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Talebi Doluee M, Shams A, Keshvari Shirvan M, DadgarMoghadam M, Sadrzadeh SM, VafadarMoradi E. Renal Colic Pain Management by Tamsulosin with Morphine Versus Morphine in Adults: A Randomized Clinical Trial. Anesth Pain Med 2023; 13:e134627. [PMID: 37601962 PMCID: PMC10439690 DOI: 10.5812/aapm-134627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 08/22/2023] Open
Abstract
Background Acute renal colic is one of the most painful situations in patients' life. The best management modality for pain alleviation is of paramount importance. Objectives This study aimed to evaluate the effect of intravenously administered morphine and oral tamsulosin compared to the independent use of morphine in patients with renal colic. Methods This double-blind clinical trial was conducted on 200 patients aged 18 to 55 years with renal colic referred to the tertiary level referral hospital. The patients were randomly assigned to two groups, A and B. The subjects in group A were treated with intravenously administered morphine and oral tamsulosin hydrochloride capsules, while group B received morphine and control. The patients' pain intensity was evaluated using a visual analog scale. Results The mean age of the patients was 35.34 ± 8.32, and 72% were males. Before the study, the mean pain intensity was higher in the tamsulosin group (8.67 ± 1.53) than in the control group (7.85 ± 2.05; P = 0.003). After four and six hours, the mean pain intensity was significantly lower in the tamsulosin group (P = 0.028 and P = 0.008, respectively). According to the results, the pain intensity was significantly reduced six hours after the treatment compared to the pre-therapy phase (P < 0.001). Conclusions Given the significant effect of tamsulosin on pain alleviation in patients with renal colic, this medicine can be used as a complementary treatment to manage the pain in these patients and reduce the administration of narcotics.
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Affiliation(s)
- Morteza Talebi Doluee
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Aida Shams
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Keshvari Shirvan
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh DadgarMoghadam
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Sayyed Majid Sadrzadeh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elnaz VafadarMoradi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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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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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: 27] [Impact Index Per Article: 4.5] [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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Ye Z, Zeng G, Chen Z, Xu H. Reply to Christian Seitz's Letter to the Editor re: Zhangqun Ye, Guohua Zeng, Huan Yang, et al. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. Eur Urol 2018;73:385-91. Eur Urol 2018; 73:e92-e93. [PMID: 29342412 DOI: 10.1016/j.eururo.2017.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/22/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Institute of Urology, Wuhan, China
| | - Guohua Zeng
- The Center of Minimally Invasive Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Institute of Urology, Wuhan, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Institute of Urology, Wuhan, China.
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Kaya FB, Cevik A, Acar N, Kaya S, Zeytin A, Can C, Metintas S. Clinical Efficacy of Metoclopramide to Treat Pain and Nausea in Renal Colic Patients: A Prospective Randomised, Double-Blind, Controlled Trial. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791502200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction This study aimed to evaluate the clinical efficacy of intravenous metoclopramide for the relief of pain and nausea among the emergency department patients with renal colic. Methods Patients were randomised into three groups: tenoxicam (20 mg); tenoxicam (10 mg) plus metoclopramide (10 mg); and metoclopramide (10 mg). Changes in pain and nausea were examined at the 10th, 20th and 30th minute after treatment. The development of side effects would be recorded. After the 30th minute, the need for additional pain and nausea relief was evaluated. Results Totally 80 patients were enrolled in each group. There was significant mean pain score difference as measured by visual analog scale (VAS) from 0 minute to 10th, 20th and 30th minute post-treatment for all treatment groups (p<0.001). There was no significant difference in mean VAS decrease from 0 minute to the 30th minute: tenoxicam group: 36 mm [95% confidence interval (CI) 28-43 mm] vs. tenoxicam plus metoclopramide: 45 mm (95% CI 38-52 mm) vs. metoclopramide group: 37 mm (95% CI 30-45 mm) (p=0.163). Similarly, no significant differences in mean nausea scores between the three groups were demonstrated at the 10th, 20th and 30th minute after treatment (p=0.236, 0.330 and 0.652 respectively). After the 30th minute, 43 (53%) patients needed additional pain relieving agent in the tenoxicam group compared to 27 (33%) patients in the tenoxicam-metoclopramide group and 33 (41%) patients in the metoclopramide group (p=0.030). No significant adverse drug reaction events were encountered. Conclusion Metoclopramide is as effective as tenoxicam to treat pain and nausea for patients with renal colic in the emergency department. (Hong Kong j.emerg.med.2015;22:93-99)
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Affiliation(s)
- F Baloglu Kaya
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - Aa Cevik
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - N Acar
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - S Kaya
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - At Zeytin
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - C Can
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
| | - S Metintas
- Eskisehir Osmangazi University Medical Center Department of Urology, Meselik, 26480, Eskisehir, Turkey
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A network meta-analysis on the beneficial effect of medical expulsive therapy after extracorporeal shock wave lithotripsy. Sci Rep 2017; 7:14429. [PMID: 29089544 PMCID: PMC5663967 DOI: 10.1038/s41598-017-14862-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 10/12/2017] [Indexed: 02/05/2023] Open
Abstract
We applied a newly introduced method, network meta-analysis, to re-evaluate the expulsion effect of drugs including tamsulosin, doxazosin, nifedipine, terazosin and rowatinex after extracorporeal shock wave lithotripsy (ESWL) as described in the literature. A systematic search was performed in Medline, Embase and Cochrane Library for articles published before March 2016. Twenty-six studies with 2775 patients were included. The primary outcome was the number of patients with successful stone expulsion. The data were subdivided into three groups according to duration of follow-up. A standard network model was established in each subgroup. In 15-day follow-up results, SUCRA outcome showed the ranking of effects was: doxazosin > tamsulosin > rowatinex > nifedipine > terazosin (88.6, 77.4, 58.6, 32.2 and 30.4, respectively). In 45-day follow-up results, SUCRA ranking was: tamsulosin > nifedipine > rowatinex (69.4, 67.2 and 62.6, respectively). In 90-day follow-up results, SUCRA ranking was: doxazosin > rowatinex > tamsulosin (84.1, 68.1 and 49.1, respectively). In conclusion, doxazosin and tamsulosin have potential to be the first choice for pharmacological therapy to promote the expulsion of urinary stone fragments after ESWL, with this doxazosin can improve the SFR in the long term, while tamsulosin may result more in accelerating the process of expulsion.
