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Hashem A, El-Assmy AM, Sharaf DE, Elgamal M, Elzalouey AE, Laymon M. A randomized trial of adjuvant tamsulosin as a medical expulsive therapy for renal stones after shock wave lithotripsy. Urolithiasis 2022; 50:473-480. [DOI: 10.1007/s00240-022-01330-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
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2
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Ouyang W, Sun G, Long G, Liu M, Xu H, Chen Z, Ye Z, Li H, Zhang Y. Adjunctive medical expulsive therapy with tamsulosin for repeated extracorporeal shock wave lithotripsy: a systematic review and meta-analysis. Int Braz J Urol 2021; 47:23-35. [PMID: 32459454 PMCID: PMC7712709 DOI: 10.1590/s1677-5538.ibju.2020.0093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/02/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose: To evaluate the efficacy of adjunctive medical expulsive therapy (MET) with tamsulosin for the promotion of stone fragments clearance for repeated extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: This meta-analysis was conducted by systematic search for randomized controlled trial (RCT) studies in PubMed/Medline, Scopus, Cochrane Library, Web of Science databases in January 2020, which compared tamsulosin with either placebo or non-placebo control for repeated ESWL. The primary endpoint was stone-free rate (SFR), the second endpoints were stone clearance time and complications. The quality assessment of included studies was performed by using the Cochrane System and Jadad score. Results: 7 RCTs were included in this meta-analysis. Tamsulosin provided higher SFR (for stones larger than 1cm, OR: 5.56, p=0.0003), except for patients with stones less than 1cm. For patients with renal stones (OR: 2.97, p=0.0005) or upper ureteral stones (OR: 3.10, p=0.004), tamsulosin can also provide a higher SFR. In addition, tamsulosin provided a shorter stone clearance time (WMD: −9.40, p=0.03) and lower pain intensity (WMD=-17.01, p <0.0001) and incidences of steinstrasse (OR: 0.37, p=0.0002). Conclusion: Adjunctive MET with tamsulosin is effective in patients with specific stone size or location that received repeated ESWL. However, no well-designed RCT that used computed tomography for the detection and assessment of residual stone fragments was found. More studies with high quality and the comparison between tamsulosin and secondary ESWL are needed in the future.
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Affiliation(s)
- Wei Ouyang
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Guoliang Sun
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Gongwei Long
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Man Liu
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua Xu
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhiqiang Chen
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhangqun Ye
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Heng Li
- Hubei Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yucong Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Rassweiler JJ, Rassweiler-Seyfried MC. Therapieverfahren – extrakorporale Stoßwellentherapie. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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Oestreich MC, Vernooij RW, Sathianathen NJ, Hwang EC, Kuntz GM, Koziarz A, Scales CD, Dahm P. Alpha-blockers after shock wave lithotripsy for renal or ureteral stones in adults. Cochrane Database Syst Rev 2020; 11:CD013393. [PMID: 33179245 PMCID: PMC8092672 DOI: 10.1002/14651858.cd013393.