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Abdel-Kader MS, Sayed AM, Sayed SM, AbdelRazek M. Evaluation of the efficacy and safety of either or both mirabegron and silodosin, as a medical expulsive therapy for distal ureteric stones. Int Urol Nephrol 2024; 56:1605-1610. [PMID: 38041752 PMCID: PMC11001674 DOI: 10.1007/s11255-023-03880-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/05/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To evaluate efficacy and safety of either or both silodosin and mirabegron as MET for distal ureteric stones ≤ 10 mm. PATIENTS AND METHODS This study enrolled a total of 105 patients, aged between 20 and 56 years, diagnosed by single radiopaque distal ureteral stone measuring ≤ 10 mm. The recruitment period spanned from May 2020 to December 2021. The patients were randomly divided into three groups, with each group consisting of 35 participants. Group A received a once-daily dose of 8 mg of silodosin, group B received a once-daily dose of 50 mg of mirabegron, and group C received a combination of both medications. Treatment was administered to all patients until the stone was expelled or for a maximum duration of four weeks. The stone-free rate was determined by analyzing KUB films with or without ultrasonography. RESULTS The rate of stone expulsion was significantly higher in group C compared to groups A and B (P = 0.04 and P = 0.004, respectively). The mean (standard deviation) time for stone expulsion in groups A, B, and C was 14 ± 2.3 days, 11 ± 3.1 days, and 7 ± 2.2 days, respectively. Group C demonstrated a significantly shorter stone expulsion time compared to groups A and B (P = 0.001 and P = 0.04, respectively). The frequency of renal colic in group C was significantly lower than that in groups A and B, resulting in a reduced requirement for analgesics (P < 0.05). Anejaculation occurred at a significantly higher rate in the silodosin group (73.9%) and combination group (84%) compared to the mirabegron group (P < 0.05). CONCLUSIONS The findings of this study suggest that both silodosin and mirabegron are effective treatments for the expulsion of lower ureteric stones. Furthermore, the combination of these medications leads to an increased rate of stone expulsion and a reduced duration of expulsion.
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Affiliation(s)
| | | | | | - Mostafa AbdelRazek
- Urology Department, Faculty of Medicine, South Valley University, Qena, Egypt
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Erdoğan E, Şimşek G, Aşık A, Yaşar H, Şahin C, Sarıca K. Optimal duration of medical expulsive therapy for lower ureteral stones: a critical evaluation. Urolithiasis 2024; 52:48. [PMID: 38520492 PMCID: PMC10960745 DOI: 10.1007/s00240-024-01548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 02/15/2024] [Indexed: 03/25/2024]
Abstract
To evaluate the optimal duration of Medical Expulsive Therapy (MET) application for distal ureteric stones on a time period based manner. 89 patients with 5-10 mm distal ureter stones received tamsulosin (0.4 mg) for MET and diclofenac sodium (75 mg) for analgesia. Patients were evaluated once a week for 4 weeks. Radiologic stone passage was evaluated by kidney ureter bladder (KUB) and ultasonography where non-contrast computed tomography (NCCT) was also performed if needed. While 23 cases (28.4%) were SF after first week, 23 were SF (28.4%) after 2 weeks, 9 cases (11.1%) after 3 and lastly 7 cases (8.6%) became SF after four weeks. Nineteen (23.5%) cases were not SF after 4 weeks. A positive relationship was found between the time period elapsed for stone passage and ureteral wall thickness (UWT) along with the degree of hydronephrosis. In addition, mean number of renal colics and emergency department (ED) visits were found to be higher in patients passing stones in the 4th week along with the ones who could not despite MET. SFR for distal ureteric stones sizing 5-10 mm was higher within the first 3 weeks under MET application. Thus, waiting for a longer period of time may result in increased analgesic and unnecessary MET treatment with increased risk of emergency department visits and additional costs as well. We believe that other options could be considered in such cases who are not SF at the end of the first 3 weeks.
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Affiliation(s)
- Erhan Erdoğan
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey.
| | - Gamze Şimşek
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Alper Aşık
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Hikmet Yaşar
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Cahit Şahin
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Kemal Sarıca
- Department of Urology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
- Department of Urology, Biruni University, Medical School, Istanbul, Turkey
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Aghaways I, Ibrahim R, Bapir R, Salih RQ, Salih KM, Abdulla BA. The role of inflammatory serum markers and ureteral wall thickness on spontaneous passage of ureteral stone < 10 mm: A prospective cohort study. Ann Med Surg (Lond) 2022; 80:104198. [PMID: 36045783 PMCID: PMC9422225 DOI: 10.1016/j.amsu.2022.104198] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction Ureteral stone is a worldwide disease and accounts for 20% of all urolithiasis. There is a widespread discussion on the preferred initial treatment method, whether medical or surgical, and each has its pros and cons. In this study, we aimed to assess the role of both ureteral wall thickness around the stone and inflammatory markers in guiding the decision-making process. Methods In this prospective study, 161 patients who presented with ureteric colic and were diagnosed with ureteral stone with NCCT were included. UWT around the stone was measured, and the NLR and PLR were calculated. The patients were given a single daily dose of tamsulosin 0.4 mg for 4 weeks with weekly follow-up to determine SSP or failure. Results Of the 161 patients with a mean age 40.12 ± 12.36 SD, 55.9% had a spontaneous stone passage. Receiver operating characteristics showed a cut off value of 2.45 mm UWT of non SSP patients with an 83% sensitivity and 86% specificity. Moreover, there was a significant correlation between higher NLR, PLR and increased UWT (Pearson correlation of 0.314 and 0.426 respectively). The combined higher NLR, PLR and increased UWT were associated with failure of SSP (p-value <0.001). Conclusion Many factors play a role in decision making for management of ureteral stones. Our study concludes that patients with high NLR, PLR, and UWT around the stone have lesser chance of SSP using MET. Their rise can be used as predictors to decide early intervention. Ureteral stone is a worldwide disease and accounts for 20% of all urolithiasis. Impacted ureteral stones occupy the majority of emergency department visits due to urolithiasis. The role of inflammatory serum markers and UWT around the stone on spontaneous passage are controversial.