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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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Nuraj P, Hyseni N. The Role of the Tamsulosin in the Medical Expulsion Therapy for Distal Ureteral Stones. Med Arch 2017; 71:137-140. [PMID: 28790547 PMCID: PMC5511523 DOI: 10.5455/medarh.2017.71.137-140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/25/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This research aims to evaluate the role of tamsulosin in the medical expulsion therapy for distal ureteral stones, including her effects in stone expulsion time, expulsion rates, stone size, pain episodes and analgesic dosage usage. MATERIAL AND METHODS The 104 patients with distal ureteral calculi were examined, with the size of the stones 4-10 mm. They were randomly divided into two groups: study group (n=52), received tamsulosin 0.4 mg in morning, for 28 days, analgesic (diclofenac 75 mg), high fluid intake and Control group (n=52) received analgesic (diclofenac 75 mg), high fluid intake. RESULTS There is no significant difference between groups, based on sex (P=0.835) and age (P=0.987). Average size of the stones was 6.5 mm (SD ± 1.6 mm), with no significant difference (P=0.996). Stone expulsion rate is 90.4% in the study group and 71.2% from the control group, with statistical significance (P=0.023). The average time of the expulsion of stones in the study group was 9.6 days (SD ± 7.1 days), control group 13.7 days (SD ± 7.3 days), with statistical significance, (P=0.034). Average dose of analgesics in the study group was 63.7 mg (SD ± 45.2 mg), control group is 109.2 (SD ± 53.3), with statistical significance (P=0.019). CONCLUSION Our study reveals that tamsulosin is efficient for the treatment of distal ureteral stones. Tamsulosin decrease the number of ureteral colic episodes, by acting as a spasmolytic, increase and hasten stone expulsion rates, reduce days of stone expulsion, decrease analgesic dose usage.
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Affiliation(s)
- Petrit Nuraj
- Department of Urology, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo
| | - Nexhmi Hyseni
- Department of Surgery, University Clinical Center of Kosovo, Prishtina, Republic of Kosovo
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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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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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Abstract
Objective: TO evaluate the role of nifedipine and the α1-adrenoreceptor antagonists tamsulosin, terazosin, and doxazosin in the expulsive treatment of ureteral calculi. Data Sources: Literature was searched via MEDLINE (1966–February 2006) with subsequent bibliographic review. MeSH headings included ureteral calculi, nifedipine, doxazosin, and adrenergic α-antagonists. Key terms were ureteral calculi, nifedipine, tamsulosin, terazosin, and doxazosin. Study Selection and Data Extraction: Trials evaluating nifedipine, tamsulosin, terazosin, and doxazosin for expulsion of ureteral stones were reviewed. All were published in English-language, peer-reviewed journals. Data Synthesis: Several trials have evaluated the effects of nifedipine and tamsulosin on ureteral stone passage rates and mean time to stone passage in stones no larger than 15 mm. In 28 day trials, the rates of ureteral stone passage were 35–70% in the control groups compared with 77.1–80% in patients treated with nifedipine and 79.3–100% in patients treated with tamsulosin. Average number of days to stone passage in the control groups was 4.6–20, and the time to stone passage was only 5–9.3 days in patients receiving nifedipine and 2.7–7.9 days in those receiving tamsulosin. The stone passage rates and time to stone passage appeared to be similar in one trial that compared tamsulosin with terazosin and doxazosin. Limited data suggest that these agents may have a role as adjuncts to shock wave lithotripsy. Adverse drug reactions were uncommon. Conclusions: Nifedipine, tamsulosin, terazosin, and doxazosin are safe and effective options in enhancing ureteral stone expulsion in selected patients with uncomplicated presentations.
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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: 86] [Impact Index Per Article: 10.8] [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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Abdel-Kader MS. Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones. Int Urol Nephrol 2016; 49:27-30. [PMID: 27837415 DOI: 10.1007/s11255-016-1448-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy of sexual intercourse in expulsion of distal ureteric stones. PATIENTS AND METHODS The study included 56 patients with distal ureteric or intramural stone. The stones size ranged from 5 to 10 mm and were detected by US, plain X-ray film, and non-enhanced CT. The patients were divided randomly into group A included 28 patients who were advised to do sexual intercourse 3-4 times/week with administration of symptomatic treatment, and group B included 28 patients receiving symptomatic treatment only (control group) and were instructed not to do sexual intercourse or masturbation during the study. Follow-up (4 weeks) was done by plain X-ray, US, and urine analysis every week and by asking the patients about stone passage, time of expulsion, number of colicky attacks, and analgesic injections. RESULTS Group A patients mean age was 36.5 ± 10.7 years and group B 37.3 ± 12.5 years. Stone expulsion rate, in the first 2 weeks for group A, was 82% (23/28), while in group B 53% (16/28), (P = 0.006). At the fourth week, expulsion rate for group A reached to 89%, but in group B 71.4%. The mean expulsion time was shorter in group A (11.9 ± 4.4 days) than group B (16.2 ± 6.7 days). The number of colicky attacks and analgesics for group A was less than group B. CONCLUSIONS Practicing sexual intercourse for 3-4 times/week for married male patients with distal ureteric stone (5-10 mm) increases the expulsion rate and decreases the frequency of renal colic and the needs for analgesic.
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Fisang C, Anding R, Müller SC, Latz S, Laube N. Urolithiasis--an interdisciplinary diagnostic, therapeutic and secondary preventive challenge. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:83-91. [PMID: 25721435 DOI: 10.3238/arztebl.2015.0083] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/24/2014] [Accepted: 11/24/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of urolithiasis in Germany is 4.7%; its incidence has trebled in the last three decades. The risk of recurrence is 50-80%, depending on the type of stone, unless secondary prevention is instituted. Risk-adapted secondary prevention lowers this risk to 10-15%. METHODS This review is based on publications retrieved by a selective search in PubMed using the key words "urolithiasis," "urinary stones," "epidemiology," "lithogenesis," "biominerals," "risk factors," and "diagnosis, therapy, metaphylaxis." These publications were evaluated with the aid of the urolithiasis guideline of the European Association of Urology. RESULTS Acute renal colic can usually be diagnosed without sophisticated equipment. Stones can be dealt with by a variety of techniques depending on their size and location, including extracorporeal shock-wave lithotripsy, ureterorenoscopy, percutaneous nephrolitholapaxy, and open surgery. Most ureteric stones of diameter up to 5 mm pass spontaneously. 75% of patients have no complications. The basic evaluation needed for secondary prevention can be carried out by any physician on an ambulatory basis. In the 25% of patients who have complications, a more extensive interdisciplinary evaluation of metabolic parameters should be performed in a clinical center for urinary stones. CONCLUSION Urolithiasis has many causes and can be treated in many different ways. An extensive metabolic work-up is often necessary for secondary prevention. The various treatment options must be considered for their suitability in each individual patient. Robust data are now available on surgical and interventional methods, but there are as yet no high-quality trials of secondary prevention. Further research should concentrate on the etiology and pathogenesis of urolithiasis.