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Shock wave lithotripsy (SWL) is a widely used method to treat renal and ureteral stone. It fragments stones into smaller pieces that are then able to pass spontaneously down the ureter and into the bladder. Alpha-blockers may assist in promoting the passage of stone fragments, but their effectiveness remains uncertain. OBJECTIVES: To assess the effects of alpha-blockers as adjuvant medical expulsive therapy plus usual care compared to placebo and usual care or usual care alone in adults undergoing shock wave lithotripsy for renal or ureteral stones. SEARCH METHODS We performed a comprehensive literature search of the Cochrane Library, the Cochrane Database of Systematic Reviews, MEDLINE, Embase, several clinical trial registries and grey literature for published and unpublished studies irrespective of language. The date of the most recent search was 27 February 2020. SELECTION CRITERIA We included randomized controlled trials of adults undergoing SWL. Participants in the intervention group had to have received an alpha-blocker as adjuvant medical expulsive therapy plus usual care. For the comparator group, we considered studies in which participants received placebo. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion/exclusion, and performed data abstraction and risk of bias assessment. We conducted meta-analysis for the identified dichotomous and continuous outcomes using RevManWeb according to Cochrane methods using a random-effects model. We judged the certainty of evidence on a per outcome basis using GRADE. MAIN RESULTS We included 40 studies with 4793 participants randomized to usual care and an alpha-blocker versus usual care alone. Only four studies were placebo controlled. The mean age of participants was 28.6 to 56.8 years and the mean stone size prior to SWL was 7.1 mm to 13.2 mm. The most widely used alpha-blocker was tamsulosin; others were silodosin, doxazosin, terazosin and alfuzosin. Alpha-blockers may improve clearance of stone fragments after SWL (risk ratio (RR) 1.16, 95% confidence interval (CI) 1.09 to 1.23; I² = 78%; studies = 36; participants = 4084; low certainty evidence). Based on the stone clearance rate of 69.3% observed in the control arm, an alpha-blocker may increase stone clearance to 80.4%. This corresponds to 111 more (62 more to 159 more) participants per 1000 clearing their stone fragments. Alpha-blockers may reduce the need for auxiliary treatments after SWL (RR 0.67, 95% CI 0.45 to 1.00; I² = 16%; studies = 12; participants = 1251; low certainty evidence), but also includes the possibility of no effect. Based on a rate of auxiliary treatments in the usual care arm of 9.7%, alpha-blockers may reduce the rate to 6.5%. This corresponds 32 fewer (53 fewer to 0 fewer) participants per 1000 undergoing auxiliary treatments. Alpha-blockers may reduce major adverse events (RR 0.60, 95% CI 0.46 to 0.80; I² = 0%; studies = 7; participants = 747; low certainty evidence). Major adverse events occurred in 25.8% of participants in the usual care group; alpha-blockers would reduce this to 15.5%. This corresponds to 103 fewer (139 fewer to 52 fewer) major adverse events per 1000 with alpha-blocker treatment. None of the reported major adverse events appeared drug-related; most were emergency room visits or rehospitalizations. Alpha-blockers may reduce stone clearance time in days (mean difference (MD) -3.74, 95% CI -5.25 to -2.23; I² = 86%; studies = 14; participants = 1790; low certainty evidence). We found no evidence for the outcome of quality of life. For those outcomes for which we were able to perform subgroup analyses, we found no evidence of interaction with stone location, stone size or type of alpha-blocker. We were unable to conduct an analysis by lithotripter type. The results were also largely unchanged when the analyses were limited to placebo controlled studies and those in which participants explicitly only received a single SWL session. AUTHORS' CONCLUSIONS Based on low certainty evidence, adjuvant alpha-blocker therapy following SWL in addition to usual care may result in improved stone clearance, less need for auxiliary treatments, fewer major adverse events and a reduced stone clearance time compared to usual care alone. We did not find evidence for quality of life. The low certainty of evidence means that our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.