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Affiliation(s)
- Ismaeel Aghaways
- Department of Surgery, College of Medicine, University of Sulaymaniyah, Sulaymaniyah, Iraq
| | - Rebaz Ibrahim
- Department of Urology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, Iraq
| | - Rawa Bapir
- Department of Urology, Sulaymaniyah Surgical Teaching Hospital, Sulaymaniyah, Iraq
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- U-merge Ltd. (Urology in Emerging Countries), London, UK
- Corresponding author. Doctor city, building 4, apartment 23, Sulaymaniyah, Iraq.
| | - Rawezh Q. Salih
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
| | - Karzan M. Salih
- Iraqi Board for Medical Specialties, Department of Surgery, Sulaymaniyah Center, Sulaymaniyah, Iraq
| | - Berwn A. Abdulla
- Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
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Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, Magri V, Mourmouris P, Ouattara A, Perletti G, Philipraj J, Trinchieri A, Buchholz N. Effect of alpha-adrenoceptor antagonists on sexual function. A systematic review and meta-analysis. Arch Ital Urol Androl 2022; 94:252-263. [PMID: 35775356 DOI: 10.4081/aiua.2022.2.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Alpha-adrenoreceptor antagonists or alpha-blockers are used in the treatment of hypertension, in the therapy of benign prostatic hyperplasia and in medical expulsive treatment of ureteral stones. These agents may affect the sexual function, with differences between drugs within the same class, depending on their selectivity for receptor subtypes. The aim of this review was to analyze the effects of alpha-blockers on sexual function. MATERIALS AND METHODS We conducted a systematic review and meta-analysis by searching PubMed, EMBASE and other databases for randomized controlled trials (RCTs) reporting sexual adverse effects in patients treated with alpha-blockers. Odds ratios for sexual dysfunction were calculated using random effects Mantel-Haenszel statistics. RESULTS Out of 608 records retrieved, 75 eligible RCTs were included in the meta-analysis. Compared with placebo, alphablockers were associated with increased odds of ejaculatory disorders both in patients with lower urinary tract symptoms (LUTS) associated to benign prostatic hyperplasia (BPH) (OR: 7.53, 95% CI: 3.77-15.02, Z = 5.73, p < 0.00001, I2 = 55%) and in patients with ureteral stones (OR: 2.88, 95% CI: 1.50-5.44, Z = 3.19, p < 0.001, I2 = 31%). Uroselective alpha-blockers showed higher odds of ejaculatory disorders. Conversely, nonselective alpha-blockers were not associated with higher odds of ejaculatory dysfunction. Silodosin was associated with increased odds of ejaculatory dysfunction compared with tamsulosin (OR: 3.52, 95% CI: 2.18-5.68, 15 series, 1512 participants, Z = 5.15, p < 0.00001, I2 = 0%). Naftopidil and alfuzosin showed lower odds of ejaculatory dysfunction compared to uroselective alpha-blockers.No statistically significant differences in the odds of erectile dysfunction were observed when alpha-blockers were compared to placebo.
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Affiliation(s)
- Rawa Bapir
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | - Kamran Hassan Bhatti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Urology Department, HMC, Hamad Medical Corporation.
| | - Ahmed Eliwa
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Zagazig University, Zagazig, Sharkia.
| | | | - Nazim Gherabi
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Faculty of Medicine Algiers 1, Algiers.
| | - Derek Hennessey
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Mercy University Hospital, Cork.
| | - Vittorio Magri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and ASST Nord Milano, Milan.
| | - Panagiotis Mourmouris
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens.
| | - Adama Ouattara
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Division of Urology, Souro Sanou University Teaching Hospital, Bobo-Dioulasso.
| | - Gianpaolo Perletti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese.
| | - Joseph Philipraj
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry.
| | - Alberto Trinchieri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Urology School, University of Milan.
| | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; and Sobeh's Vascular and Medical Center, Dubai Health Care City, Dubai.
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Seerwan M, Khan G, Ilyas M, Waheed D, Ur Rehman A, Humayun F. EFFICACY OF DOXAZOSIN VERSUS TAMSULOSIN IN LOWER URETERIC STONE EXPULSION IN ADULT POPULATION OF DISTRICT DERA ISMAIL KHAN, PAKISTAN. GOMAL JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.46903/gjms/19.04.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Urolithiasis is the third common disease of the urinary tract after UTIs and pathological diseases of the prostate. The objective of this study was to compare the efficacy of doxazosin versus tamsulosin in lower ureteric stone expulsion in adult population of District Dera Ismail Khan, Pakistan.Materials Methods: This non-randomized control trial was conducted in the Department of Urology, Gomal Medical College, Dera Ismail Khan, Pakistan from February 2020 to December 2020. The 252 patients included in our study were divided in to two groups. The patients in experimental group received Tab. doxazosin 4 mg daily for 4 weeks and Tab. diclofenac sodium 50 mg B.D for 5 days and then on need basis. The patients in control group received Cap. tamsulosin 0.4 mg daily for 4 weeks and similarly Tab. diclofenac sodium 50 mg as in experimental group. All the patients were followed regularly for expulsion of ureteric stones for four weeks. Sex, age and stone size were matching, while stone expulsion was a research variable. Hypothesis was verified by McNemar chi-square test.Results: Out of 252 patients, 113 (89.68%) patients in experimental group, while 77 (61.11%) patients in control group passed the stones. There was statistically significant difference in efficacy in doxazosin group as compared to tamsulosin group (p-value=.0001).Conclusion: The use of doxazosin as the medical expulsion therapy for the lower ureteric stone proved to be more effective as compared to tamsulosin as demonstrated by our results.
