective randomized comparative study was conducted involving 200 patients (aged 2-18 years) who underwent ESWL. Participants were allocated to a study group (n = 50, receiving α1-blockers: tamsulosin 0.2 mg/day for ages 2-5, silodosin 4 mg/day for ages > 5) or a control group (n = 150, receiving standard therapy). Primary endpoints were stone-free rate (SFR) and stone expulsion time. Secondary endpoints included pain dynamics (visual analog scale, VAS), analgesic requirements, and adverse events. Statistical analysis was performed using StatTech v.4.8.3.

Results: The odds of being stone-free were 2.11 times higher with α1-blocker therapy (OR = 2.11; 95% CI: 1.02-4.37). The median expulsion time was reduced from 7 [5-9] days in the control group to 5 [4-7] days in the study group (p = 0.010). ROC analysis identified a 6-day threshold for stone passage (sensitivity 63.6%, specificity 72.1%, AUC = 0.627; p = 0.010). Pain intensity was significantly lower in the study group on postoperative day 1 (3 [0-4] vs. 6 [5-8] points, p < 0.001), with reduced analgesic requirements (1 [0-2] vs. 2 [1-4] doses/day, p = 0.003). Adverse events were mild and infrequent (5 cases of nasal congestion, 2 of nausea).

Conclusion: Adjunctive therapy with α1-blockers after ESWL in children with urolithiasis improves treatment efficacy, shortens stone expulsion time, reduces pain, and demonstrates a favorable safety profile. An optimal timeframe for efficacy assessment is 6 days post-ESWL.

Comment Peter Alken

Good to see that there are publications from Russia. However, I do not agree that “the nature of the intervention did not allow blinding of patients and physicians”. I think it would have been possible and would have increased the value of the study just as measurement of the daily urine volume or placebo tablets for the control group would have done. The persons evaluating the patients in the follow up examinations and evaluating the results were not blinded. The results are to good and contradictory or at least difficulty to understand: “Stone disintegration was observed in 42 patients in the main group, while this figure was only 102 (in the control group (p = 0.029).” That would mean 8/50 failures in the therapeutic arm and 48/150 in the control arm. That does not fit to the number or reinterventions: “Data on the need for additional medical interventions are of particular interest. In the study group, the need for ureterolithoextraction arose in only 2 patients (4%), while in the control group, a similar intervention was required in 11 patients (7.3%).” What happened to the other failures?  In addition, no additional SWL sessions were mentioned in 200 renal stone patients with average stone sizes of around 9 mm. There are no data on the machine used and the shockwave application details.

Peer Review should have prohibited a publication with so many missing data.

Peter Alken