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Seerwan M, Khan G, Ilyas M, Waheed D, Ur Rehman A, Humayun F. EFFICACY OF DOXAZOSIN VERSUS TAMSULOSIN IN LOWER URETERIC STONE EXPULSION IN ADULT POPULATION OF DISTRICT DERA ISMAIL KHAN, PAKISTAN. GOMAL JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.46903/gjms/19.04.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Urolithiasis is the third common disease of the urinary tract after UTIs and pathological diseases of the prostate. The objective of this study was to compare the efficacy of doxazosin versus tamsulosin in lower ureteric stone expulsion in adult population of District Dera Ismail Khan, Pakistan.Materials Methods: This non-randomized control trial was conducted in the Department of Urology, Gomal Medical College, Dera Ismail Khan, Pakistan from February 2020 to December 2020. The 252 patients included in our study were divided in to two groups. The patients in experimental group received Tab. doxazosin 4 mg daily for 4 weeks and Tab. diclofenac sodium 50 mg B.D for 5 days and then on need basis. The patients in control group received Cap. tamsulosin 0.4 mg daily for 4 weeks and similarly Tab. diclofenac sodium 50 mg as in experimental group. All the patients were followed regularly for expulsion of ureteric stones for four weeks. Sex, age and stone size were matching, while stone expulsion was a research variable. Hypothesis was verified by McNemar chi-square test.Results: Out of 252 patients, 113 (89.68%) patients in experimental group, while 77 (61.11%) patients in control group passed the stones. There was statistically significant difference in efficacy in doxazosin group as compared to tamsulosin group (p-value=.0001).Conclusion: The use of doxazosin as the medical expulsion therapy for the lower ureteric stone proved to be more effective as compared to tamsulosin as demonstrated by our results.
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Yu B, Zheng X, Sun Z, Cao P, Zhang J, Gao Z, Cao H, Zhang F, Wang W. The safety and efficacy of doxazosin in medical expulsion therapy for distal ureteric calculi: A meta-analysis. PLoS One 2021; 16:e0245741. [PMID: 33493214 PMCID: PMC7833139 DOI: 10.1371/journal.pone.0245741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Alpha-adrenergic receptor blockers can be effectively used in the context of medical expulsion therapy (MET) to treat ureteric stones. This study was designed to evaluate the safety and efficacy of doxazosin in MET relative to placebo or tamsulosin. Methods We systematically searched the PubMed, the Cochrane Library, EMBASE, Chinese Academic Database, and Web of Science databases to select randomized controlled trials (RCT) that compared the use of doxazosin with placebo or tamsulosin to treat ureteric stones. All patients we included were limited to those diagnosed with visible stones in the distal ureter. The diameter of ureteric stones does not exceed 10 mm. Results Eight trials comparing doxazosin with placebo or tamsulosin containing 667 patients were assessed in the final analysis. The meta-analysis showed that doxazosin effectively treated ureteric stones and was better than placebo in terms of efficacy. Relative to the placebo group, the expulsion rate of stones from the distal ureter (OR = 3.00, 95% CI [2.15, 4.19], I2 = 0%, P < 0.00001) was significantly increased, and the expulsion time (days) was shortened (mean difference) (MD) = −4.03, 95% CI [−4.53, −3.53], P < 0.00001). The doxazosin group experienced fewer pain episodes (MD = −0.78, CI = [−0.94, −0.23], I2 = 0%, P < 0.00001) than the placebo group. A subgroup analysis showed that the doxazosin group had a higher expulsion rate (of 5–10 mm stones) compared with the placebo group. Although doxazosin resulted in significantly more adverse effects compared with the placebo, the patient’s symptoms were mild and no further medical interventions were required. Moreover, the expulsion time (days) was shorter for patients receiving doxazosin (MD = −0.61, 95% CI [−0.97, −0.24], I2 = 39%, P = 0.001) than those receiving tamsulosin. Conclusion Compared with the placebo group, patients receiving doxazosin had a greater expulsion rate, a reduced expulsion time, and fewer pain episodes. The expulsion time of doxazosin was shorter than that of tamsulosin.