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Humayun F, Mujtaba G, Seerwan M, Khan G, Javed N, Adnan M. EFFICACY OF ALFUZOSIN VERSUS CONTROL GROUP IN UPPER URETERIC STONE EXPULSION IN ADULT POPULATION OF LAHORE, PAKISTAN. GOMAL JOURNAL OF MEDICAL SCIENCES 2022. [DOI: 10.46903/gjms/19.04.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Urinary stone disease is one of the commonest urological diseases worldwide. The objective of this study was to compare the efficacy of alfuzosin versus control group in upper ureteric stone expulsion in adult population of district Lahore, Pakistan.Materials Methods: This trial was conducted in Department of Urology, Sheikh Zayed Hospital, Lahore, Pakistan form January 2017 to June 2017. All adult patients with upper ureteric stone size 5-10 mm were eligible. Those with multiple stones, having fever, severe pain, history of surgery in past two weeks and growth on urine culture or pyuria were excluded. Experimental and control groups each had 30 patients. Experimental group received Tab. alfuzosin 10 mg daily for four weeks and Tab. diclofenac sodium 50 mg SOS for acute pain. The control group received Tab. diclofenac sodium 50 mg SOS for acute pain. We followed all patients for four weeks for expulsion of ureteric stones by X-ray KUB or CT KUB. Sex, age and stone size were matching variables. Stone expulsion (yes, no) was research variable. We compared count of stone expulsion between two groups by using McNemar chi-square test at alpha 0.5 using GraphPad.Results: Out of 30 patients in experimental group, 23 (76.67%) were men and seven (23.33%) women and out of 30 in control group, 20 (66.67%) were men and 10 (33.33%) women, almost similar in both groups. Mean age in experimental group was 39.45±10.33 years and in control group it was 37.38±8.28 years, almost similar in both groups. Mean stone size was 7.45±1.47 (5-10) mm in the experimental and 7.28±1.68 (5-10) mm in control group, being comparable in both the groups. In experimental group, stone expulsion was achieved in 23 (76.67%) cases and not in seven (23.33%) cases and in control group, it was achieved in 16 (53.33%) cases and not in 14 (46.67%) cases. There was statistically no significant difference in efficacy of alfuzosin versus control group (p=.1213).Conclusion: Our study showed no difference in efficacy of alfuzosin versus control group for upper ureteric stone expulsion in adult population of district Lahore, Pakistan.
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Karanam S, Kumar A, Tyagi AY, Sharma T, Suchitra MM, Siva KV. Changes in renal function following per cutaneous nephro lithotomy in chronic kidney disease patients with symptomatic renal calculus disease. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2022. [DOI: 10.4103/jdrntruhs.jdrntruhs_150_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Ramasamy V, Aarthy P, Sharma V, Singh Thakur A. Role of inflammatory markers and their trends in predicting the outcome of medical expulsive therapy for distal ureteric calculus. Urol Ann 2022; 14:8-14. [PMID: 35197696 PMCID: PMC8815354 DOI: 10.4103/ua.ua_139_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
Objective: Symptomatic ureteric stones cause surrounding inflammation-promoting obstruction. C-reactive protein (CRP), white blood cell count (WC), and neutrophil percentage (NP) tend to rise after inflammatory response. Monitoring response during the course of medical expulsive therapy (MET) may help in deciding early intervention, thereby decreasing morbidity. We assessed the role and trends of these markers in predicting the outcome of MET. Materials and Methods: One hundred and ninety-two patients with distal ureteric calculus of size >5 mm were included in this prospective study from April 2017 to March 2018 after ethical committee approval. CRP, NP, and WC were measured on day 1, 7, and 14 of MET, and analysis was done. Results: On univariate analysis, stone size and mean values of CRP, WC, and NP on day 1, 7 and 14 in stone nonpassers were significantly higher compared to stone passers (P < 0.05). Receiver operator curve analysis showed area under the curve value of 0.798 (P = 0.001) for CRP and cut off value determined was 1.35 mg/dL. Multivariate analysis of different variables showed significant association of higher CRP (>1.35 mg/dL) and larger stone size (>7 mm) with MET failure. Decreasing trend of CRP was seen in both groups, but values were higher in stone nonpassers. WC and NP showed decreasing trend in stone passers but persistently high in stone nonpassers. Conclusions: Higher CRP and larger stone size were associated with failure of MET. WC and NP showed decreasing trend in stone passers and persistently higher in nonpassers, which may potentially predict failure of MET, however, their role need to be further studied.
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Sharma G, Kaundal P, Pareek T, Tyagi S, Sharma AP, Devana SK, Singh SK. Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int J Clin Pract 2021; 75:e14214. [PMID: 33825273 DOI: 10.1111/ijcp.14214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Medical expulsive therapy has been found to be effective for distal ureteric stones; however, which drug is most efficacious in terms of stone expulsion rate (SER) and stone expulsion time (SET) is not known. With this review we aimed to compare the efficacy of various drug treatments for distal ureter stones used as medical expulsive therapy in terms of SER and SET. METHODS Systematic literature search was conducted to include all the randomised study comparing various drug interventions for lower ureter stones. Standard preferred reporting items for systematic review and meta-analysis for network meta-analysis (PRISMA-NMA) were pursued. RESULTS In this review, 50 randomised studies with 12,382 patients were included. For stone expulsion rate (SER), compared with placebo all the treatment groups were more effective except nifedipine and sildenafil. According to the SUCRA values obtained, naftopidil plus steroid was the highest rank and nifedipine lowest. For stone expulsion time (SET), compared with placebo only tadalafil plus silodosin, nifedipine plus steroid, alfuzosin, silodosin, tadalafil and tamsulosin were more effective. SUCRA values were highest for tadalafil plus silodosin and least for naftopidil plus steroid. From subgroup analysis with individual drugs for SER, SUCRA values were highest for naftopidil followed by silodosin and SET was highest for silodosin and least for naftopidil. CONCLUSION For lower ureter stone, tadalafil plus silodosin is the best combination and silodosin best individual drug considering the SET and SER. Nifedipine as monotherapy is no more effective than control group.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pawan Kaundal
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarun Pareek
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shantanu Tyagi
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aditya P Sharma
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudheer K Devana
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shrawan K Singh
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sahin MO, Sen V, Ongun S, Irer B, Yildiz G. Comparison of the efficacy of silodosin and a terpene combination in the medical expulsive therapy of distal ureteral stones. Int J Clin Pract 2021; 75:e13866. [PMID: 33236480 DOI: 10.1111/ijcp.13866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 11/20/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE We aimed to compare the efficacy of silodosin and a terpene combination in the treatment of distal ureteral stones. METHODOLOGY The data of the patients admitted to the urology policlinic with renal colic, diagnosed with distal ureteral stones, and followed up with medical expulsive therapy between December 2017 and June 2018 were retrospectively reviewed. The patients were divided into two groups: Group 1 comprised 72 patients that received 8 mg/day silodosin and Group 2 consisted of 51 patients that were given three capsules of a terpene combination daily. The groups were compared in terms of the patients' demographic characteristics, medical history, localisation of the present stone, renal collecting system status, daily fluid intake, number of emergency service visits, number of additional analgesic applications needed, number of pain attacks, number of days off work, stone expulsion rate and time to stone expulsion. RESULTS Of the total 123 patients, 98 (79.7%) were stone-free. The stone-free rate was 75.0% in Group 1 and 86.3% in Group 2, with no statistical difference between the two groups. However, the number of visits to the emergency service because of pain, number of additional analgesic applications required, number of days off work, and time to stone expulsion were statistically significantly lower in Group 2 than in Group 1. CONCLUSIONS The treatment of distal ureteral stones with silodosin is as effective as the terpene combination. However, the terpene combination is more effective than silodosin in managing pain and accelerating stone expulsion.