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Zorba OÜ, Ogullar S, Yazar S, Akca G. CT-Based Determination of Ureteral Stone Volume: A Predictor of Spontaneous Passage. J Endourol 2015. [PMID: 26207417 DOI: 10.1089/end.2015.0481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Which ureteral stone can pass spontaneously? It is hard to answer this question exactly. The size and location of the stone are the most important predictors. However, there is still a considerable gray zone that needs to be clarified. We try to identify the role of stone volume (SV) in the prediction of spontaneous passage (SP). MATERIALS AND METHODS Seventy-eight patients with a solitary ureteral stone were retrospectively evaluated. Ureter SV measurements were taken in three planes and were calculated using the following formula: V = (X) × (Y) × (Z) × 0.52. SVs, and the longest diameters (LDs) were compared between patients who passed stones spontaneously and those who needed intervention. RESULTS The SVs and LDs were significantly lower in patients who passed stones spontaneously than in patients who required intervention (41.2 ± 35.5 vs 128.1 ± 91.1 mm(3), p = 0.001; 5.7 ± 1.8 vs 7.4 ± 1.7 mm, p = 0.001). The optimum cutoff values were 7.0 mm and 52.6 mm(3) for the LD and SV, respectively. For those stones of ≤7 mm, the volumes of the stones that could and could not pass did not differ significantly. However, the volume of the stones >7.0 mm that could pass was significantly higher than of those that could not. SP was 30.6% for stones >7 mm; however, when we removed the stones >52.6 mm(3), SP increased to 75% for stones higher than 7 mm (p = 0.001). CONCLUSIONS To classify ureteral stones using only one parameter such as stone diameter may lead to heterogeneity within the group. SV may be used in addition to size to determine a more definite homogeneous group to predict SP more precisely.
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Affiliation(s)
- Orhan Ünal Zorba
- 1 Department of Urology, School of Medicine, Recep Tayyip Erdoagan University , Rize, Turkey
| | - Sabri Ogullar
- 2 Department of Radiology, School of Medicine, Recep Tayyip Erdoagan University , Rize, Turkey
| | - Selim Yazar
- 1 Department of Urology, School of Medicine, Recep Tayyip Erdoagan University , Rize, Turkey
| | - Gorkem Akca
- 1 Department of Urology, School of Medicine, Recep Tayyip Erdoagan University , Rize, Turkey
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Eficacia y seguridad de tamsulosina para el tratamiento conservador del cólico nefrítico: revisión sistemática con metaanálisis de ensayos clínicos aleatorizados. Med Clin (Barc) 2015; 145:239-47. [DOI: 10.1016/j.medcli.2015.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 02/06/2023]
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Effect of medical expulsive therapy on the health-related quality of life of patients with ureteral stones: a critical evaluation. Int Urol Nephrol 2015; 47:1271-5. [DOI: 10.1007/s11255-015-1036-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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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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Sfoungaristos S, Kavouras A, Kanatas P, Duvdevani M, Perimenis P. Early hospital admission and treatment onset may positively affect spontaneous passage of ureteral stones in patients with renal colic. Urology 2014; 84:16-21. [PMID: 24685060 DOI: 10.1016/j.urology.2014.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 12/28/2013] [Accepted: 01/02/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of early hospital admission and onset of medical expulsive therapy (MET) in spontaneous passage of ureteral stones causing renal colic. METHODS We recruited 392 patients referred to the emergency room with symptoms of renal colic. All patients received standard MET of oral tamsulosin 0.4 mg at the time of diagnosis. In group A, patients who received MET in <2 hours from the symptom onset were included, whereas group B consisted of patients treated in >2 hours. The association of MET onset and stone-free rates after 6 weeks of follow-up was evaluated. Early MET onset predictive impact on spontaneous stone passage was evaluated as well. RESULTS The stone-free rate in group A and B patients was 71.2% and 59.7% (P=.018), respectively. A significant association was observed between spontaneous calculus elimination and stone size (P≤.001), location within the ureter (P=.007), and the interval between pain onset and pharmaceutical management (P=.018). Patients who received a late-onset MET had an increased risk to develop febrile upper urinary tract infection during the follow-up period (P=.040). In the multivariate analysis, size (P≤.001) and early therapy onset (P=.019) were statistically important predictors for stone-free status after the surveillance period. CONCLUSION Patients with renal colic who admitted to the emergency department earlier since symptom onset may have increased potential to be stone free during the surveillance period.
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Janane A, Hamdoun A, Hajji F, Dakkak Y, Ghadouane M, Ameur A, Abbar M. Usefulness of adjunctive alpha1-adrenergic antagonists after single extracorporeal shock wave lithotripsy session in ureteral stone expulsion. Can Urol Assoc J 2014; 8:E8-E11. [PMID: 24454608 DOI: 10.5489/cuaj.1261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We evaluate the efficiency of α-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones. METHODS A total of 356 patients with solitary lower ureteral stones who underwent single ESWL sessions were divided into 2 groups. Group 1 received our standard medical therapy, and Group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during the treatment period. A computed tomography scan was systematically performed 3 months after ESWL. RESULTS In total, 82 of the 170 patients in Group 1 (48.2%) and 144 of the 186 patients in Group 2 (77.4%) (p = 0.002) were stone-free. Among the patients with stones 10 to 15 mm in diameter, the stone-free rate was 38.4% in Group 1 and 77.1% in Group 2 (p = 0.003). Average stone expulsion time was 10.6 days and 8.4 days in Groups 1 and 2, respectively. Ureteral colic occurred in 40 patients (23.5%) in Group 1, but only in 10 patients (5.3%) in Group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 5 of the 186 patients in Group 2 (2.6%). CONCLUSION Adjunctive therapy with α1-adrenergic antagonists after ESWL is more efficient than, and equally as safe as, lithotripsy alone to manage patients with lower ureteral stones. The adding of α-blockers is more reliable and helpful for stones with a large dimension, and can also decrease stone elimination time and episodes of ureteral colic.