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Affiliation(s)
- Baozhong Yu
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Xiang Zheng
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Zejia Sun
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
| | - Peng Cao
- Capital Medical University, Beijing, China
| | | | - Zihao Gao
- Capital Medical University, Beijing, China
| | | | | | - Wei Wang
- Affiliated Beijing Chaoyang Hospital of Capital Medical University, Beijing, China
- * E-mail:
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Kucukpolat S, Kocaaslan R, Kadihasanoglu M, Bagcioglu M, Kocan H, Sarica K. Is Medical Therapy for Distal Ureteral Stones Efficient? Tamsulosin versus Deflazacort: A Prospective Randomised Trial. Aktuelle Urol 2019; 53:454-460. [PMID: 31537025 DOI: 10.1055/a-0770-2627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION To evaluate the efficacy of tamsulosin and deflazacort in the spontaneous expulsion of distal ureteral stones when applied in an independent or combined manner. METHODS 134 patients with distal ureteral stones (4 - 10 mm) were included in tothe study. All patients were randomized into four groups: group 1 (n = 37) patients receiving tamsulosin (0.4 mg/day); group 2 (n = 26) patients receiving deflazacort (30 mg/day); group 3 (n = 37) patients receiving combined treatment (tamsulosin and deflazacort) with the same dosages; and group 4, control group cases (n = 34), receiving paracetamol on demand. Although deflazacort treatment was limited to 10 days due to the possible associated side effects, α-blocker and paracetamol lasted up to four weeks. Patients were followed up on a weekly basis and at the end of four weeks all groups were compared primarily with respect to the stone expulsion rates. RESULTS No statistically significant difference was noted between all groups regarding the age, sex, or stone burden (p > 0.05). Spontaneous stone expulsion rates after 4 weeks were 64.8 %, 69.2 %, 75.7 %, and 26.4 % in group 1, 2, 3, and 4 respectively. Spontaneous passage rates were statistically higher in all treatment groups when compared with the control group. Despite the highest spontaneous stone expulsion rate noted in group 3; this difference was not statistically significant when compared with the group 1 and 2. No major side effect related to the medications was observed. CONCLUSIONS Tamsulosin facilitated the spontaneous passage of distal ureteral stones < 10 mm in size in an effective manner particularly when applied in combination with an oral corticosteroid.
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Affiliation(s)
| | | | | | | | - Huseyin Kocan
- Istanbul Kanuni Sultan Suleyman Egitim ve Arastirma Hastanesi, Urology, Istanbul, Turkey
| | - Kemal Sarica
- Kafkas Universitesi Tip Fakultesi, Urology, Kars, Turkey
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What Is the Role of α-Blockers for Medical Expulsive Therapy? Results From a Meta-analysis of 60 Randomized Trials and Over 9500 Patients. Urology 2018; 119:5-16. [DOI: 10.1016/j.urology.2018.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
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Campschroer T, Zhu X, Vernooij RW, Lock TM. α-blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review. BJU Int 2018; 122:932-945. [DOI: 10.1111/bju.14454] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Thijs Campschroer
- Department of Urology; Rijnstate Hospital Arnhem; Arnhem The Netherlands
| | - Xiaoye Zhu
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Robin W.M. Vernooij
- Department of Research; Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht The Netherlands
| | - Tycho M.T.W. Lock
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Urology; Central Military Hospital; Utrecht The Netherlands
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Yallappa S, Amer T, Jones P, Greco F, Tailly T, Somani BK, Umez-Eronini N, Aboumarzouk OM. Natural History of Conservatively Managed Ureteral Stones: Analysis of 6600 Patients. J Endourol 2018; 32:371-379. [DOI: 10.1089/end.2017.0848] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sachin Yallappa
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Department of Urology, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Tarik Amer
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Department of Urology, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Patrick Jones
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Francesco Greco
- Department of Urology, EAU Young Academic Urologists Group, Arnhem, The Netherlands
| | - Thomas Tailly
- Department of Urology, EAU Young Academic Urologists Group, Arnhem, The Netherlands
| | - Bhaskar K. Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
- Department of Urology, EAU Young Academic Urologists Group, Arnhem, The Netherlands
| | - Nkem Umez-Eronini
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Omar M. Aboumarzouk
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Department of Urology, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
- Department of Urology, EAU Young Academic Urologists Group, Arnhem, The Netherlands
- Department of Urology, Islamic Universities of Gaza, College of Medicine, Gaza, Palestine
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Campschroer T, Zhu X, Vernooij RWM, Lock MTWT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev 2018; 4:CD008509. [PMID: 29620795 PMCID: PMC6494465 DOI: 10.1002/14651858.cd008509.