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Affiliation(s)
- Makinna C Oestreich
- University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robin Wm Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | | | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea, South
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea, South
| | - Gretchen M Kuntz
- Borland Health Sciences Library, University of Florida-Jacksonville, Jacksonville, Florida, USA
| | - Alex Koziarz
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Charles D Scales
- Department of Urology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Philipp Dahm
- Urology Section, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA
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Oestreich MC, Sathianathen NJ, Hwang EC, Vernooij RWM, Kuntz GM, Scales CD, Dahm P. Alpha-blockers after shock wave lithotripsy for renal or ureteral stones in adults. Hippokratia 2019. [DOI: 10.1002/14651858.cd013393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Makinna C Oestreich
- University of Minnesota; University of Minnesota Medical School; Minneapolis Minnesota USA
| | | | - Eu Chang Hwang
- Chonnam National University Medical School, Chonnam National University Hwasun Hospital; Department of Urology; Hwasun Korea, South
- Yonsei University Wonju College of Medicine; Institute of Evidence Based Medicine; Wonju Korea, South
| | - Robin WM Vernooij
- University Medical Center Utrecht; Department of Nephrology and Hypertension; Utrecht Netherlands
- University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care; Utrecht Netherlands
| | - Gretchen M Kuntz
- University of Florida-Jacksonville; Borland Health Sciences Library; 653-1 West Eight St. 2nd FL LRC Jacksonville Florida USA 32209
| | - Charles D Scales
- Duke University School of Medicine; Department of Urology; Durham North Carolina USA
| | - Philipp Dahm
- Minneapolis VA Health Care System; Urology Section; One Veterans Drive Mail Code 112D Minneapolis Minnesota USA 55417
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Koski RR, Zufall WH. Efficacy and Safety of Alpha-Blockers for Kidney Stones in Adults. J Pharm Technol 2018; 34:54-61. [PMID: 34860948 PMCID: PMC5998442 DOI: 10.1177/8755122517750398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Objective: To review the literature for α-blocker treatment of kidney stones. Data Sources: PubMed search performed November 15, 2017, using the following search terms: alpha-blocker, alfuzosin, silodosin, or tamsulosin AND kidney or ureteral stones. Additional studies found through references of primary and tertiary literature. Inclusion criteria included English language, randomized controlled trials (not included in meta-analyses), and meta-analyses evaluating US available alpha-blockers as medical expulsive therapy with or without lithotripsy in adults with renal or ureteral stones, and no date limits. Study Selection and Data Extraction: Seven randomized controlled trials (RCTs), 1 case-control trial, and 6 meta-analyses were found and included in this review. Two RCTs and 4 meta-analyses evaluated alpha-blockers without lithotripsy. Five RCTs, 1 case-control trial, and 2 meta-analyses evaluated their use post-lithotripsy. The primary endpoint was stone clearance rate in most studies. Data Synthesis: For ureteral stones ≤10 mm treated without lithotripsy, alpha-blockers increased clearance in all meta-analyses and one RCT versus control. For ureteral or renal stones treated with lithotripsy, 4 RCTs and all meta-analyses found benefit with alpha-blockers compared with control. When results were stratified by stone size, alpha-blockers performed better for stones 10 to 20 mm, while there was no difference for stones <10 mm. Conclusion: Alpha-blockers are beneficial without lithotripsy for ureteral stones 5 to 10 mm. They are beneficial post-lithotripsy for renal or ureteral stones >10 mm. They can be considered post-lithotripsy for stones 5 to 10 mm, but little benefit may be seen. Although all uroselective alpha-blockers have been found to be effective, most data are with tamsulosin 0.4 mg daily.
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7
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How can and should we optimize extracorporeal shockwave lithotripsy? Urolithiasis 2017; 46:3-17. [PMID: 29177561 PMCID: PMC5773650 DOI: 10.1007/s00240-017-1020-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 11/11/2017] [Indexed: 11/05/2022]
Abstract
It is well recognized that the popularity of extracorporeal shock wave lithotripsy (SWL), despite its non-invasive character, has decreased during recent years. This is partly explained by the technological achievements in endoscopy and urologists’ enthusiasm for such procedures. Another explanation is that many urologists have been insufficiently successful with SWL. The latter effect might to some extent be a result of the performance of the lithotripter used, but in too many cases, it is evident that the principles of how shock wave lithotripsy should be carried out are poorly applied. The purpose of this article is to emphasize some important aspects on how SWL best should be used. Based on decades of experience, it stands to reason that success with SWL does not come automatically and attention has to be paid to all details of this technique.
