Yoshioka T. et al., 2020: Preoperative Use of Alpha-1 Receptor Blockers in Male Patients Undergoing Extracorporeal Shock Wave Lithotripsy for a Ureteral Calculus.
Yoshioka T, Omae K, Kawada T, Inoue Y, Sugimoto M, Oeda T, Uehara S, Araki M, Fukuhara S.
1Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima 960-1295, Japan.
2Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto 606-8501, Japan.
3Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University, Fukushima 960-1295, Japan.
4Department of Urology, Onomichi Municipal Hospital, Hiroshima 722-8503, Japan.
5Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima 730-8519, Japan.
6Department of Urology, Kawasaki Medical School General Medical Center, Okayama 700-8505, Japan.
7Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan.
In this retrospective single-center cohort study, we investigated the impact of preoperative use of an alpha-1 adrenergic receptor (AR) blocker on the outcome of single-session extracorporeal shock wave lithotripsy (SWL) in 193 male patients who underwent SWL for a single ureteral calculus between 2006 and 2016. We reviewed their medical records to obtain the data on the preoperative use of alpha-1 AR blockers. The primary outcome was treatment success after single-session SWL. We performed a multivariable logistic regression analysis adjusting for clinically important confounders to examine the association between preoperative use of alpha-1 AR blockers and the treatment success of SWL. Among the 193 patients, 15 (7.8%) were taking an alpha-1 AR blocker preoperatively. A multivariable analysis showed that preoperative use of an alpha-1 AR blocker was a significant negative predictor for treatment success of SWL (adjusted odds ratio 0.17; 95% confidence intervals, 0.04-0.74). Our findings suggest that the preoperative use of an alpha-1 AR blocker was a negative predictor of treatment success of SWL in male patients with a single ureteral calculus. Clinicians should pay more attention to the preoperative drug use in determining an appropriate stone therapy modality.
Acta Med Okayama. 2020 Aug;74(4):293-299. doi: 10.18926/AMO/60367.PMID: 32843760 FREE ARTICLE
The results of SWL were evaluated with regard to pre-treatment with alpha-receptor antagonists. The surprising conclusion was that the medical treatment had a negative effect on the outcome of SWL.
It is difficult to interpret these results because the retrospective analysis only included 15 patients. Seven of these patients had been treated with alpha-receptor antagonists because of BPH. Only 4% of the patients had been given alpha-receptor antagonists as MET. It is also of note that the proportion of patients with distally located stones was larger in patients not given MET. Did the enlarge prostate play a role?
The SWL results were overall good.
Although the results are interesting, the number of patients with MET included in this study is too small for definite conclusions on any negative effect of alpha-receptor antagonists. This is also so in view of the small average diameter of the stones.