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ureteral colic is a common reason for patients to seek medical care. Alpha-blockers are commonly used to improve stone passage through so-called medical expulsive therapy (MET), but their effectiveness remains controversial. This is an update of a 2014 Cochrane review; since that time, several large randomised controlled trials (RCTs) have been reported, making this update relevant. OBJECTIVES To assess effects of alpha-blockers compared with standard therapy for ureteral stones 1 cm or smaller confirmed by imaging in adult patients presenting with symptoms of ureteral stone disease. SEARCH METHODS On 18 November 2017, we searched CENTRAL, MEDLINE Ovid, and Embase. We also searched ClinicalTrials.gov and the WHO Portal/ICTRP to identify all published/unpublished and ongoing trials. We checked all references of included and review articles and conference proceedings for articles relevant to this review. We sent letters to investigators to request information about unpublished or incomplete studies. SELECTION CRITERIA We included RCTs of ureteral stone passage in adult patients that compared alpha-blockers versus standard therapy. DATA COLLECTION AND ANALYSIS Two review authors screened studies for inclusion and extracted data using standard methodological procedures. We performed meta-analysis using a random-effects model. Primary outcomes were stone clearance and major adverse events; secondary outcomes were stone expulsion time, number of pain episodes, use of diclofenac, hospitalisation, and surgical intervention. We assessed the quality of evidence on a per-outcome basis using the GRADE approach. MAIN RESULTS We included 67 studies with 10,509 participants overall. Of these, 15 studies with 5787 participants used a placebo.Stone clearance: Based on the overall analysis, treatment with an alpha-blocker may result in a large increase in stone clearance (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.36 to 1.55; low-quality evidence). A subset of higher-quality, placebo-controlled trials suggest that the likely effect is probably smaller (RR 1.16, 95% CI 1.07 to 1.25; moderate-quality evidence), corresponding to 116 more (95% CI 51 more to 182 more) stone clearances per 1000 participants.Major adverse events: Based on the overall analysis, treatment with an alpha-blocker may have little effect on major adverse events (RR 1.25, 95% CI 0.80 to 1.96; low-quality evidence). A subset of higher-quality, placebo-controlled trials suggest that alpha-blockers likely increase the risk of major adverse events slightly (RR 2.09, 95% CI 1.13 to 3.86), corresponding to 29 more (95% CI 3 more to 75 more) major adverse events per 1000 participants.Patients treated with alpha-blockers may experience shorter stone expulsion times (mean difference (MD) -3.40 days, 95% CI -4.17 to -2.63; low-quality evidence), may use less diclofenac (MD -82.41, 95% CI -122.51 to -42.31; low-quality evidence), and likely require fewer hospitalisations (RR 0.51, 95% CI 0.34 to 0.77; moderate-quality evidence), corresponding to 69 fewer hospitalisations (95% CI 93 fewer to 32 fewer) per 1000 participants. Meanwhile, the need for surgical intervention appears similar (RR 0.74, 95% CI 0.53 to 1.02; low-quality evidence), corresponding to 28 fewer surgical interventions (95% CI 51 fewer to 2 more) per 1000 participants.A predefined subgroup analysis (test for subgroup differences; P = 0.002) suggests that effects of alpha-blockers may vary with stone size, with RR of 1.06 (95% CI 0.98 to 1.15; P = 0.16; I² = 62%) for stones 5 mm or smaller versus 1.45 (95% CI 1.22 to 1.72; P < 0.0001; I² = 59%) for stones larger than 5 mm. We found no evidence suggesting possible subgroup effects based on stone location or alpha-blocker type. AUTHORS' CONCLUSIONS For patients with ureteral stones, alpha-blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events. Subgroup analyses suggest that alpha-blockers may be less effective for smaller (5 mm or smaller) than for larger stones (greater than 5 mm).
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Affiliation(s)
- Thijs Campschroer
- Radboud University Nijmegen Medical CenterDepartment of UrologyGeert Grooteplein Zuid 10NijmegenGelderlandNetherlands6525 GA
| | - Xiaoye Zhu
- University Medical Center UtrechtDepartment of UrologyUtrechtNetherlands
| | - Robin WM Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL)Department of ResearchGodebaldkwartier 419UtrechtNetherlands3511 DT
| | - MTW Tycho Lock
- University Medical Center UtrechtDepartment of UrologyUtrechtNetherlands
- Central Military HospitalDepartment of UrologyUtrechtNetherlands
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Sridharan K, Sivaramakrishnan G. Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials. Expert Rev Clin Pharmacol 2018; 11:291-307. [DOI: 10.1080/17512433.2018.1424537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kannan Sridharan
- Associate Professor, Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Gowri Sivaramakrishnan
- Assistant Professor in Prosthodontics, School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji Islands
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Goyal SK, Singh V, Pandey H, Chhabra MK, Aggarwal SP, Bhat A. Comparative efficacy of tamsulosin versus tadalafil as medical expulsive therapy for distal ureteric stones. Urol Ann 2018; 10:82-86. [PMID: 29416281 PMCID: PMC5791464 DOI: 10.4103/ua.ua_36_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of this study was to compare the relative efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteric stones. Patients and Methods: This was a prospective study performed between December 2014 and February 2016. A total of 123 adult patients (>18 years of age) presenting with distal ureteric stones sized 6–10 mm were randomized to treatment with tamsulosin 0.4 mg once daily (Group A) or tadalafil10 mg once daily (Group B). Therapy was given for a maximum of 4 weeks. The stone expulsion rate was the primary endpoint. Time to stone expulsion, number of colic episodes, analgesic use, number of hospital visits for pain, endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done using Fisher's exact test and Chi-square test. Results: A total of 61 patients were included in tamsulosin group and 62 patients in tadalafil group. A statistically insignificant difference was found for stone clearance rate between both groups as a whole (Group A-73.77%, Group B-69.35%, P = 0.690) as well as when we considered both subgroups (A1-78.05%, B1-75.0%, P = 0.802; A2-65.0%, B2-55.6%, P = 0.741). All the primary and secondary outcome measures were more in favour of stones ≤8 mm size than stones >8 mm size. No statistical difference was found for adverse drug effects except for retrograde ejaculation, which was significantly high in tamsulosin group (P < 0.001). Conclusion: This study showed that although tamsulosin is more effective for stone clearance than tadalafil, but this difference was not significant (P = 0.690).