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8
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Mehrabi S, Manzouri L, Kohzadi A, Mehrabi F. Efficacy of tamsulosin versus tamsulosin plus
lithorex-B as medical expulsive therapy following extracorporeal shock-wave lithotripsy of renal and upper ureteric stones; a randomized clinical trial. J Nephropharmacol 2017. [DOI: 10.15171/npj.2017.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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9
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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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10
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Sharma NL, Alexander CE, Grout E, Turney BW. Shock-wave lithotripsy: variance within UK practice. Urolithiasis 2016; 45:193-201. [PMID: 27216432 DOI: 10.1007/s00240-016-0886-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/24/2016] [Indexed: 11/24/2022]
Abstract
The objectives of this study are to determine the current treatment policies of UK shock-wave lithotripsy centres. Fixed-site lithotripter centres in the UK were identified via the national Therapeutic Interventions for Stones of the Ureter (TISU) study (n = 25). Questionnaires were completed regarding current SWL protocols for each centre, including management of anticoagulation, use of antibiotics and analgesia, urine testing, pacemakers, and arterial aneurysms. Data were collected regarding service delivery. Responses were obtained for 21 centres. Most centres use the Storz Modulith (85.7 %). Wide variation was observed in clinical contraindications to SWL, with 47.6 % centres performing SWL in patients with an abdominal aortic aneurysm, 66.7 % performing SWL in patients with a pacemaker, and 66.7 % of centres not performing SWL in asymptomatic patients with a urine dipstick positive for nitrites and leucocytes. The management of anticoagulation pre- and post-SWL showed wide variation, with the omission of anticoagulation ranging from 0 to 10 days pre-SWL. Seventeen distinct analgesia regimens were reported and prophylactic antibiotics are routinely administered in 25.0 % of centres. Tamsulosin is prescribed to all patients in 20.0 % of centres and a further 15.0 % of centres routinely prescribe tamsulosin post-SWL of ureteric stones. The included centres undertake SWL a median of 4 days per week and treat a median of six patients per list. Emergency SWL is unavailable in 30.0 % of centres. This observational real-life study has identified a significant disparity in the delivery of SWL throughout the UK, despite high numbers of patients with renal and ureteric stones being treated with this modality. Further studies should address the key areas of controversy, including an assessment of technical training, and facilitate the development of national guidelines to ensure a high level of standardized care for SWL patients.
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Affiliation(s)
- N L Sharma
- Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Trust, Oxford, UK.
| | - C E Alexander
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - E Grout
- Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Trust, Oxford, UK
| | - B W Turney
- Oxford Stone Group, Department of Urology, Nuffield Department of Surgical Sciences, Oxford University Hospitals NHS Trust, Oxford, UK
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Eryildirim B, Sahin C, Tuncer M, Sabuncu K, Tarhan F, Sarica K. Medical Expulsive Therapy Following Shock Wave Lithotripsy in Ureteral Calculi: An Effective Approach for the Improvement of Health-Related Quality of Life. Urol Int 2016; 97:260-265. [PMID: 27105135 DOI: 10.1159/000446002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the possible effects of medical expulsive therapy (MET) on the health-related quality of life (HRQOL) of patients undergoing shock wave lithotripsy (SWL) for ureteric stones. METHODS Eighty patients treated with SWL for ureteric stones were included in this study. Patients were divided into 2 groups; Group 1 received medical therapy only for colic pain and Group 2 received MET in addition to medical therapy. Patients requiring DJ stenting and auxiliary measures after SWL procedure were excluded. The remaining 54 patients were further evaluated (Group 1: n = 26, Group 2: n = 28) and followed up during the 4-week period for analgesic requirement, number of renal colic attacks, emergency department (ED) visits and the HRQOL scores by using EQ-5D index and EQ-5D visual analogue scale (VAS) values. RESULTS During the 4-week follow-up period, cases undergoing SWL only required significantly higher amount of analgesics. In addition to the lower number of renal colic attacks and ED visits, EQ-5D index and EQ-5D VAS values also demonstrated higher mean values in patients undergoing SWL + MET. CONCLUSION In addition to the increased spontaneous stone passage rates, MET following SWL for ureteral calculi could increase the HRQOL scores by lowering the number of both renal colic attacks and ED visits along with decreased analgesic need.
