Article

Medical expulsive treatment of distal-ureteral stones using tamsulosin: A single-center experience

Department of Urology, Second University, Naples, Italy.
Journal of Endourology (Impact Factor: 2.1). 02/2006; 20(1):12-6. DOI: 10.1089/end.2006.20.12
Source: PubMed

ABSTRACT To evaluate the efficacy of the addition of tamsulosin to our standard expulsive pharmacologic therapy for the treatment of distal-ureteral stones.
A series of 96 patients referred to our department for the management of symptomatic distal-ureteral calculi were randomly divided into group 1 (N = 46) who received diclofenac (100 mg/daily) plus aescin (80 mg/daily) and group 2 (N = 50) who received the same therapy plus tamsulosin (0.4 mg/daily) for a maximum of 2 weeks. There were no differences between the groups with respect to age, sex, or stone size. The primary endpoint was the expulsion rate. Expulsion time, need for analgesics, need for hospitalization, and drug side effects were the secondary endpoints.
The expulsion rate was significantly higher in group 2 (90%) than in group 1 (58.7%; P = 0.01), and group 2 achieved stone passage in a shorter time (mean 4.4 v 7.5 days, respectively; P = 0.005). Lower analgesic use was found in group 2 (P = 0.003), as well as significantly fewer hospitalizations for recurrent colic (P = 0.01). Both groups experienced few side effects associated with expulsive therapy.
A conservative approach should be considered as an option in the management of uncomplicated distal-ureteral stones. Even if the best pharmacologic expulsive regimen remains to be established, the use of the selective alpha-blocker tamsulosin is recommended in this setting.

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    • "Recent studies suggest that α-blockade may be useful in the treatment of ureterolithiasis by increasing the success of stone passage and decreasing the time to stone passage by causing smooth muscle relaxation in the ureter [1] [2] [3] [4] [5] [6] [7] [8]. The use of medications such as α-blockers to improve stone passage, termed medical expulsive therapy, has been evaluated in 2 recent meta-analyses that suggest that α-blockade improves the likelihood of stone passage, with a number needed to treat of only 3.3 in one study and 4 in another [9] [10]. "
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    ABSTRACT: We sought to determine how frequently tamsulosin is used by emergency physicians (EPs) for the treatment of patients with ureteral stones, and examine factors influencing its use. We distributed online and paper surveys to 240 EPs in five states in the United States. Surveys asked the length of time in practice, the type of hospital setting, and the self-reported frequency of tamsulosin use by quartile. A total of 103 EPs (43%) responded to the survey. The majority (60%, 95% CI 51% to 69%) reported the use of tamsulosin in fewer than 25% of patients presenting with ureteral stones, and many (27%, 95% CI 20% to 36%) had not heard of the use of tamsulosin for urinary-stone passage. Practice in a county hospital was associated with infrequent tamsulosin use (p=.02). Despite evidence that alpha-blockade may be beneficial to patients presenting to the emergency department with ureteral stones, this approach is still used inconsistently by EPs.
    The American journal of emergency medicine 10/2009; 27(7):776-8. DOI:10.1016/j.ajem.2008.06.007 · 1.15 Impact Factor
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    • "The patient, the attending urologist, and the investigators were not aware of study arm assignments until the final assessment of outcome. Sample-size calculation was performed based on previous reports of spontaneous stone expulsion and assumed a clinically relevant difference in expulsion rate of 25% [13] [16] [17] [20]. The stone expulsion rate was estimated to be 90% and 65% for patients with and without tamsulosin medication, respectively. "
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    ABSTRACT: Numerous randomised trials have confirmed the efficacy of medical expulsive therapy with tamsulosin in patients with distal ureteral stones; however, to date, no randomised, double-blind, placebo-controlled trials have been performed. The objective of this trial was to evaluate the efficacy of medical expulsive therapy with tamsulosin in a randomised, double-blind, placebo-controlled setting. Patients presenting with single distal ureteral stones < or = 7 mm were included in this trial. Patients were randomised in a double-blind fashion to receive either tamsulosin or placebo for 21 d. The medication was discontinued after either stone expulsion or intervention. Abdominal computed tomography was performed to assess the initial and final stone status. MEASUREMENTS AND LIMITATIONS: The primary end point was the stone expulsion rate. Secondary end points were time to stone passage, the amount of analgesic required, the maximum daily pain score, safety of the therapy, and the intervention rate. Ten of 100 randomised patients were excluded from the analysis. No statistically significant differences in patient characteristics and stone size (median: 4.1 mm [tamsulosin arm] vs 3.8 mm [placebo arm], p=0.3) were found between the two treatment arms. The stone expulsion rate was not significantly different between the tamsulosin arm (86.7%) and the placebo arm (88.9%; p=1.0). Median time to stone passage was 7 d in the tamsulosin arm and 10 d in the placebo arm (log-rank test, p=0.36). Patients in the tamsulosin arm required significantly fewer analgesics than patients in the placebo arm (median: 3 vs 7, p=0.011). A caveat is that the exact time of stone passage was missing for 29 patients. Tamsulosin treatment does not improve the stone expulsion rate in patients with distal ureteral stones < or = 7 mm. Nevertheless, patients may benefit from a supportive analgesic effect. CLINICALTRIALS.GOV: NCT00831701.
    European Urology 04/2009; 56(3):407-12. DOI:10.1016/j.eururo.2009.03.076 · 12.48 Impact Factor
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    • "With respect to the potential facilitative effect of ureteral relaxation on stone passage, a-blocker and b-agonists have been shown to relax the ureteral wall at the level of an artificial stone, permitting fluid flow beyond the stone [12]. Recently a-blockade has indeed been shown to be beneficial in reducing the time of stone expulsion and number of colic events, and in increasing the number of stone passages, either without interventional therapy or after ESWL treatment [13] [14] [15] [16]. "
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    ABSTRACT: In delayed extracorporeal shock wave lithotripsy (ESWL) treatment, increasing stone impaction is associated with delayed stone clearance. Whether colic patients treated by rapid ESWL have the same time to stone clearance as noncolic patients, which supports the thesis that stones in both groups are nonimpacted, has not been investigated yet, and was the objective of this study. A total of 82 patients were prospectively enrolled and treated with piezoelectric ESWL for a solitary proximal ureteral stone. Of these, 56 patients experienced at least one colic episode compared with 26 noncolic patients. Hydronephrosis has been assessed with the use of ultrasound and intravenous urography (IVU). Time to stone clearance after the first ESWL and stone-free rates after a follow-up period of 3 mo were recorded. In colic and noncolic patients, mean stone size was 7.8mm (p=0.7). Ultrasound-detected hydronephrosis was present in 88% versus 39% (p<0.0001), whereas IVU-detected hydronephrosis was present in 60% versus 7.7% (p=0.0001). Mean number of impulses applied was 8000+/-4000 versus 6700+/-3400 (p=0.1). Mean time to stone clearance was 9.5+/-12.1 d versus 4.6+/-3.8 d (p=0.1). Colic and noncolic patients were considered as treatment success in 83% and 81% after 3 mo of follow-up (p=0.9). Treatment outcome and time to stone clearance after rapid ESWL in colic patients compared with noncolic patients is comparable and independent of concomitant hydronephrosis. This finding suggests an absence of significant impaction in proximal ureteral stones treated within 24h after a first colic episode, enforcing the concept of performing rapid ESWL in patients harbouring proximal ureteral stones.
    European Urology 10/2007; 52(4):1223-7. DOI:10.1016/j.eururo.2007.02.001 · 12.48 Impact Factor
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