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Affiliation(s)
| | - Volkan Sen
- Department of Urology, Manisa State Hospital, Manisa, Turkey
| | - Sakir Ongun
- Department of Urology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Guner Yildiz
- Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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Sahin MO, Sen V, Irer B, Ongun S, Yildiz G. Can the Hounsfield unit predict the success of medical expulsive therapy using silodosin in 4- to 10-mm distal ureteral stones? Int J Clin Pract 2021; 75:e13844. [PMID: 33231905 DOI: 10.1111/ijcp.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to investigate the predictive ability of the Hounsfield unit (HU) on non-contrast computed tomography (NCCT) for the success of medical expulsive therapy (MET) using silodosin in distal ureteric stones of 4-10 mm. METHODOLOGY The data of patients who underwent MET were retrospectively screened. The patients were divided into two groups as Groups 1 and 2 depending on the presence or absence of stone expulsion, respectively. In addition to HU calculated using the NCCT images, state of the collecting systems, daily fluid intake, number of emergency department visits, and number of pain attacks were compared. RESULTS A total of 88 patients were included in the study. Sixty-four patients (72.7%) expelled the stone after MET while the treatment was not successful in 24 patients (27.3%). The stone area was significantly larger in Group 2 (28.4 ± 15.7 mm2 vs 46.8 ± 16.1 mm2 ; P < .001). NCCT-HU was calculated as 542.5 ± 256.8 for Group 1 and 873.1 ± 335.2 for Group 2, indicating a significant difference (P < .001). The mean number of pain attacks was 1.5 ± 1.2 in Group 1 and 2.2 ± 1.4 in Group 2 (P = .048). The number of visits to the emergency department significantly differed between Groups 1 and 2 (1.1 ± 1.0 and 1.8 ± 1.3, respectively; P = .010). CONCLUSIONS In this study, HU and stone area values calculated on NCCT were found to be effective factors in predicting the treatment success for MET. Therefore, we consider that it would be useful to consider these parameters in the selection of an appropriate treatment for distal ureteric stones.
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Affiliation(s)
| | - Volkan Sen
- Department of Urology, Manisa State Hospital, Manisa, Turkey
| | - Bora Irer
- Department of Urology, Izmir Metropolitan Municipality Esrefpasa Hospital, Izmir, Turkey
| | - Sakir Ongun
- Department of Urology, Balikesir University School of Medicine, Balikesir, Turkey
| | - Guner Yildiz
- Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
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Can ureteral wall thickness (UWT) be used as a potential parameter for decision-making in uncomplicated distal ureteral stones 5-10 mm in size? A prospective study. World J Urol 2021; 39:3555-3561. [PMID: 33738575 DOI: 10.1007/s00345-021-03608-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 01/25/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the correlation between ureteral wall thickness (UWT) and stone passage (SP) and its cut-off value in distal uncomplicated ureteral stones. PATIENTS AND METHODS In the prospective study from January 2019 to January 2020 at a tertiary care hospital, we reviewed 212 patients aged above 18 years with single, symptomatic, radiopaque, and distal ureteric stone sized 5-10 mm, who were treated with MET (Silodosin 8 mg once daily) until SP or a maximum of 4 weeks. There were 2 groups: responders and non-responders. Demographic data of the patients and all stone radiological parameters including stone size, laterality, density, UWT, the diameter of the ureter proximal to the stone (PUD), and the degree of hydronephrosis were recorded and compared between the 2 groups. RESULTS There were 126 (59.4%) in the responder group and 86 (40.6%) in the non-responder group. On univariate analysis, gender, stone density, stone size, PUD, UWT, and the degree of hydronephrosis were significant factors for stone passage. However, using multivariate analysis, only UWT and the degree of hydronephrosis were significant. ROC analysis showed that 3.75 mm is the cut-off value for UWT, with 86% and 87.3% sensitivity and specificity, respectively. CONCLUSIONS UWT and hydronephrosis can be used as potential predictors for SP and can help with decision-making in patients with uncomplicated 5-10 mm lower ureteric stones.
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Sharma G, Pareek T, Kaundal P, Tyagi S, Singh S, Yashaswi T, Devan SK, Sharma AP. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int Braz J Urol 2021; 48:742-759. [PMID: 34003612 PMCID: PMC9388169 DOI: 10.1590/s1677-5538.ibju.2020.0548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction: The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alpha-blockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones. Materials and Methods: For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706). Results: In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from “very low” to “moderate” according to the CINeMA approach. Conclusion: Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.