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Affiliation(s)
- Bilal Eryildirim
- Training and Research Hospital, Urology Clinic, Istanbul, Turkey
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Ahmed AF, Shalaby E, El-Feky M, Kotb A, Elsotohi E, El-Kholy M, Ragab A, Salem E. Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial. Urol Int 2016; 97:266-272. [PMID: 27082108 DOI: 10.1159/000445840] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/30/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To evaluate the efficacy of adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for renal stones. MATERIALS AND METHODS This prospective study was conducted on patients who underwent single-session SWL for solitary renal stone less than 20 mm. Post-SWL, patients were randomly divided into 2 groups; the tamsulosin group (TG), received a daily dose of tamsulosin 0.4 mg, for a maximum of 12 weeks, with post-SWL traditional analgesia and control group (CG), received the traditional analgesia alone. RESULTS The study enrolled 271 patients and eventually only 249 (123 in TG and 126 in CG) completed the study. The overall stone free rate was 73.5%: 78.0% in TG and 69.0% in CG (p = 0.108). In TG, 8.1% of patients experienced at least one episode of acute renal/ureteral colic compared with 19.8% of controls (p = 0.008). The mean cumulative analgesia dosage per subject was 313 mg in TG and 346 mg in CG (p < 0.001). Overall, 14 patients developed steinstrasse and 6 of them (all in CG) needed urgent intervention (p = 0.031). CONCLUSIONS Daily tamsulosin therapy does not enhance the clearance of stone fragments but decreases the pain episodes, analgesia dosage and need for adjuvant intervention after SWL for renal stones.
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Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Interventional Treatment for Urolithiasis. Eur Urol 2015; 69:475-82. [PMID: 26344917 DOI: 10.1016/j.eururo.2015.07.041] [Citation(s) in RCA: 968] [Impact Index Per Article: 107.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/16/2015] [Indexed: 12/12/2022]
Abstract
CONTEXT Management of urinary stones is a major issue for most urologists. Treatment modalities are minimally invasive and include extracorporeal shockwave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrolithotomy (PNL). Technological advances and changing treatment patterns have had an impact on current treatment recommendations, which have clearly shifted towards endourologic procedures. These guidelines describe recent recommendations on treatment indications and the choice of modality for ureteral and renal calculi. OBJECTIVE To evaluate the optimal measures for treatment of urinary stone disease. EVIDENCE ACQUISITION Several databases were searched to identify studies on interventional treatment of urolithiasis, with special attention to the level of evidence. EVIDENCE SYNTHESIS Treatment decisions are made individually according to stone size, location, and (if known) composition, as well as patient preference and local expertise. Treatment recommendations have shifted to endourologic procedures such as URS and PNL, and SWL has lost its place as the first-line modality for many indications despite its proven efficacy. Open and laparoscopic techniques are restricted to limited indications. Best clinical practice standards have been established for all treatments, making all options minimally invasive with low complication rates. CONCLUSION Active treatment of urolithiasis is currently a minimally invasive intervention, with preference for endourologic techniques. PATIENT SUMMARY For active removal of stones from the kidney or ureter, technological advances have made it possible to use less invasive surgical techniques. These interventions are safe and are generally associated with shorter recovery times and less discomfort for the patient.
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Affiliation(s)
- Christian Türk
- Department of Urology, Rudolfstiftung Hospital, Vienna, Austria
| | - Aleš Petřík
- Department of Urology, Region Hospital, České Budějovice, Czech Republic; Department of Urology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Kemal Sarica
- Department of Urology, Dr. Lutfi Kirdar Kartal Research and Training Hospital, Istanbul, Turkey
| | | | - Andreas Skolarikos
- Second Department of Urology, Sismanoglio Hospital, Athens Medical School, Athens, Greece
| | - Michael Straub
- Department of Urology, Technical University Munich, Munich, Germany
| | - Thomas Knoll
- Department of Urology, Sindelfingen-Böblingen Medical Centre, University of Tübingen, Sindelfingen, Germany.