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Affiliation(s)
- Suresh Kumar Goyal
- Department of Urology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - Vikash Singh
- Department of Urology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
| | - Himanshu Pandey
- Department of Urology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | | | - Amilal Bhat
- Department of Urology, Dr. S. N. Medical College, Jodhpur, Rajasthan, India
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Sridharan K, Sivaramakrishnan G. Medical expulsive therapy in urolithiasis: a mixed treatment comparison network meta-analysis of randomized controlled clinical trials. Expert Opin Pharmacother 2017; 18:1421-1431. [DOI: 10.1080/14656566.2017.1362393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kannan Sridharan
- School of Health Sciences, Fiji National University, Suva, Fiji Islands
| | - Gowri Sivaramakrishnan
- School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji Islands
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Preliminary study of the efficacy of the combination of tamsulosin and trospium as a medical expulsive therapy for distal ureteric stones. AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Medical Expulsive Therapy in Urolithiasis: A Review of the Quality of the Current Evidence. Eur Urol Focus 2017; 3:27-45. [DOI: 10.1016/j.euf.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 01/30/2023]
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The efficacy and safety of adrenergic alpha-antagonists in treatment of distal ureteral stones in pediatric patients: A systematic review and meta-analysis. J Pediatr Surg 2017; 52:360-365. [PMID: 27837990 DOI: 10.1016/j.jpedsurg.2016.10.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 08/13/2016] [Accepted: 10/04/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We carried out a systematic review and meta-analysis to evaluate the efficacy and safety of adrenergic alpha-antagonists as a medical expulsive therapy for ureteral stones in pediatric patients. METHODS The PubMed, EMBASE and Cochrane Controlled Trials Register databases were searched up to January 2016. All randomized controlled trials and all cohort studies in which patients were randomized to receive either adrenergic alpha-antagonists or placebo for ureteral stones were identified. The outcome measures assessed were overall stone expulsion rate (primary), expulsion time (secondary), and treatment-emergent adverse events. RESULTS Five trials with a total of 406 pediatric patients met the inclusion criteria. According to the doses of adrenergic alpha-antagonists, the pooling effects of adrenergic alpha-antagonists were analyzed, with a higher expulsion rate obtained than in controls, the stone expulsion rate (OR=2.70, 95% CI 1.49 to 4.91, P=0.001). Adrenergic alpha-antagonists statistically did not significantly decrease the number of the stone expulsion time with the placebo, the stone expulsion time (SMD=-4.65, 95% CI -9.76 to 0.45, P=0.07). Safety assessments included common treatment-emergent adverse events (TEAEs) (OR=2.01, 95% CI 0.74 to 5.48, P=0.17). Compared with placebos, there was a higher stone expulsion rate with the adrenergic alpha-antagonists; in addition, fewer adverse effects were observed. CONCLUSIONS This meta-analysis may suggest that adrenergic alpha-antagonists are a safe and effective medical expulsive therapy choice for ureteral stones in pediatric patients. As the level of classification of evidence-based medicine, the level of evidence of our article is Ia. But it remains to need a large-scale multicenter randomized controlled study to be further confirmed. LEVEL OF EVIDENCE The level of evidence of our study is V.
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Raison N, Ahmed K, Brunckhorst O, Dasgupta P. Alpha blockers in the management of ureteric lithiasis: A meta-analysis. Int J Clin Pract 2017; 71. [PMID: 28097758 DOI: 10.1111/ijcp.12917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/08/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Effective medical expulsion for ureteric stones with α-blockers offers numerous advantages over surgical alternatives. However, its effectiveness remains uncertain and with the publication of new trial data, the available evidence requires reappraisal. OBJECTIVE The aim of this study was to assess the efficacy of α-blockers the management of ureteric lithiasis. METHODS A systematic review of the literature, with predefined search criteria, was conducted using PubMed and Embase. All randomised trials comparing α-blocker monotherapy to placebo or standard therapy were included. Stone expulsion rate was the primary outcome measure. Secondary outcome measures were time to stone expulsion, analgesic usage and pain scores. Subgroup analyses assessed individual adrenergic antagonists and variations in standard therapy. Sensitivity analysis was based on stone location, stone size, Cochrane Risk of Bias score and study protocol. Summary effects were calculated using a random-effect model and presented as Relative risks (RR) and mean differences (MD) for dichotomous and continuous outcome measures, respectively. RESULTS Sixty-seven studies randomising 6654 patients were included in the meta-analysis. Stone expulsion rates improved with α-blockers (RR, 1.49; 95% CI 1.38-1.61). Contrast enhanced funnel showed evidence of publication bias. Stone expulsion time was 3.99 days (CI -4.75 to -3.23) shorter with α-blockers. Similarly, patients required 106.53 mg [CI -148.20 to -64.86] less diclofenac compared with control/placebo, and had 0.80 [CI -1.07 to -0.54] fewer pain episodes. Visual Analogue Scores were also reduced, -2.43 [CI -3.87 to -0.99]. All formulations of α-antagonists all demonstrated beneficial effects over conservative treatment/placebo. Sensitivity analysis demonstrated significant effects of stone location, stone size and study design. CONCLUSIONS AND RELEVANCE Despite the opposing results of recently published trial, current evidence continues to demonstrate a potential benefit of α-blocker treatment particularly for distal stones over 5 mm.