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Affiliation(s)
- Gopal Sharma
- Department of Urology, Advanced Urology Centre, Level II, B-Block, PGIMER, Chandigarh, India
| | - Tarun Pareek
- Department of Urology, Advanced Urology Centre, Level II, B-Block, PGIMER, Chandigarh, India
| | - Pawan Kaundal
- Department of Urology, Advanced Urology Centre, Level II, B-Block, PGIMER, Chandigarh, India
| | - Shantanu Tyagi
- Department of Urology, Advanced Urology Centre, Level II, B-Block, PGIMER, Chandigarh, India
| | - Saket Singh
- Department of Urology, Advanced Urology Centre, Level II, B-Block, PGIMER, Chandigarh, India
| | - Thummala Yashaswi
- Department of Urology, Advanced Urology Centre, Level II, B-Block, PGIMER, Chandigarh, India
| | - Sudheer Kumar Devan
- Department of Urology, Advanced Urology Centre, Level II, B-Block, PGIMER, Chandigarh, India
| | - Aditya Prakash Sharma
- Department of Urology, Advanced Urology Centre, Level II, B-Block, PGIMER, Chandigarh, India
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Soliman MG, El-Gamal O, El-Gamal S, Abdel Raheem A, Abou-Ramadan A, El-Abd A. Silodosin versus Tamsulosin as Medical Expulsive Therapy for Children with Lower-Third Ureteric Stones: Prospective Randomized Placebo-Controlled Study. Urol Int 2021; 105:568-573. [PMID: 33524970 DOI: 10.1159/000513074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022]
Abstract
AIM To compare the efficacy and safety of silodosin versus tamsulosin as medical expulsive therapy for stones of lower-third ureter in children. PATIENTS AND METHODS This prospective single-blind placebo-controlled randomized study included 167 pediatric patients who presented with distal ureteric stone (DUS) less than 1 cm. Patients were randomized into 3 groups; group I received silodosin 4 mg once daily, and group II received tamsulosin 0.4 mg while those in group III had placebo. The side effects of the used drugs, both rate and time of stone expulsion, and number of pain episodes were compared among the study groups for a maximum of 4 weeks. RESULTS Follow-up data of our patients after treatment revealed that the stone expulsion rate was significantly higher and the time to stone expulsion was significantly shorter in group I (89.3%, 12.4 ± 2.3 days) and group II (74.5%, 16.2 ± 4.2 days) compared to group III (51.8%, 21.2 ± 5.6). However, a statistically significant difference between silodosin and tamsulosin groups in favor of the former one was reported regarding the 2 studied items. Meanwhile, pain episodes requiring analgesia were statistically fewer in group I and II in contrast to placebo group. Adverse events were comparable among all groups. CONCLUSION Silodosin provides significantly better stone expulsion rate and shorter expulsion time than tamsulosin for treatment of DUS. Both medications showed good safety profiles in children. However, further studies are required on a larger scale to confirm our results. Assessment of drug safety on younger age-group is still needed.
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Affiliation(s)
| | - Osama El-Gamal
- Urology Department, Tanta Faculty of Medicine, Tanta, Egypt
| | - Samir El-Gamal
- Urology Department, Tanta Faculty of Medicine, Tanta, Egypt
| | | | | | - Ahmed El-Abd
- Urology Department, Tanta Faculty of Medicine, Tanta, Egypt
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Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial. Adv Urol 2020; 2020:4347598. [PMID: 32411212 PMCID: PMC7204220 DOI: 10.1155/2020/4347598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/15/2019] [Accepted: 01/08/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. Conclusion Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.
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Kızılay F, Ülker V, Çelik O, Özdemir T, Çakmak Ö, Can E, Nazlı O. The evaluation of the effectiveness of Gilaburu (Viburnum opulus L.) extract in the medical expulsive treatment of distal ureteral stones. Turk J Urol 2019; 45:S63-S69. [PMID: 30978165 PMCID: PMC7595025 DOI: 10.5152/tud.2019.23463] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Medical expulsive therapy is an important non-invasive treatment modality that facilitates the passage of ureteral stones. The aim of the present study was to evaluate the efficacy of Gilaburu (Viburnum opulus) extract in the treatment of distal ureteral stones <10 mm. MATERIAL AND METHODS Data of 103 patients were retrospectively analyzed. Patients were divided into two groups: those given V. opulus 1000 mg peroral 3×2 and diclofenac 50 mg peroral on-demand (n=53) and those given only diclofenac sodium 50 mg peroral on-demand (n=50). Comparisons of stone expulsion rates and the elapsed time until the expulsion between the groups were determined as primary outcome measures. The comparison of the need for additional treatment [ureteroscopy (URS) or extracorporeal shock wave lithotripsy (ESWL)], the need for emergency admission, analgesic requirement, and the complication rates in additional treatment were determined as secondary outcome measures. RESULTS The mean age of the patients was 45.8±14.5 years. The rate of stone expulsion was significantly higher (82% vs. 66%, p=0.026), and elapsed time to stone expulsion was significantly shorter (9±1.8 vs. 14±2.3 day, p=0.018) in the V. opulus group. The need for additional treatment (URS and ESWL) and analgesic requirement was less in the V. opulus group (9.4% vs. 20%, p=0.038 and 24.5% vs. 44%, p=0.042, respectively). CONCLUSION V. opulus is an herbal treatment alternative that facilitates the passage of ureteral stones <10 mm. Prospective, randomized studies are needed to support these results.
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Affiliation(s)
- Fuat Kızılay
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Volkan Ülker
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Orçun Çelik
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Turan Özdemir
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | - Özgür Çakmak
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ertan Can
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Oktay Nazlı
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
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Jain A, Sreenivasan SK, Manikandan R, Dorairajan LN, Sistla S, Adithan S. Association of spontaneous expulsion with C-reactive protein and other clinico-demographic factors in patients with lower ureteric stone. Urolithiasis 2019; 48:117-122. [PMID: 31025078 DOI: 10.1007/s00240-019-01137-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/19/2019] [Indexed: 01/24/2023]
Abstract
The purpose of our study is to analyze the definitive relation of C-reactive protein (CRP) and other factors with the spontaneous stone passage in patients with distal ureteric calculus of 5-10 mm and to calculate the risk of failure of expectant management in patients. 185 patients of ureteric colic, who were subjected to medical expulsive therapy (MET), were included prospectively from August 2016 to May 2018 and followed up for 4 weeks. Patients were divided into two groups. Group A included successful spontaneous passage patients and group B included failure in the same. The parameters analyzed were age, gender, longitudinal and transverse diameter of stone, CRP, total leucocyte count, ureteric diameter and hydroureteronephrosis (HUN). We performed univariate and multivariate analysis. Receiver operating characteristics curve was used to determine the cutoff value for significantly associated variables. 122 (65.90%) and 63 (34.10%) patients were included in group A and B, respectively. In univariate analysis, CRP, longitudinal and transverse diameter of stone, HUN, proximal and distal ureteric diameters were statistically significant. However, in multivariate analysis, only negative CRP (p = 0.002), smaller longitudinal diameter of stone (p < 0.001) and absence of HUN (p = 0.005) were significantly associated with successful expulsion. Cutoff for CRP was 0.41 mg/dl and longitudinal diameter was 6.7 mm. The success rate in the group of patients with no risk factor was 96.7% and with all three risk factors was 16.7%. Patients with a longitudinal diameter of stone > 6.7 mm, HUN, and CRP > 0.41 mg/dl should be considered for early intervention. The success rate of MET can be increased to 86% after exclusion of patients with all three risk factors.