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Affiliation(s)
- Abdellatif Janane
- Department of Urology, University Military Hospital Mohammed V. Rabat, Morocco
| | - Abdelaziz Hamdoun
- Department of Urology, University Military Hospital Mohammed V. Rabat, Morocco
| | - Fouad Hajji
- Department of Urology, University Military Hospital Mohammed V. Rabat, Morocco
| | - Youssef Dakkak
- Department of Urology, University Military Hospital Mohammed V. Rabat, Morocco
| | - Mohamed Ghadouane
- Department of Urology, University Military Hospital Mohammed V. Rabat, Morocco
| | - Ahmed Ameur
- Department of Urology, University Military Hospital Mohammed V. Rabat, Morocco
| | - Mohamed Abbar
- Department of Urology, University Military Hospital Mohammed V. Rabat, Morocco
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Doizi S, Letendre J, Bensalah K, Traxer O. Prise en charge pharmacologique de la lithiase urinaire. Prog Urol 2013; 23:1312-7. [DOI: 10.1016/j.purol.2013.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 11/28/2022]
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Sorensen MD, Bailey MR, Hsi RS, Cunitz BW, Simon JC, Wang YN, Dunmire BL, Paun M, Starr F, Lu W, Evan AP, Harper JD. Focused ultrasonic propulsion of kidney stones: review and update of preclinical technology. J Endourol 2013; 27:1183-6. [PMID: 23883117 PMCID: PMC3787400 DOI: 10.1089/end.2013.0315] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION A noninvasive tool to reposition kidney stones could have significant impact in the management of stone disease. Our research group has developed a noninvasive transcutaneous ultrasound device. A review and update of the current status of this technology is provided. DISCUSSION OF TECHNOLOGY: Stone propulsion is achieved through short bursts of focused, ultrasonic pulses. The initial system consisted of an eight-element annular array transducer, computer, and separate ultrasound imager. In the current generation, imaging and therapy are completed with one ultrasound system and a commercial probe. This generation allows real-time ultrasound imaging, targeting, and propulsion. Safety and effectiveness for the relocation of calyceal stones have been demonstrated in the porcine model. ROLE IN ENDOUROLOGY: This technology may have applications in repositioning stones as an adjunct to lithotripsy, facilitating clearance of residual fragments after lithotripsy, expelling de novo stones, and potentially repositioning obstructing stones. Human trials are in preparation.
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Affiliation(s)
- Mathew D. Sorensen
- Division of Urology, Department of Veteran Affairs Medical Center, Seattle, Washington
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Michael R. Bailey
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Ryan S. Hsi
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
| | - Bryan W. Cunitz
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Julianna C. Simon
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Yak-Nam Wang
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Barbrina L. Dunmire
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Marla Paun
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Frank Starr
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Wei Lu
- Applied Physics Laboratory, Center for Industrial and Medical Ultrasound, University of Washington, Seattle, Washington
| | - Andrew P. Evan
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jonathan D. Harper
- Department of Urology, University of Washington School of Medicine, Seattle, Washington
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Dadali M, Aydogmus Y, Emir L, Aydin A, Hascicek MA, Bagbanci S. Does the endoscopic treatment of lower ureter stones affect uroflowmetric values? A prospective clinical trial. Urol Int 2013; 91:315-9. [PMID: 24052067 DOI: 10.1159/000353090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 05/13/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to document if stones at the lower ureter alter the micturition capability of the patients and to investigate whether endoscopic removal of these stones restores normal urinary flow rates or not in the 3 months of follow-up. METHODS Forty patients with lower ureteral stone (group 1) and 20 control subjects with proximal ureteral stone (group 2) were enrolled into the study. All patients underwent uroflowmetry testing before and 3 months after the treatment for endoscopic stone removal. The mean average and peak flow rates with a sufficient voided volume (≥150 ml) were evaluated before and after surgery and compared between the groups. RESULTS Mean values of the peak flow rates before and after surgery were 20.3 and 27.5 ml/s in group 1 and 22.5 and 23.6 ml/s in group 2, and the mean average flow rate values before and after surgery were 10.5 and 13.6 ml/s in group 1 and 11.4 and 12.1 ml/s in group 2. Statistically significant differences were determined between before and after ureteroscopy values were determined in terms of average (p < 0.05) and peak flow rates (p < 0.01) in group I; however, there no significant difference was seen in the control group. CONCLUSION We document for the first time in the literature that patients with lower ureteric stones have a reduction in their urinary stream which resolves with endoscopic removal of the stones.
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Affiliation(s)
- Mumtaz Dadali
- Ahi Evran University Faculty of Medicine Department of Urology, Kırsehir, Turkey
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Lee SR, Jeon HG, Park DS, Choi YD. Longitudinal stone diameter on coronal reconstruction of computed tomography as a predictor of ureteral stone expulsion in medical expulsive therapy. Urology 2012; 80:784-9. [PMID: 22901820 DOI: 10.1016/j.urology.2012.06.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/11/2012] [Accepted: 06/18/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate stone diameter and ureteral dilation using computerized tomography as a predictor of ureteral stone expulsion after medical expulsive therapy. MATERIALS AND METHODS We retrospectively reviewed the records of 328 patients with symptomatic ureteral stones <10 mm on axial computerized tomography images, who were treated with alpha blockers for 2 weeks. Computerized tomography scans were also performed 2 weeks after medical expulsive therapy to confirm ureteral stone expulsion. Patients were divided into upper ureteral stones and lower ureteral stones above and below the iliac vessels, respectively. Transverse stone diameter and longitudinal stone diameter were defined as the largest stone diameter determined on the axial and coronal computerized tomography images, respectively. Ureteral diameter was determined on one computerized tomography slice proximal to each ureteral stone on axial computerized tomography images, and the ratio of ureter-to-stone diameter was defined as ureteral diameter divided by transverse stone diameter. RESULTS Among 328 patients, the stone expulsion rate was 44.1% in 145 upper ureteral stones and 69.4% in 183 lower ureteral stones. Transverse stone diameter, longitudinal stone diameter, ureteral diameter, and the ratio of ureter-to-stone diameter were significantly lower in patients with ureteral stone expulsion in upper ureteral stones and lower ureteral stones (P < .001 for all parameters). Logistic regression analysis revealed that only longitudinal stone diameter was a significant predictor of stone expulsion in patients with upper ureteral stones (odds ratio 0.580, P = .040) and lower ureteral stones (odds ratio 0.415, P = .012). CONCLUSION Longitudinal stone diameter was a significant predictor of stone expulsion in patients with upper ureteral stones and lower ureteral stones after medical expulsive therapy. Measurement of stone diameters in coronal reconstruction may help to better choose a patient who is suitable for medical expulsive therapy.