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Adamu B, Alhassan SU, Effa EE. Adjunctive medical expulsive therapy for kidney and ureteral stone fragments following shock wave lithotripsy. Hippokratia 2015. [DOI: 10.1002/14651858.cd009156.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bappa Adamu
- Aminu Kano Teaching Hospital; Department of Medicine; No 1 Hospital Road Kano Kano Nigeria PMB 3452
| | - Sani Usman Alhassan
- Bayero University Kano; Department of Surgery; 1 Hospital Rd Kano Nigeria PMB 3452
| | - Emmanuel E Effa
- College of Medical Sciences, University of Calabar; Internal Medicine; PMB 1115 Calabar Cross River State Nigeria 540001
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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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16
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Chen K, Mi H, Xu G, Liu L, Sun X, Wang S, Meng Q, Lv T. The Efficacy and Safety of Tamsulosin Combined with Extracorporeal Shockwave Lithotripsy for Urolithiasis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Endourol 2015; 29:1166-76. [PMID: 25915454 DOI: 10.1089/end.2015.0098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Many studies have been conducted to investigate adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for urolithiasis. The results from those studies, however, are still inconsistent. Therefore, we performed a meta-analysis to provide an update on the clinical efficacy and safety of tamsulosin combined with SWL for urolithiasis. METHODS A systematic search was performed in PubMed, Cochrane Library, and Embase to identify all relevant randomized controlled trials until January 2015. Two reviewers independently assessed trial quality and extracted data. Meta-analysis was conducted with Review Manager (RevMan), version 5.1. RESULTS Twenty-one studies (2093 subjects in total) were identified in the current meta-analysis. Compared with a control group, the experimental group (tamsulosin combined with SWL) showed an increased overall benefit for stone expulsion, with pooled risk ratio (RR) of 1.20 (95% confidence interval [CI], 1.15-1.26). With respect to the different geographic regions, European and American had a high possibility of improvement in stone expulsion (RR: 1.33, 95% CI, 1.19-1.49). According to the stone locations (renal, upper and lower ureteral) and sizes (4-10 mm and 11-24 mm), tamsulosin is more useful for lower ureteral stone (RR: 1.28; 95% CI, 1.14-1.43) and larger sized stones (RR: 1.49; 95% CI, 1.28-1.75). The effect estimates did not vary markedly when stratified by follow-up durations but varied by dose of tamsulosin. Furthermore, a shorter expulsion time, reduced occurrence of steinstrasse, fewer incidences of colic, and lower analgesic requirements were observed within the experimental group. In addition, tamsulosin is well tolerated, and its adverse events rarely led to dropouts of patients. CONCLUSIONS Overall, evidence suggests that tamsulosin combined with SWL is safe and effective in enhancing stone expulsion for patients with urolithiasis. Furthermore, high-quality, randomized and placebo-controlled trials evaluating the efficacy and safety of tamsulosin should be performed.
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Affiliation(s)
- Kai Chen
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Hua Mi
- 2 Institute of Urology and Nephrology, First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi Zhuang Autonomous Region, China
| | - Guangyu Xu
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Lin Liu
- 3 Department of Oncology, The People's Hospital of AnQiu City , Shandong Province, China
| | - Xiubin Sun
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Shiping Wang
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Qingrong Meng
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
| | - Tao Lv
- 1 Department of Urology, The People's Hospital of LaiWu City, LaiWu Affiliated Hospital of Taishan Medical College , Shandong Province, China
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Sahin C, Eryildirim B, Kafkasli A, Coskun A, Tarhan F, Faydaci G, Sarica K. Predictive parameters for medical expulsive therapy in ureteral stones: a critical evaluation. Urolithiasis 2015; 43:271-5. [DOI: 10.1007/s00240-015-0762-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
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A comparison of nifedipine and tamsulosin as medical expulsive therapy for the management of lower ureteral stones without ESWL. Sci Rep 2014; 4:5254. [PMID: 24919112 PMCID: PMC4052729 DOI: 10.1038/srep05254] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/22/2014] [Indexed: 02/05/2023] Open
Abstract
Administration of nifedipine or tamsulosin has been suggested to augment stone expulsion rates. We aimed to compare the stone expulsion rates and adverse effects associated with the use of nifedipine or tamsulosin as medical expulsive therapy (MET) for the management of lower ureteral stones (LUS) without extracorporeal shock wave lithotripsy (ESWL) via a literature review and meta-analysis. Relevant randomized controlled trials (RCTs) were identified from the Medline, EMBASE, Cochrane CENTRAL, and Google Scholar databases. Finally, a total of 7 RCTs with 3897 patients were included. Our meta-analysis showed that tamsulosin could significantly increase the stone expulsion rate relative to nifedipine in patients with LUS (random-effects model; risk ratio [RR] = 0.81; 95% confidence interval [CI] = 0.75–0.88; P < 0.00001). The subgroup analysis indicated no statistically significant difference between the drugs with regard to minor or major adverse effects (fixed-effect model; RR = 1.19, 95% CI = 0.91–1.54, P = 0.20; and RR = 1.63, 95% CI = 0.22–11.82, P = 0.63, respectively). This meta-analysis demonstrated that tamsulosin was more effective than nifedipine in patients with LUS, as evidenced by the higher stone expulsion rate. Tamsulosin treatment should therefore be considered for patients with LUS.