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Affiliation(s)
- Amit Jain
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India
| | - Sreerag Kodakkattil Sreenivasan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India.
| | - Ramanitharan Manikandan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India
| | - Lalgudi Narayanan Dorairajan
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, Puducherry, 605006, India
| | - Sujatha Sistla
- Department of Microbiology, JIPMER Pondicherry, Puducherry, 605006, India
| | - Subathra Adithan
- Department of Radiodiagnosis, JIPMER Pondicherry, Puducherry, 605006, India
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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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19
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Campschroer T, Zhu X, Vernooij RW, Lock TM. α-blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review. BJU Int 2018; 122:932-945. [DOI: 10.1111/bju.14454] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Thijs Campschroer
- Department of Urology; Rijnstate Hospital Arnhem; Arnhem The Netherlands
| | - Xiaoye Zhu
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Robin W.M. Vernooij
- Department of Research; Netherlands Comprehensive Cancer Organisation (IKNL); Utrecht The Netherlands
| | - Tycho M.T.W. Lock
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
- Department of Urology; Central Military Hospital; Utrecht The Netherlands
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Shafique MN, Hussain M. Efficacy of Tamsulosin alone versus Tamsulosin Phloroglucinol combination therapy for medical expulsion of lower Ureteral calculi. Pak J Med Sci 2018; 34:393-398. [PMID: 29805415 PMCID: PMC5954386 DOI: 10.12669/pjms.342.14134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To see whether phloroglucinol-added tamsulosin therapy exhibits better efficacy than tamsulosin alone in medical expulsion of lower ureteral stone (LUS). Methods Sixty four consecutive adult patients presented in a urological setting at Sialkot, Pakistan between January 2015 and December 2016 with solitary, unilateral 3-8mm sized lower ureteral stone (reported by noncontrast computed tomography of the kidney-ureter-bladder) were documented. Group either study or control was allotted, randomly. Same 0.4 mg tamsulosin, once daily was given to all the participants. However, additional 40 mg phloroglucinol, thrice daily was advised for study group (n = 32). The therapy terminated on confirmation of stone expulsion otherwise continued for 6 weeks. Patients were asked to use 50 mg diclophenac Na on colic episode. Results Demographic characteristics revealed 81.2% (n = 52) male patients while age statistics as M = 42.3, SD = 5.93 (range 32-60) years. The study group showed higher stone expulsion rate (100%) and time to expulsion (M = 10.34 days) than control. The values were statistically significant (p = .02 and p = .0001; χ2 test in SPSS). Similarly, combination therapy had advantage on mono therapy for reporting statistically lesser numbers of colic episode (p = .03) and consumption of analgesic (p = .02). A marked difference in rate of adverse effects i.e. 68.8 vs. 90.6% was observed in study and control groups. Conclusion Phloroglucinol-added therapy is a better choice for expulsion of LUS than tamsulosin alone with reference to stone expulsion rate and medication time.
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Affiliation(s)
- Muhammad Nadeem Shafique
- Dr. Muhammad Nadeem Shafique, Masters in Surgery (MS) Urology, Department of rology, Sialkot Medical College, Sialkot, Pakistan
| | - Mujahid Hussain
- Dr. Mujahid Hussain, PhD, Department of Biology, FG College, Sialkot Cantt, Pakistan
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Yallappa S, Amer T, Jones P, Greco F, Tailly T, Somani BK, Umez-Eronini N, Aboumarzouk OM. Natural History of Conservatively Managed Ureteral Stones: Analysis of 6600 Patients. J Endourol 2018; 32:371-379. [DOI: 10.1089/end.2017.0848] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sachin Yallappa
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Department of Urology, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Tarik Amer
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Department of Urology, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Patrick Jones
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
| | - Francesco Greco
- Department of Urology, EAU Young Academic Urologists Group, Arnhem, The Netherlands
| | - Thomas Tailly
- Department of Urology, EAU Young Academic Urologists Group, Arnhem, The Netherlands
| | - Bhaskar K. Somani
- Department of Urology, University Hospitals Southampton NHS Trust, Southampton, United Kingdom
- Department of Urology, EAU Young Academic Urologists Group, Arnhem, The Netherlands
| | - Nkem Umez-Eronini
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Omar M. Aboumarzouk
- Glasgow Urological Research Unit, Department of Urology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
- Department of Urology, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
- Department of Urology, EAU Young Academic Urologists Group, Arnhem, The Netherlands
- Department of Urology, Islamic Universities of Gaza, College of Medicine, Gaza, Palestine
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Campschroer T, Zhu X, Vernooij RWM, Lock MTWT. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev 2018; 4:CD008509. [PMID: 29620795 PMCID: PMC6494465 DOI: 10.1002/14651858.cd008509.