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Affiliation(s)
- Seung Ryeol Lee
- Department of Urology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
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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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Cha WH, Choi JD, Kim KH, Seo YJ, Lee K. Comparison and efficacy of low-dose and standard-dose tamsulosin and alfuzosin in medical expulsive therapy for lower ureteral calculi: prospective, randomized, comparative study. Korean J Urol 2012; 53:349-54. [PMID: 22670195 PMCID: PMC3364475 DOI: 10.4111/kju.2012.53.5.349] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 03/15/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Typically in Korea, for a standard dose (0.4 mg) of tamsulosin, two low doses (0.2 mg) are administered. The aim of this study was to evaluate and compare the efficacy of tamsulosin (0.2 mg and 0.4 mg) and alfuzosin (10 mg) in the treatment of lower ureteral stones. MATERIALS AND METHODS A total of 141 patients presenting with a single 4- to 10-mm sized lower ureteral stone were randomly assigned to 4 groups. Patients in group 1 (n=41) and group 2 (n=30) received an oral dose of 0.2 mg tamsulosin once and twice daily, respectively, and patients in group 3 (n=36) received a daily oral dose of 10 mg alfuzosin. Patients in group 4 (n=34) received trospium chloride only. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated. RESULTS There were no significant differences in patient background, including age, sex, BMI, stone size, stone side, and symptom duration. The spontaneous stone passage rate through the ureter was higher and the stone expulsion time was faster in groups 1, 2, and 3 than in group 4. There were no statistically different changes in groups 1, 2, and 3. The adverse effects observed in all groups were comparable and were mild. CONCLUSIONS Tamsulosin at 0.2 mg and 0.4 mg and alfuzosin (10 mg) proved to be safe and effective. A first cycle of medical expulsive therapy with tamsulosin 0.2 mg could be considered as an option in the management of single lower ureteral stone.
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Affiliation(s)
- Woo Heon Cha
- Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea
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Georgiev MI, Ormanov DI, Vassilev VD, Dimitrov PD, Mladenov VD, Popov EP, Simeonov PP, Panchev PK. Efficacy of tamsulosin oral controlled absorption system after extracorporeal shock wave lithotripsy to treat urolithiasis. Urology 2011; 78:1023-6. [PMID: 21917304 DOI: 10.1016/j.urology.2011.01.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 01/03/2011] [Accepted: 01/21/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To determine the efficacy of the tamsulosin oral controlled absorption system as an adjuvant therapy to extracorporeal shock wave lithotripsy (ESWL) for the expulsion of ureteral and renal stones. METHODS A consecutive sample of 248 patients with ureteral or renal stones who underwent ESWL in an academic hospital was included in a 12-week, prospective, open-label, randomized clinical trial. Of the 248 patients, 186, including 77 with ureteral stones (mean size 9 mm) and 109 with renal stones (mean size 13 mm) completed the study. After successful ESWL, the patients were randomized to standard medical care (corticosteroids and analgesics) or standard care plus the tamsulosin oral controlled absorption system 0.4 mg/d for 1 month. The stone clearance rate, interval to the elimination of stone fragments, incidence of renal colic, and the need for rehospitalization were assessed at 4, 8, and 12 weeks. RESULTS The stone clearance rate was significantly greater for the patients treated with tamsulosin than for those in the standard care group at 4 (73.4% vs 55.9%, respectively; P < .001) and 12 (91.3% vs 74.6%, respectively; P < .05) weeks. Tamsulosin treatment was also associated with a significantly lower interval to the elimination of stone fragments (P < .001), a significantly lower rehospitalization rate (P < .001), and a significantly lower proportion of patients with acute renal colic (P < .05) than standard care alone. No severe adverse events leading to treatment discontinuation were observed. CONCLUSION Adjuvant treatment with tamsulosin, in addition to standard treatment with steroids and analgesics, improved the outcome of ESWL.
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Affiliation(s)
- Marin I Georgiev
- Department of Urology, University Hospital Alexandrovska, Medical University Sofia, Sofia, Bulgaria.
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Griwan MS, Singh SK, Paul H, Pawar DS, Verma M. The efficacy of tamsulosin in lower ureteral calculi. Urol Ann 2011; 2:63-6. [PMID: 20882156 PMCID: PMC2943682 DOI: 10.4103/0974-7796.65110] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 01/21/2010] [Indexed: 11/24/2022] Open
Abstract
Context: There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL). Aims: Recent studies have reported excellent results with medical expulsive therapy (MET) for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. Settings and Design: We conducted a comparative study in between watchful waiting and MET with tamsulosin. Materials and Methods: We conducted a comparative study in between watchful waiting (Group I) and MET with tamsulosin (Group II) in 60 patients, with a follow up of 28 days. Statistical Analysis: Independent 't' test and chi-square test. Results: Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively) as compared to Group I. Conclusions: It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.
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Affiliation(s)
- M S Griwan
- Department of Surgery, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Abstract
Most ureteral stones can be observed with reasonable expectation of uneventful stone passage. When an active ureteral stone treatment is warranted, the best procedure to choose is dependent on several factors, besides stone size and location, including operators’ experience, patients’ preference, available equipment and related costs. Placement of double-J stent or nephrostomy tube represents the classical procedures performed in a renal colic due to acute ureteral obstruction when the conservative drug therapy does not resolve the symptoms. These maneuvers are usually followed by ureteroscopy or extracorporeal shockwave lithotripsy, which currently represent the mainstay of treatment for ureteral stones. In this review paper a literature search was performed to identify reports dealing with emergency management of renal colic due to ureteral stones. The main aspects related to this debated issue are analyzed and the advantages and disadvantages of each treatment option are carefully discussed.