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Affiliation(s)
- Nicholas Raison
- MRC Centre for Transplantation, Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital, London, UK
| | - Oliver Brunckhorst
- GKT School Of Medical Education, King's College London, The Strand, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital, London, UK
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Hollingsworth JM, Canales BK, Rogers MAM, Sukumar S, Yan P, Kuntz GM, Dahm P. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ 2016; 355:i6112. [PMID: 27908918 PMCID: PMC5131734 DOI: 10.1136/bmj.i6112] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To investigate the efficacy and safety of alpha blockers in the treatment of patients with ureteric stones. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Central Register of Controlled Trials, Web of Science, Embase, LILACS, and Medline databases and scientific meeting abstracts to July 2016. REVIEW METHODS Randomized controlled trials of alpha blockers compared with placebo or control for treatment of ureteric stones were eligible. : Two team members independently extracted data from each included study. The primary outcome was the proportion of patients who passed their stone. Secondary outcomes were the time to passage; the number of pain episodes; and the proportions of patients who underwent surgery, required admission to hospital, and experienced an adverse event. Pooled risk ratios and 95% confidence intervals were calculated for the primary outcome with profile likelihood random effects models. Cochrane Collaboration's tool for assessing risk of bias and the GRADE approach were used to evaluate the quality of evidence and summarize conclusions. RESULTS 55 randomized controlled trials were included. There was moderate quality evidence that alpha blockers facilitate passage of ureteric stones (risk ratio 1.49, 95% confidence interval 1.39 to 1.61). Based on a priori subgroup analysis, there seemed to be no benefit to treatment with alpha blocker among patients with smaller ureteric stones (1.19, 1.00 to 1.48). Patients with larger stones treated with an alpha blocker, however, had a 57% higher risk of stone passage compared with controls (1.57, 1.17 to 2.27). The effect of alpha blockers was independent of stone location (1.48 (1.05 to 2.10) for upper or middle stones; 1.49 (1.38 to 1.63) for lower stones). Compared with controls, patients who received alpha blockers had significantly shorter times to stone passage (mean difference -3.79 days, -4.45 to -3.14; moderate quality evidence), fewer episodes of pain (-0.74 episodes, -1.28 to -0.21; low quality evidence), lower risks of surgical intervention (risk ratio 0.44, 0.37 to 0.52; moderate quality evidence), and lower risks of admission to hospital (0.37, 0.22 to 0.64; moderate quality evidence). The risk of a serious adverse event was similar between treatment and control groups (1.49, 0.24 to 9.35; low quality evidence). CONCLUSIONS Alpha blockers seem efficacious in the treatment of patients with ureteric stones who are amenable to conservative management. The greatest benefit might be among those with larger stones. These results support current guideline recommendations advocating a role for alpha blockers in patients with ureteric stones. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration No CRD42015024169.