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ureteral colic is a common reason for patients to seek medical care. Alpha-blockers are commonly used to improve stone passage through so-called medical expulsive therapy (MET), but their effectiveness remains controversial. This is an update of a 2014 Cochrane review; since that time, several large randomised controlled trials (RCTs) have been reported, making this update relevant. OBJECTIVES To assess effects of alpha-blockers compared with standard therapy for ureteral stones 1 cm or smaller confirmed by imaging in adult patients presenting with symptoms of ureteral stone disease. SEARCH METHODS On 18 November 2017, we searched CENTRAL, MEDLINE Ovid, and Embase. We also searched ClinicalTrials.gov and the WHO Portal/ICTRP to identify all published/unpublished and ongoing trials. We checked all references of included and review articles and conference proceedings for articles relevant to this review. We sent letters to investigators to request information about unpublished or incomplete studies. SELECTION CRITERIA We included RCTs of ureteral stone passage in adult patients that compared alpha-blockers versus standard therapy. DATA COLLECTION AND ANALYSIS Two review authors screened studies for inclusion and extracted data using standard methodological procedures. We performed meta-analysis using a random-effects model. Primary outcomes were stone clearance and major adverse events; secondary outcomes were stone expulsion time, number of pain episodes, use of diclofenac, hospitalisation, and surgical intervention. We assessed the quality of evidence on a per-outcome basis using the GRADE approach. MAIN RESULTS We included 67 studies with 10,509 participants overall. Of these, 15 studies with 5787 participants used a placebo.Stone clearance: Based on the overall analysis, treatment with an alpha-blocker may result in a large increase in stone clearance (risk ratio (RR) 1.45, 95% confidence interval (CI) 1.36 to 1.55; low-quality evidence). A subset of higher-quality, placebo-controlled trials suggest that the likely effect is probably smaller (RR 1.16, 95% CI 1.07 to 1.25; moderate-quality evidence), corresponding to 116 more (95% CI 51 more to 182 more) stone clearances per 1000 participants.Major adverse events: Based on the overall analysis, treatment with an alpha-blocker may have little effect on major adverse events (RR 1.25, 95% CI 0.80 to 1.96; low-quality evidence). A subset of higher-quality, placebo-controlled trials suggest that alpha-blockers likely increase the risk of major adverse events slightly (RR 2.09, 95% CI 1.13 to 3.86), corresponding to 29 more (95% CI 3 more to 75 more) major adverse events per 1000 participants.Patients treated with alpha-blockers may experience shorter stone expulsion times (mean difference (MD) -3.40 days, 95% CI -4.17 to -2.63; low-quality evidence), may use less diclofenac (MD -82.41, 95% CI -122.51 to -42.31; low-quality evidence), and likely require fewer hospitalisations (RR 0.51, 95% CI 0.34 to 0.77; moderate-quality evidence), corresponding to 69 fewer hospitalisations (95% CI 93 fewer to 32 fewer) per 1000 participants. Meanwhile, the need for surgical intervention appears similar (RR 0.74, 95% CI 0.53 to 1.02; low-quality evidence), corresponding to 28 fewer surgical interventions (95% CI 51 fewer to 2 more) per 1000 participants.A predefined subgroup analysis (test for subgroup differences; P = 0.002) suggests that effects of alpha-blockers may vary with stone size, with RR of 1.06 (95% CI 0.98 to 1.15; P = 0.16; I² = 62%) for stones 5 mm or smaller versus 1.45 (95% CI 1.22 to 1.72; P < 0.0001; I² = 59%) for stones larger than 5 mm. We found no evidence suggesting possible subgroup effects based on stone location or alpha-blocker type. AUTHORS' CONCLUSIONS For patients with ureteral stones, alpha-blockers likely increase stone clearance but probably also slightly increase the risk of major adverse events. Subgroup analyses suggest that alpha-blockers may be less effective for smaller (5 mm or smaller) than for larger stones (greater than 5 mm).
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Affiliation(s)
- Thijs Campschroer
- Radboud University Nijmegen Medical CenterDepartment of UrologyGeert Grooteplein Zuid 10NijmegenGelderlandNetherlands6525 GA
| | - Xiaoye Zhu
- University Medical Center UtrechtDepartment of UrologyUtrechtNetherlands
| | - Robin WM Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL)Department of ResearchGodebaldkwartier 419UtrechtNetherlands3511 DT
| | - MTW Tycho Lock
- University Medical Center UtrechtDepartment of UrologyUtrechtNetherlands
- Central Military HospitalDepartment of UrologyUtrechtNetherlands
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Sridharan K, Sivaramakrishnan G. Efficacy and safety of alpha blockers in medical expulsive therapy for ureteral stones: a mixed treatment network meta-analysis and trial sequential analysis of randomized controlled clinical trials. Expert Rev Clin Pharmacol 2018; 11:291-307. [DOI: 10.1080/17512433.2018.1424537] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kannan Sridharan
- Associate Professor, Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Gowri Sivaramakrishnan
- Assistant Professor in Prosthodontics, School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji Islands
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Rahman MJ, Faridi MS, Mibang N, Singh RS. Comparing tamsulosin, silodosin versus silodosin plus tadalafil as medical expulsive therapy for lower ureteric stones: A randomised trial. Arab J Urol 2017; 16:245-249. [PMID: 29892490 PMCID: PMC5992261 DOI: 10.1016/j.aju.2017.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/02/2017] [Accepted: 11/14/2017] [Indexed: 10/25/2022] Open
Abstract
Objective To compare the efficacy of tamsulosin, silodosin, and silodosin plus tadalafil as medical expulsive therapy (MET) for distal ureteric calculi. Methods In all, 120 patients who met the inclusion criteria were randomised into one of three treatment arms: tamsulosin (Group A), silodosin (Group B), and silodosin plus tadalafil (Group C). The drugs were given for a maximum of 4 weeks. The primary endpoint was the stone expulsion rate and secondary endpoints were stone expulsion time, number of pain episodes, and side-effects associated with MET. The follow-up period was for 4 weeks, after which ureteroscopic lithotripsy was done to remove any stones that were not expelled. Results There was a statistically significantly higher stone expulsion rate in Group C (90%) as compared to groups A (57.5%) and B (77.5%) with a shorter mean time to stone expulsion. Also, there were statistically fewer pain episodes in Group C as compared to groups A and B. There were no serious side-effects. Conclusion The present study concludes that the combination of silodosin and tadalafil increases the ureteric stone expulsion rate and decreases the expulsion time significantly. This combination provided significantly better control of pain without any serious side-effects.