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Abstract
The objective of this review article is to present the current literature on medical expulsive therapy (MET) and help guide practitioners in the appropriate use of MET for treatment of stone disease. Kidney stones can be treated with multiple modalities including medical therapy, ureteroscopy, shock wave lithotripsy (SWL), percutaneous nephrostolithotomy, open/laparoscopic stone removal, and/or combinations of these modalities. The choice of intervention depends on patient factors, anatomical considerations, surgeon preference, and stone location and characteristics. MET is an excellent treatment modality in the appropriately selected patient. The AUA/EAU guidelines suggest MET as a reasonable treatment choice in select patients. A review of the data suggests the use of alpha antagonist and calcium channel blockers can improve stone expulsion rates. Most data suggests alpha antagonists as superior to calcium channel blockers. There are numerous available alpha antagonists, all of which have supporting data for their use in MET. Evidence suggests that MET can decrease colic events, narcotic use, and hospital visits. MET may also reduce medical costs and prevent unnecessary surgeries and the associated risks. Further, there is a role for alpha antagonists and calcium channel blockers in improving stone passage and decreasing pain in those subjects treated with other modalities (i.e. SWL and ureteroscopy). Despite this evidence, MET remains underutilized as a treatment modality.
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Affiliation(s)
- Kyle D Wood
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Ilya Gorbachinsky
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Jorge Gutierrez
- Department of Urology, Wake Forest Baptist Health, Winston-Salem, NC, USA
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Park YH, Lee HE, Park JY, Lee SB, Kim HH. A prospective randomized controlled trial of the efficacy of tamsulosin after extracorporeal shock wave lithotripsy for a single proximal ureteral stone. Korean J Urol 2013; 54:527-30. [PMID: 23956828 PMCID: PMC3742905 DOI: 10.4111/kju.2013.54.8.527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 06/18/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the efficacy of tamsulosin on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with a single proximal ureteral stone. MATERIALS AND METHODS This prospective randomized controlled trial was performed on 88 patients with a single proximal ureteral stone. After consenting with a doctor, the patients were allocated to the treatment (tamsulosin 0.2 mg once a day) or control (no medication) group, and the efficacy of tamsulosin was evaluated. The primary outcome of this study was the stone-free rate, and the secondary outcomes were the period until clearance, pain intensity, analgesic requirement, and incidence of complications. RESULTS A stone-free state was reported in 37 patients (84.1%) in the treatment group and 29 (65.9%) in the control group (p=0.049). The mean expulsion period of the stone fragments was 10.0 days in the treatment group and 13.2 days in the control group (p=0.012). There were no statistically significant differences in aceclofenac requirement or pain score between the two groups. Only one patient in the treatment group experienced transient dizziness associated with medical expulsive therapy, and this adverse event disappeared spontaneously. CONCLUSIONS The results of this prospective randomized controlled trial of the efficacy of tamsulosin after ESWL for a single proximal ureteral stone suggest that tamsulosin helps in the earlier clearance of stone fragments and reduces the expulsion period of stone fragments after ESWL.