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Affiliation(s)
- Luis Osorio
- Department of Urology, Santo Antonio General Hospital, Oporto, Portugal
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Picozzi SCM, Marenghi C, Casellato S, Ricci C, Gaeta M, Carmignani L. Management of ureteral calculi and medical expulsive therapy in emergency departments. J Emerg Trauma Shock 2011; 4:70-6. [PMID: 21633572 PMCID: PMC3097585 DOI: 10.4103/0974-2700.76840] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 07/08/2010] [Indexed: 11/18/2022] Open
Abstract
Introduction: Ureteral stones are a common problem in daily emergency department practice. Patients may be offered medical expulsive therapy (MET1) to facilitate stone expulsion and this should be offered as a treatment for patients with distal ureteral calculi, who are amenable to waiting management. Emergency department clinicians and family practitioners are often in the front line regarding the diagnosis and treatment of symptomatic nephrolithiasis and this commentary is dedicated to them because their decisions directly influence the outcome of the acute stone episode and appropriate referral patterns. Materials and Methods: The aim of this systematic review and meta-analysis was to understand the role of MET in the treatment of obstructing ureteral calculi. A bibliographic search covering the period from January 1980 to March 2010 was conducted in PubMed, MEDLINE and EMBASE. The searches were restricted to publications in English. This analysis is based on the 21 studies that fulfilled the predefined inclusion criteria. Results: A metaregression analysis of expulsion time showed a statistically significant advantage in the experimental group, in which the mean expulsion time was 6.2 days compared to 10.3 days in controls. The treatment effect on expulsion rate (P = 0.53) was partially lost as the size of the stones decreased because of the high spontaneous expulsion rate of small stones and the expulsion time was not influenced by pharmacological treatment (P = 0.76) if the stone size was smaller than 5 mm. Analysis of the tamsulosin database. A total of 1283 participants were included in the 17 studies. These studies showed that compared to standard therapy or placebo, tamsulosin had significant benefits, being associated with both a higher stone expulsion rate (P < 0.001) and reduction of the expulsion time (P = 0.02). Reductions in the need for analgesic therapy, hospitalization and surgery are also shown. Analysis of the nifedipine database. The number of participants in each trial ranged from 25 to 70. Compared to standard therapy, the use of nifedipine significantly improved the spontaneous stone expulsion rate (P < 0.001). The mean expulsion time was slightly, but not statistically significantly, different (P = 0.19) between the treatment and control groups. A possible benefit of nifedipine, in terms of significantly reducing the doses of analgesics required, was reported in three studies. There was no difference between the tamsulosin- and nifedipine-treated groups with regard to expulsion time (P = 0.17) or expulsion rate (P = 0.79). Conclusions: Despite all its advantages, MET is rarely used, representing a failure of the translation of medical science into practice. These data raise concerns not only about the quality of care of patients who could benefit from resolution of stones without anaesthetic and surgical risks but also with regard to potential cost savings. MET should be offered as a treatment for patients with distal ureteral calculi who are amenable to a waiting management.
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Ochoa-Gómez R, Prieto-Díaz-Chávez E, Trujillo-Hernández B, Vásquez C. Tamsulosin does not have greater efficacy than conventional treatment for distal ureteral stone expulsion in Mexican patients. ACTA ACUST UNITED AC 2011; 39:491-5. [DOI: 10.1007/s00240-011-0380-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
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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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Ohgaki K, Horiuchi K, Hikima N, Kondo Y. Facilitation of expulsion of ureteral stones by addition of α1-blockers to conservative therapy. ACTA ACUST UNITED AC 2010; 44:420-4. [PMID: 20604720 DOI: 10.3109/00365599.2010.497769] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE An antispasmodic agent and a medicine that facilitates stone expulsion are given commonly as conservative therapy for ureteral stones in Japan. The goal of this study was to compare the efficacy of the addition of various α(1)-blockers to the conservative therapy for spontaneous passage of ureteral stones. MATERIAL AND METHODS The subjects were 132 patients with stones from the upper to the lower ureter who were randomly placed into one of four groups and followed for 1 month to assess spontaneous passage of stones. The control group received daily doses of 240 mg flopropione as an antispasmodic agent and 1350 mg extract of Quercus salicina Blume/Quercus stenophylla Makino as a medicine that facilitates stone expulsion. The other three groups received this therapy and daily doses of 30 mg urapidil, 0.2 mg tamsulosin or 50 mg naftopidil, respectively. The characteristics of the stones and stone expulsion were evaluated by urinalysis, a kidney, ureter and bladder (KUB) X-ray, ultrasound and computed tomography. RESULTS All patients completed the study and there were no major side-effects. There was no difference in age, stone position or stone size among the groups. Multivariate analysis using a Cox proportional hazards model indicated that the probability of stone expulsion for 1 month was increased 2.38 times (95% confidence interval 1.23-4.61) by naftopidil compared with control therapy alone (p = 0.01). CONCLUSION Naftopidil in combination with an antispasmodic agent and a medicine that facilitates stone expulsion produces a significantly increased rate of ureteral stone expulsion.
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Affiliation(s)
- Kenji Ohgaki
- Department of Urology, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Kanagawa, Japan.
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Does tamsulosin change the management of proximally located ureteral stones? ACTA ACUST UNITED AC 2010; 38:195-9. [PMID: 20182703 DOI: 10.1007/s00240-010-0257-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 01/26/2010] [Indexed: 12/17/2022]
Abstract
The objective of this study is to assess the efficacy of an alpha-1 adrenergic receptor blocking agent on the spontaneous passage of proximal ureteral calculi < or =10 mm. 92 patients having single radio-opaque proximal ureteral stone < or =10 mm were randomized into two groups. Group 1 patients (n = 50) were followed with classical conservative approach and patients in Group 2 (n = 42) additionally received tamsulosin, 0.4 mg/day during 4 weeks follow-up. The stone passage rates, stone expulsion time, VAS score, change in colic episodes, and hospital re-admission rates for colicky pain were compared. The patients were furthermore stratified according to stone diameters <5 and 5-10 mm. The data of these subgroups were also compared. Stone expulsion rates showed statistically significant difference between tamsulosin receivers and non-receivers (35.7 vs 30%, p = 0.04). Time to stone expulsion period was also shortened in those receiving tamsulosin (8.4 +/- 3.3 vs 11.6 +/- 4.1 days, p = 0.015). Likewise, the mean VAS score and renal colic episodes during follow-up period were significantly diminished in Group 2 patients (4.5 +/- 2.3 vs 8.8 +/- 2.9, p < 0.01 and 66.6 vs 36%, p = 0.001, respectively). Among the stones <5 mm, tamsulosin receiving patients had higher spontaneous passage rate (71.4 vs 50%, p < 0.001). The prominent effect of tamsulosin on the 5-10 mm stones was the relocation of the stones to a more distal part of ureter (39.3 vs 18.7%, p = 0.001). Administration of tamsulosin in the medical management of proximal ureteral calculi can facilitate the spontaneous passage rate in the stone <5 mm and the relocation of the stones between 5 and 10 mm to more distal part of the ureter.