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Affiliation(s)
- John M Hollingsworth
- Department of Urology, University of Michigan, 2800 Plymouth Rd, Building 16, 1st Floor, Ann Arbor, MI 48109, USA
| | - Benjamin K Canales
- Department of Urology, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, USA
| | - Mary A M Rogers
- Department of Internal Medicine, Division of General Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, 4th Floor, Ann Arbor, MI 48109, USA
| | - Shyam Sukumar
- Minneapolis Veterans Administration Health Care System and Department of Urology, University of Minnesota, Mayo Memorial Building, 420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA
| | - Phyllis Yan
- Department of Urology, University of Michigan, 2800 Plymouth Rd, Building 16, 1st Floor, Ann Arbor, MI 48109, USA
| | - Gretchen M Kuntz
- Borland Library, University of Florida, 653-1 W 8th St, Jacksonville, FL 32209, USA
| | - Philipp Dahm
- Minneapolis Veterans Administration Health Care System and Department of Urology, University of Minnesota, Mayo Memorial Building, 420 Delaware St SE, MMC 394, Minneapolis, MN 55455, USA
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Sen H, Erturhan S, Sadioglu E, Bayrak O, Seckiner İ. A comparison of efficacy of doxazosin 4 and 8 mg in medical expulsive therapy of distal ureteral stones: a prospective randomized clinical trial. Urolithiasis 2016; 45:461-464. [PMID: 27717996 DOI: 10.1007/s00240-016-0927-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/28/2016] [Indexed: 10/20/2022]
Abstract
We aimed to investigate the efficacy of two different doses of doxazosin, 4 and 8 mg, in medical expulsive therapy (MET). This prospective randomized study included a total of 66 patients with distal ureteral stones which were radio-opaque and ≤10 mm. All patients were randomly divided into three groups: Group 1 included 25 patients receiving 4 mg doxazosin. Group 2 included 22 patients receiving 8 mg doxazosin. Diclofenac 100 mg p.o. and daily 1500-2000 cc hydration were advised to the patients in Groups 1 and 2 to relieve pain. Group 3 consisted of 19 patients who were defined as control group and received only hydration and analgesics. The mean age of the patients was 30 ± 7.6, 37.9 ± 11.5 and 33 ± 11.3 in Group 1, Group 2 and Group 3, respectively. The mean stone size was 6.6 ± 1.4, 7.1 ± 1.5 and 6.6 ± 1.5 in Group 1, Group 2 and Group 3, respectively. The stone expulsion rate of the patient groups was 18/25 (72 %), 15/22 (68.1 %) and 5/19 (25.3 %). There were significantly fewer pain episodes and lower analgesic requirement in Groups 1 and 2 (p = 0.021). However, the difference between Group 1 and Group 2 was non-significant (p = 0.207). Given the data of the present study, doxazosin, an alpha receptor blocker, exhibited equal efficacy with 4 or 8 mg doses in MET and was used safely and efficiently in ureteral stones <10 mm. The findings of the present study showed that 4 mg dose is effective, when doxazosin is preferred for MET.
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Affiliation(s)
- Haluk Sen
- Faculty of Medicine, Gaziantep University, Gaziantep, Turkey.
| | - Sakip Erturhan
- Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Erkan Sadioglu
- Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Omer Bayrak
- Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - İlker Seckiner
- Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Ding H, Ning Z, Dai Y, Shang P, Yang L. The role of Silodosin as a new medical expulsive therapy for ureteral stones: a meta-analysis. Ren Fail 2016; 38:1311-1319. [DOI: 10.1080/0886022x.2016.1215221] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Shabana W, Teleb M, Dawod T, Abu Taha H, Abdulla A, Shahin A, Eladl M, Abo-Hashem S. Outcome of α-blockers, with or without methylprednisolone combination, in medical expulsive therapy for lower ureteric stones: A prospective randomised study. Arab J Urol 2016; 14:7-11. [PMID: 26966586 PMCID: PMC4767789 DOI: 10.1016/j.aju.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/13/2015] [Accepted: 11/22/2015] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare the safety and efficacy of tamsulosin, alfuzosin, and their combinations with methylprednisolone, in the medical management of lower ureteric stones. Patients and methods Between September 2012 and June 2014, patients diagnosed with a single lower ureteric stone of ⩽10 mm (longest dimension) were enrolled. Patients with urinary tract infection, severe hydronephrosis, pregnancy, hypertension, diabetes, ulcer disease, or renal insufficiency were excluded. According to the medication added to the analgesic anti-inflammatory, patients were stratified into four groups, with 53 patients in each. Group I patients received tamsulosin 0.4 mg and those in Group II received tamsulosin 0.4 mg and methylprednisolone 8 mg. Group III patients received alfuzosin 10 mg and those in Group IV received alfuzosin 10 mg and methylprednisolone 8 mg. Treatment was continued until stone expulsion or to a maximum of 2 weeks. The patients’ demographics, stone criteria, and stone-free rates were calculated and analysed. Results The mean (SD) maximum stone dimension was 7.8 (1.5), 8.1 (1.3), 7.9 (1.6) and 8.0 (1.4) mm in Groups I, II, III and IV, respectively. Groups II and IV had significantly higher stone-free rates than Groups I and III (P < 0.05), whilst there were no statistically significant differences between Groups I and III or between Groups II and IV. There was no statistical difference among the four groups for the time to stone expulsion. Three patients in Group II and two patients in Group IV developed transient hyperglycaemia, which resolved after cessation of methylprednisolone. Conclusions The combination of alfuzosin or tamsulosin with methylprednisolone seems to be effective and safe for managing lower ureteric stones of <1 cm.