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Affiliation(s)
- Yong Hyun Park
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Rosa M, Usai P, Miano R, Kim FJ, Agrò EF, Bove P, Micali S. Recent finding and new technologies in nephrolitiasis: a review of the recent literature. BMC Urol 2013; 13:10. [PMID: 23413950 PMCID: PMC3599704 DOI: 10.1186/1471-2490-13-10] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 02/06/2013] [Indexed: 11/24/2022] Open
Abstract
This review summarizes recent literature on advances regarding renal and ureteral calculi, with particular focus in areas of recent advances in the overall field of urolithiasis. Clinical management in everyday practice requires a complete understanding of the issues regarding metabolic evaluation and subgrouping of stone-forming patients, diagnostic procedures, effective treatment regime in acute stone colic, medical expulsive therapy, and active stone removal. In this review we focus on new perspectives in managing nephrolitihiasis and discuss recentadvances, including medical expulsive therapy, new technologies, and refinements of classical therapy such as shock wave lithotripsy, give a fundamental modification of nephrolithiasis management. Overall, this field appears to be the most promising, capable of new developments in ureterorenoscopy and percutaneous approaches. Further improvements are expected from robotic-assisted procedures, such as flexible robotics in ureterorenoscopy.
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Affiliation(s)
- Marco Rosa
- Department of Urology, University of Modena, Via del Pozzo, 71-41124, Modena, Italy
| | - Paolo Usai
- Department of Urology, University of Cagliari, Via Aurelio Nicolodi, 1 09123, Cagliari, Italy
| | - Roberto Miano
- Department of Urology, University “Tor Vergata”, Rome, Italy
| | - Fernando J Kim
- Department of Urology, Denver Health Care Center, 777 Bannock Street, Denver, CO, 80204-4597, USA
| | | | - Pierluigi Bove
- Department of Urology, University “Tor Vergata”, Rome, Italy
| | - Salvatore Micali
- Department of Urology, Denver Health Care Center, 777 Bannock Street, Denver, CO, 80204-4597, USA
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Lee JK, Jeong CW, Jeong SJ, Hong SK, Byun SS, Lee SE. Impact of tamsulosin on ureter stone expulsion in korean patients: a meta-analysis of randomized controlled studies. Korean J Urol 2012; 53:699-704. [PMID: 23136630 PMCID: PMC3490090 DOI: 10.4111/kju.2012.53.10.699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/25/2012] [Indexed: 12/03/2022] Open
Abstract
Purpose Using meta-analysis, the study's aim was to evaluate the efficacy of tamsulosin, an alpha-blocker, in the treatment of ureteral stones with or without shockwave lithotripsy (SWL) in Korean patients. Materials and Methods Relevant randomized controlled studies published through June 2011 were identified in a search of MEDLINE, KoreaMed, and the Korean Medical Database. No language restriction was applied. Only randomized controlled trials conducted with Korean patients were eligible for the analysis. The primary outcome assessed was the stone clearance rate. Two reviewers independently assessed the quality of the study and extracted the data. Meta-analysis was conducted by using R, version 2.13.0. Results A total of 6 articles were selected as being suitable for evaluation. Pooling of the trials demonstrated a 43% higher expulsion rate for tamsulosin treatment compared to a control group (risk ratio [RR], 1.43; 95% confidence interval [CI]: 1.24 to 1.65). Similar results were obtained in all subgroup analyses according to stone location (upper: RR, 1.31; 95% CI, 1.02 to 1.68, lower: RR, 1.50; 95% CI, 1.20 to 1.88) or concomitant SWL (yes: RR, 1.38; 95% CI, 1.14 to 1.68, no: RR, 1.48; 95% CI, 1.21 to 1.83). Conclusions This meta-analysis of randomized controlled studies provides a high level of evidence supporting the suggestion that treatment with tamsulosin augments the stone expulsion rate for ureter stones with or without SWL in a Korean population. However, a high-quality, large-scale, multicenter, randomized controlled trial is warranted to fully support this hypothesis.
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Affiliation(s)
- Jung Keun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Zaytoun OM, Yakoubi R, Zahran ARM, Fouda K, Marzouk E, Gaafar S, Fareed K. Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial. ACTA ACUST UNITED AC 2011; 40:327-32. [DOI: 10.1007/s00240-011-0410-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Accepted: 07/30/2011] [Indexed: 11/24/2022]
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