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Al-Ansari A, Al-Naimi A, Alobaidy A, Assadiq K, Azmi MD, Shokeir AA. Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients. Urology 2010; 75:4-7. [PMID: 20109697 DOI: 10.1016/j.urology.2009.09.073] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Revised: 08/28/2009] [Accepted: 09/10/2009] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To study the impact of tamsulosin on the rate of spontaneous passage of distal ureteral stones. METHODS A total of 100 patients with stones sized 10 mm or smaller, located in the distal part of the ureter were included. Patients were randomly assigned to 2 equal groups. Group 1 received 0.4 mg tamsulosin once daily and group 2 received placebo. The investigators and the patients were masked to the type of treatment. Patients were followed-up until passage of the stone, or for a maximum of 4 weeks. The number of pain episodes, need for analgesia, stone expulsion rate and time, and possible side effects of medications were observed in both groups. RESULTS Apart from 4 patients in the placebo group who were lost to follow-up, all patients complied with the prescribed medications and continued the study. Stone expulsion occurred in 41 of 50 patients (82%) in group 1 and in 28 of 46 patients (61%) in group 2 (P = .02). The chance of stone expulsion was 3 times higher in the tamsulosin group (relative risk [RR] = 2.93; 95% CI, 1.152-7.45). In group 1, patients with stones sized < or = 5 mm showed a significantly higher expulsion rate compared to those with larger stones (> 5 mm). Age, gender, and stone laterality had no significant impact on the expulsion rate. The expulsion time was significantly shorter in the tamsulosin group (6.4 +/- 2.77 days vs 9.87 +/- 5.4 days for groups 1 and 2, respectively). Moreover, the frequency of pain episodes, the need for diclofenac, and its total dosage were significantly lower in the tamsulosin group. Side effects observed in both groups were comparable and mild, and no patient withdrew because of them. CONCLUSIONS Tamsulosin is a safe and effective drug that enhances spontaneous passage of distal ureteral stones sized 10 mm or smaller.
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Brown AM, Schriger DL, Barrett TW. Outcome Measures, Interim Analyses, and Bayesian Approaches to Randomized Trials. Ann Emerg Med 2010; 55:216-224.e1. [DOI: 10.1016/j.annemergmed.2009.09.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wang H, Liu K, Ji Z, Li H. Effect of α1-Adrenergic Antagonists on Lower Ureteral Stones With Extracorporeal Shock Wave Lithotripsy. Asian J Surg 2010; 33:37-41. [DOI: 10.1016/s1015-9584(10)60007-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2010] [Indexed: 10/19/2022] Open
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Morúa AG, García JDG, Montelongo RM, Guerra LSG. [Use of alfuzosin for expulsion of stones in the distal third of ureter]. Actas Urol Esp 2009; 33:1005-10. [PMID: 19925762 DOI: 10.1016/s0210-4806(09)72901-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Ureteral stones occur in approximately 12% of the population worldwide, and their incidence has significantly increased in recent years in Western countries. Seventy percent of ureteral stones are located in the distal third of the ureter. Several factors have a strong influence on spontaneous passage of ureteral stones, including stone size, shape, and location. Alpha blockers are currently attributed a potential role in rapid expulsion of stones in the distal third of the ureter. MATERIALS AND METHODS Thirty patients diagnosed of stones in the distal third of ureter of sizes ranging from 4 mm and 10 mm were divided into two groups. The first group was given Buscopan 10 mg plus ketorolac 10 mg every 8 hours, while the second group received alfuzosin 10 mg every 24 hours. RESULTS In group 1, mean stone size was 6.4 mm. Stone expulsion occurred in only 4 patients after a mean of 11.4 days. In group 2, mean stone size was 5.8 mm, and stone expulsion occurred in 13 patients after a mean of 3.3 days.The two stones that were not passed where the biggest ones (9 mm and 10 mm). CONCLUSIONS Use of alpha-adrenergic blockers for ureteral distal third stones has been shown to be effective for increasing the stone expulsion rate and even the number of stones passed, and for faster symptom relief.
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Tamsulosin for Ureteral Stones in the Emergency Department: A Randomized, Controlled Trial. Ann Emerg Med 2009; 54:432-9, 439.e1-2. [DOI: 10.1016/j.annemergmed.2008.12.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 11/26/2008] [Accepted: 12/19/2008] [Indexed: 11/22/2022]
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Chan CW, Tekwani KL, Watts HF, Kulstad EB. Emergency physicians report infrequent use of α-blockade for the treatment of ureteral stones. Am J Emerg Med 2009; 27:776-8. [DOI: 10.1016/j.ajem.2008.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Accepted: 06/09/2008] [Indexed: 10/20/2022] Open
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Sayed MAB, Abolyosr A, Abdalla MA, El-Azab AS. Efficacy of tamsulosin in medical expulsive therapy for distal ureteral calculi. ACTA ACUST UNITED AC 2009; 42:59-62. [PMID: 17853008 DOI: 10.1080/00365590701571076] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the potential role of tamsulosin in the medical treatment of distal ureteral stones. MATERIAL AND METHODS Ninety patients with symptomatic distal ureteral calculi were enrolled. They were randomly divided into two groups: Group A (n=45) received diclofenac 100 mg on demand for 4 weeks plus levofloxacin 250 mg daily for the first week and were well hydrated; and Group B (n=45) received the same therapy plus tamsulosin 0.4 mg/daily for 4 weeks. Abdominal ultrasound scans and KUB X-rays were performed weekly. Stone expulsion rates, time to expulsion, pain episodes and analgesic usage were determined. Intervention by means of shock-wave lithotripsy (SWL) or ureteroscopy was evaluated. RESULTS The stone expulsion rate was 51.1% for Group A, compared to 88.9% for Group B (p=0.001). The average time to expulsion was 12.53+/-2.12 days for Group A and 7.32+/-0.78 days for Group B (p=0.04). The number of pain episodes was significantly lower in Group B and mean use of analgesics was lower for Group B (0.14+/-0.5 vials) than Group A (2.78+/-2.7 vials). Twenty-two patients in Group A failed to pass their stones after 4 weeks but only five in Group B. Of the patients who were not stone-free, 19 were treated with SWL and eight underwent ureteroscopy. CONCLUSION Our study reveals the efficacy of tamsulosin for the treatment of distal ureteral stones. Tamsulosin should be added to the standard medical approach for treating these stones.
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Smith RD, Shah M, Patel A. Recent advances in management of ureteral calculi. F1000 MEDICINE REPORTS 2009; 1. [PMID: 20948727 PMCID: PMC2948312 DOI: 10.3410/m1-53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The management of patients with urinary tract stone disease has changed dramatically over recent years, with current treatment modalities focused on their minimal invasiveness. In this article we will discuss the recent advances in the field of urolithiasis management, with a focus on medical expulsive therapy, extra-corporeal shockwave lithotripsy and ureteroscopy.