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Affiliation(s)
- Waleed Shabana
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
| | - Mohamed Teleb
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
| | - Tamer Dawod
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
- Corresponding author at: Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia 44111, Egypt. Tel.: +20 115 2266604; fax: +20 552 386920.Zagazig UniversityFaculty of MedicineUrology DepartmentZagazigSharkia44111Egypt
| | - Hisham Abu Taha
- Saad Specialist Hospital, Urology Department, Alkhobar, Saudi Arabia
| | - Alla Abdulla
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
| | - Ashraf Shahin
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
| | - Mahmoud Eladl
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
| | - Safwat Abo-Hashem
- Zagazig University, Faculty of Medicine, Urology Department, Zagazig, Sharkia, Egypt
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Campschroer T, Zhu Y, Duijvesz D, Grobbee DE, Lock MTWT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev 2014:CD008509. [PMID: 24691989 DOI: 10.1002/14651858.cd008509.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Urinary stone disease is one of the most common reasons for patients visiting a urology practice, affecting about 5% to 10% of the population. Annual costs for stone disease have rapidly increased over the years and most patients with ureteral colic or other symptoms seek medical care. Stone size and location are important predictors of stone passage. In most cases medical expulsive therapy is an appropriate treatment modality and most studies have been performed with alpha-blockers. Alpha-blockers tend to decrease intra-ureteral pressure and increase fluid passage which might increase stone passage. Faster stone expulsion will decrease the rate of complications, the need for invasive interventions and eventually decrease healthcare costs. A study on the effect of alpha-blockers as medical expulsive therapy in ureteral stones is therefore warranted. OBJECTIVES This review aimed to answer the following question: does medical treatment with alpha-blockers compared to other pharmacotherapy or placebo impact on stone clearance rate, in adult patients presenting with symptoms of ureteral stones less than 10 mm confirmed by imaging? Other clinically relevant outcomes such as stone expulsion time, hospitalisation, pain scores, analgesic use and adverse effects have also been explored. SEARCH METHODS We searched the Cochrane Renal Group's Specialised Register to 9 July 2012 through contact with the Trials Search Co-ordinator using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE, handsearching conference proceedings, and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs), comparing alpha-blockers with other pharmacotherapy or placebo on ureteral stone passage in adult patients were included. DATA COLLECTION AND ANALYSIS Two authors independently assessed study quality and extracted data. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for continuous outcomes. Reporting bias was investigated using funnel plots. Subgroup analysis was used to explore possible sources of heterogeneity. Sensitivity analysis was performed removing studies of poor methodological quality. MAIN RESULTS Thirty-two studies (5864 participants) were included. The stone-free rates were significantly higher in the alpha-blocker group (RR 1.48, 95% CI 1.33 to 1.64) when compared to standard therapy. Stone expulsion time was 2.91 days shorter with the use of alpha-blockers (MD -2.91, 95% CI -4.00 to -1.81). Use of alpha-blockers reduced the number of pain episodes (MD -0.48, 95% CI -0.94 to -0.01), the need for analgesic medication (diclofenac) (MD -38.17 mg, 95% CI -74.93 to -1.41) and hospitalisation (RR 0.35, 95% CI 0.13 to 0.97). Patients using alpha-blockers were more likely to experience adverse effects when compared to standard therapy (RR 2.74, 95% CI 1.38 to 5.45) or placebo (RR 2.73, 95% CI 1.50 to 4.96). Most adverse effects were mild of origin and did not lead to cessation of therapy, and several studies reported no adverse events in either the treatment or control group.In 7/32 studies patients and doctors were both blinded. In the other studies blinding was not described in the methods or no blinding had taken place. Two studies described incomplete data and only one study showed a relatively high number of patients who withdrew from the study. These factors limited the methodological strength of the evidence found. AUTHORS' CONCLUSIONS The use of alpha-blockers in patients with ureteral stones results in a higher stone-free rate and a shorter time to stone expulsion. Alpha-blockers should therefore be offered as part of medical expulsive therapy as one of the primary treatment modalities.
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Affiliation(s)
- Thijs Campschroer
- Department of Urology, University Medical Center Utrecht, Heidelberglaan 100, PO Box C04.236, Utrecht, Netherlands, 3584 CX
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Nazim SM, Ather MH, Khan N. Measurement of Ureteric Stone Diameter in Different Planes on Multidetector Computed Tomography – Impact on the Clinical Decision Making. Urology 2014; 83:288-92. [DOI: 10.1016/j.urology.2013.09.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 09/13/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
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Park YH, Lee HE, Park JY, Lee SB, Kim HH. A prospective randomized controlled trial of the efficacy of tamsulosin after extracorporeal shock wave lithotripsy for a single proximal ureteral stone. Korean J Urol 2013; 54:527-30. [PMID: 23956828 PMCID: PMC3742905 DOI: 10.4111/kju.2013.54.8.527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 06/18/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the efficacy of tamsulosin on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with a single proximal ureteral stone. MATERIALS AND METHODS This prospective randomized controlled trial was performed on 88 patients with a single proximal ureteral stone. After consenting with a doctor, the patients were allocated to the treatment (tamsulosin 0.2 mg once a day) or control (no medication) group, and the efficacy of tamsulosin was evaluated. The primary outcome of this study was the stone-free rate, and the secondary outcomes were the period until clearance, pain intensity, analgesic requirement, and incidence of complications. RESULTS A stone-free state was reported in 37 patients (84.1%) in the treatment group and 29 (65.9%) in the control group (p=0.049). The mean expulsion period of the stone fragments was 10.0 days in the treatment group and 13.2 days in the control group (p=0.012). There were no statistically significant differences in aceclofenac requirement or pain score between the two groups. Only one patient in the treatment group experienced transient dizziness associated with medical expulsive therapy, and this adverse event disappeared spontaneously. CONCLUSIONS The results of this prospective randomized controlled trial of the efficacy of tamsulosin after ESWL for a single proximal ureteral stone suggest that tamsulosin helps in the earlier clearance of stone fragments and reduces the expulsion period of stone fragments after ESWL.
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Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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22
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Abstract
To the best of our knowledge, there have been no published studies of doxazosin transfer into human milk. In rats, milk concentrations twentyfold higher than in plasma have been reported. Based on these animal data, some references advise to avoid breastfeeding during doxazosin therapy. However, the physicochemical properties of doxazosin suggest low transfer into human milk. A 37-year-old breastfeeding woman who was administered doxazosin 4 mg daily for 2 doses was studied. Doxazosin concentrations in milk and plasma were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The milk/plasma area under the concentration-time curve (AUC0-18 hours) ratio was 0.1. This finding is consistent with what could be predicted based on the physicochemical properties of doxazosin. The average and maximum milk concentrations were 2.9 and 4.2 µg/L. These values correspond to estimated relative infant doses of 0.06% and 0.09%, respectively, assuming standard infant milk intake. These values are well below the generally accepted cutoff of 10% for predicting safety during breastfeeding. A low relative infant dose of < 0.1% suggests that maternal doxazosin therapy may be compatible with breastfeeding after careful individual risk-benefit analysis.
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Lu Z, Dong Z, Ding H, Wang H, Ma B, Wang Z. Tamsulosin for ureteral stones: a systematic review and meta-analysis of a randomized controlled trial. Urol Int 2012; 89:107-15. [PMID: 22739357 DOI: 10.1159/000338909] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/14/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To evaluate the efficacy of tamsulosin as a medical expulsive therapy of ureteral stones. METHODS We searched PubMed, EMBASE, the Cochrane Library, and ISI-Science Citation Index up to December 2011. All randomized controlled trials were identified in which patients were randomized to receive either tamsulosin or standard therapy with/without placebo for ureteral stones. Outcome measures assessed were overall stone expulsion rate (primary) and expulsion time, and the number of pain episodes (secondary). Three authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5.0. RESULTS Twenty-nine trials with a total of 2,763 patients met the inclusion criteria. The pooled analysis showed a 19% improvement in stone clearance with tamsulosin. According to the doses of tamsulosin, the pooling effects of tamsulosin were analyzed, with a higher expulsion rate obtained than in controls. Compared with calcium channel blockers, there was a higher stone expulsion rate in tamsulosin. In addition, a shorter expulsion time, fewer colic episodes and adverse effects were observed. CONCLUSIONS Tamsulosin is a safe and effective medical expulsive therapy choice for ureteral stones. It should be recommended for most patients with distal ureteral stones before stones are 10 mm in size. In future, high-quality multicenter, randomized and placebo-controlled trials are needed to evaluate the outcome.
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Affiliation(s)
- Zeping Lu
- Institute of Urology, Key Laboratory of Diseases of Urological System Gansu Province, Gansu Nephro-Urological Clinical Center, The Second Hospital of Lanzhou University, Lanzhou, China
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Ateş F, Eryıldırım B, Öztürk MI, Turan T, Gürbüz C, Ekinci MO, Yıldırım A, Göktaş C, Şenkul T, Sarıca K. Does the use of doxazosin influence the success of SWL in the treatment of upper ureteral stones? A multicenter, prospective and randomized study. ACTA ACUST UNITED AC 2012; 40:537-42. [DOI: 10.1007/s00240-011-0455-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 12/22/2011] [Indexed: 11/28/2022]
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Zaytoun OM, Yakoubi R, Zahran ARM, Fouda K, Marzouk E, Gaafar S, Fareed K. Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial. ACTA ACUST UNITED AC 2011; 40:327-32. [DOI: 10.1007/s00240-011-0410-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 07/30/2011] [Indexed: 11/24/2022]
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Gurbuz MC, Polat H, Canat L, Kilic M, Caskurlu T. Efficacy of three different alpha 1-adrenergic blockers and hyoscine N-butylbromide for distal ureteral stones. Int Braz J Urol 2011; 37:195-200; discussion 201-2. [DOI: 10.1590/s1677-55382011000200006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2010] [Indexed: 11/21/2022] Open
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