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Affiliation(s)
- Richard Daron Smith
- St Mary's Hospital, Imperial Healthcare NHS TrustPraed Street, Paddington, London W2 1NYUK
| | - Mushtaq Shah
- The Royal London HospitalWhitechapel, London E1 1BBUK
| | - Anup Patel
- St Mary's Hospital, Imperial Healthcare NHS TrustPraed Street, Paddington, London W2 1NYUK
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Seitz C, Liatsikos E, Porpiglia F, Tiselius HG, Zwergel U. Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol 2009; 56:455-71. [PMID: 19560860 DOI: 10.1016/j.eururo.2009.06.012] [Citation(s) in RCA: 185] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 06/09/2009] [Indexed: 12/27/2022]
Abstract
CONTEXT Medical expulsive therapy (MET) for urolithiasis has gained increasing attention in the last years. It has been suggested that the administration of alpha-adrenoreceptor antagonists (alpha-blockers) or calcium channel blockers augments stone expulsion rates and reduces colic events. OBJECTIVE To evaluate the efficacy and safety of MET with alpha-blockers and calcium channel blockers for upper urinary tract stones with and without prior extracorporeal shock wave lithotripsy (ESWL). EVIDENCE ACQUISITION A systematic review of the literature was performed in Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews searched through 31 December 2008 without time limit. Efficacy and safety end points were evaluated in 47 randomised, controlled trials assessing the role of MET. Meta-analysis was conducted using Review Manager (RevMan) v.5.0 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). EVIDENCE SYNTHESIS Pooling of alpha-blocker and calcium channel blocker studies demonstrated a higher and faster expulsion rate compared to a control group (risk ratio [RR]: 1.45 vs 1.49; 95% confidence interval [CI]: 1.34-1.57 vs 1.33-1.66). Similar results have been obtained after ESWL (RR: 1.29 vs 1.57; 95% CI: 1.16-1.43 vs 1.21-2.04). Additionally, lower analgesic requirements, fewer colic episodes, and fewer hospitalisations were observed within treatment groups. CONCLUSIONS Pooled analyses suggest that MET with alpha-blockers or calcium channel blockers augments stone expulsion rates, reduces the time to stone expulsion, and lowers analgesia requirements for ureteral stones with and without ESWL for stones < or = 10 mm. There is some evidence that a combination of alpha-blockers and corticosteroids might be more effective than treatment with alpha-blockers alone. Renal stones after ESWL also seem to profit from MET. The vast majority of randomised studies incorporated into the present systematic review are small, single-centre studies, limiting the strength of our conclusions. Therefore, multicentre, randomised, placebo-controlled trials are needed.
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Affiliation(s)
- Christian Seitz
- Department of Urology, General Hospital of Bolzano, Bolzano, Italy.
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Porpiglia F, Fiori C, Ghignone G, Vaccino D, Billia M, Morra I, Ragni F, Scarpa RM. A second cycle of tamsulosin in patients with distal ureteric stones: a prospective randomized trial. BJU Int 2009; 103:1700-3. [DOI: 10.1111/j.1464-410x.2008.08295.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lipkin M, Shah O. Medical therapy of stone disease: from prevention to promotion of passage options. Curr Urol Rep 2009; 10:29-34. [PMID: 19116093 DOI: 10.1007/s11934-009-0007-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medical therapy has been used for many years in the prevention of urinary stones. Medications directed at correcting urinary metabolic abnormalities responsible for promoting stone formation include thiazide diuretics, citrate salts, and allopurinol. All have proven to be efficacious. In addition, intake of citrate-rich juices, such as lemonade, may help to reduce urinary stone formation. More recently, there has been increasing interest in and use of medical therapy to aide in the passage of ureteral stones. Medical expulsive therapy (MET) has been shown to be cost effective compared with observation followed by treatment. Alpha-adrenergic receptor blockers are most commonly prescribed to promote passage of ureteral stones. They are able to facilitate stone passage, reduce time to passage, and decrease pain. Calcium-channel blockers also increase stone-passage rates. Steroids are useful adjuncts in MET.
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Affiliation(s)
- Michael Lipkin
- Department of Urology, New York University School of Medicine, 150 E. 32nd Street, 2nd Floor, New York, NY 10016, USA
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Watts HF, Tekwani KL, Chan CW, Rzechula KH, Kulstad EB. The effect of alpha-blockade in emergency department patients with ureterolithiasis. J Emerg Med 2009; 38:368-73. [PMID: 19217243 DOI: 10.1016/j.jemermed.2008.08.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Revised: 07/22/2008] [Accepted: 08/15/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent studies suggest that alpha-blockade with tamsulosin may be useful in the treatment of ureterolithiasis by increasing the success of, and decreasing the time to, stone passage. OBJECTIVES We sought to determine stone passage success rates in patients diagnosed with ureterolithiasis and discharged from our Emergency Department (ED) with tamsulosin. METHODS We conducted a non-randomized retrospective cohort study over a 1-year period during which we made monthly follow-up telephone calls to patients discharged from our ED with a diagnosis of ureterolithiasis determined by computed tomography (CT) scan. Stone size and location (proximal, middle, or distal ureter) were determined from radiologist reports and prescriptions were determined from electronic medical records. Patients were asked if they spontaneously passed their stone, how much time was required before stone passage, and if any subsequent hospital visit was required after discharge due to pain or complication resulting from the ureteral stone. RESULTS During the study, a total of 213 patients were discharged from the ED with ureterolithiasis diagnosed by CT scan; of these, 119 (56%) were successfully contacted and 113 (53%) agreed to participate. Of the 113 patients, 83 (73%) had been prescribed tamsulosin and 30 (27%) had not. Overall age (43 years), gender (67% male), median stone size (3 mm, interquartile range 2-4 mm), and location (71% distal ureter) were similar in the two cohorts. Of tamsulosin recipients, 84% (95% confidence interval [CI] 75-91%) reported passing their stone, whereas 60% (95% CI 42-75%) of non-recipients passed their stone. CONCLUSION Patients with ureterolithiasis discharged from our ED and given tamsulosin by prescription had moderately high ureteral stone passage success rates in our non-randomized retrospective cohort study. Compared to non-recipients of tamsulosin, patients receiving tamsulosin seemed to have greater success in stone passage.
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Affiliation(s)
- Hannah F Watts
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA
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Abstract
Kidney stone disease remains a major health and economic burden on the nation. It has been increasingly recognized that nephrolithiasis can be both a chronic or systemic illness. There have been major limitations in the development of new drugs for the prevention and management of this disease, largely due to our lack of understanding of the complex pathophysiologic mechanisms involving the interaction of three major target organs: the kidney, bone, and intestine. We also do not yet understand the molecular genetic basis of this polygenic disorder. These limitations are coupled with the incorrect perception that kidney stone disease is solely an acute illness, and the lack of reliable tests to assess outcome measures. All of these factors combined have diminished the willingness of the pharmaceutical industry to engage in the development of novel drugs.
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Tamsulosin Facilitates Earlier Clearance of Stone Fragments and Reduces Pain After Shockwave Lithotripsy for Renal Calculi: Results From an Open-Label Randomized Study. Urology 2008; 72:1006-11. [DOI: 10.1016/j.urology.2008.05.035] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 04/27/2008] [Accepted: 05/03/2008] [Indexed: 11/13/2022]
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