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Affiliation(s)
- Md Jawaid Rahman
- Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - M Shazib Faridi
- Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Naloh Mibang
- Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Rajendra Sinam Singh
- Department of Urology, Regional Institute of Medical Sciences, Imphal, Manipur, India
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Arda E, Cakiroglu B, Yuksel I, Akdeniz E, Cetin G. Medical Expulsive Therapy for Distal Ureteral Stones: Tamsulosin Versus Silodosin in the Turkish Population. Cureus 2017; 9:e1848. [PMID: 29348991 PMCID: PMC5768321 DOI: 10.7759/cureus.1848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Our aim was to contribute a study that includes a higher patient population to the limited number of studies comparing tamsulosin and silodosin in the treatment of distal ureteral stones. Material and methods Patients who presented with renal colic to the urology emergency clinic and were diagnosed with ureteral stones and followed-up with conservative treatment between January 2010 and January 2016 were retrospectively screened. According to the inclusion-exclusion criteria, the patients were divided into three groups. Group 1: 150 patients followed with watchful waiting (WW), Group 2: 156 patients who received 0.4 mg of tamsulosin daily, and Group 3: 159 patients who received 8 mg of silodosin daily. The side effects of the used drugs, duration of stone reduction, and expulsion rates were evaluated and compared separately. Results A total of 465 patients were included in the study. No statistically significant difference was found in terms of age, gender, and stone size among the groups. The patient characteristics and results are shown in Table 1. The differences in stone expulsion rate between the groups in the first week were calculated using the Chi-square test and found to be non-significant (p = 0.155); whereas, the stone expulsion rates between Group 1 versus Group 2 and Group 1 versus Group 3 were found to be significantly different after the second and third week. Conclusion According to our results, no statistically significant superiority between tamsulosin and silodosin was shown in the treatment of distal ureteral stones in the Turkish population.
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Affiliation(s)
- Ersan Arda
- Urology, Trakya University Medical Faculty
| | | | | | - Esra Akdeniz
- Biostatistics, Marmara University School of Medicine
| | - Gizem Cetin
- Anesthesiology, Trakya University Medical Faculty
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Singal R, Bhatia G, Mittal A, Singal S, Zaman M. To compare the efficacy of tamsulosin and alfuzosin as medical expulsive therapy for ureteric stones. Avicenna J Med 2017; 7:115-120. [PMID: 28791244 PMCID: PMC5525465 DOI: 10.4103/ajm.ajm_87_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aims and Objectives: This study aims to evaluate the efficacy of tamsulosin and alfuzosin for the distal ureteral stone. This study assessed the spontaneous passage and expulsion of the stone. Materials and Methods: The study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, from May 2013 to May 2014. A total number of 136 patients diagnosed as distal ureteric stone (US) of size <10 mm were included in this study. It was divided into two groups (I and II) out of which 36 cases were excluded. Group I received tablet tamsulosin 0.4 mg/day, and Group II received alfuzosin 10 mg/day. The efficacy of tamsulosin and alfuzosin as an adjunctive medical therapy was determined. Results: Both the drugs can be safely used for the distal USs. The stone expulsion rate was seen in 36 patients (72.0%) in Group I, and in 34 patients (68.0%) in Group II (P = 0.545). The passage of stones noticed by 32 patients in each Groups I and II (P = 1.000). The mean number of pain attacks was 2.91 ± 1.01 for Group I, and 1.8 ± 0.83 for Group II (P < 0.001 and P < 0.001). Thus, we propagate the use of alfuzosin significantly lower number of pain attacks. The drug-related side-effects were postural hypertension (four in Group I and one in Group II) and retrograde ejaculation (eight in Group I, and one in Group II). Thus, the difference was statistically significant in terms of retrograde ejaculation but insignificant for postural hypotension. Conclusion: There is no difference between both medications in term of efficacy (passing stones) for the management of distal ureteral stones. Both medications are safe and effective. In addition, alfuzosin was better tolerated than tamsulosin as it has fewer side effects.
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Affiliation(s)
- Rikki Singal
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Gaurav Bhatia
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Amit Mittal
- Department of Radiodiagnosis and Imaging, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Samita Singal
- Department of Radiodiagnosis and Imaging, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Muzzafar Zaman
- Department of Surgery, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Sridharan K, Sivaramakrishnan G. Medical expulsive therapy in urolithiasis: a mixed treatment comparison network meta-analysis of randomized controlled clinical trials. Expert Opin Pharmacother 2017; 18:1421-1431. [DOI: 10.1080/14656566.2017.1362393] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kannan Sridharan
- School of Health Sciences, Fiji National University, Suva, Fiji Islands
| | - Gowri Sivaramakrishnan
- School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji Islands
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Computed tomography findings predicting the success of silodosin for medical expulsive therapy of ureteral stones. Kaohsiung J Med Sci 2017; 33:290-294. [DOI: 10.1016/j.kjms.2017.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 11/23/2022] Open
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Preliminary study of the efficacy of the combination of tamsulosin and trospium as a medical expulsive therapy for distal ureteric stones. AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Medical Expulsive Therapy in Urolithiasis: A Review of the Quality of the Current Evidence. Eur Urol Focus 2017; 3:27-45. [DOI: 10.1016/j.euf.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 05/02/2017] [Indexed: 01/30/2023]
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Raison N, Ahmed K, Brunckhorst O, Dasgupta P. Alpha blockers in the management of ureteric lithiasis: A meta-analysis. Int J Clin Pract 2017; 71. [PMID: 28097758 DOI: 10.1111/ijcp.12917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/08/2016] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Effective medical expulsion for ureteric stones with α-blockers offers numerous advantages over surgical alternatives. However, its effectiveness remains uncertain and with the publication of new trial data, the available evidence requires reappraisal. OBJECTIVE The aim of this study was to assess the efficacy of α-blockers the management of ureteric lithiasis. METHODS A systematic review of the literature, with predefined search criteria, was conducted using PubMed and Embase. All randomised trials comparing α-blocker monotherapy to placebo or standard therapy were included. Stone expulsion rate was the primary outcome measure. Secondary outcome measures were time to stone expulsion, analgesic usage and pain scores. Subgroup analyses assessed individual adrenergic antagonists and variations in standard therapy. Sensitivity analysis was based on stone location, stone size, Cochrane Risk of Bias score and study protocol. Summary effects were calculated using a random-effect model and presented as Relative risks (RR) and mean differences (MD) for dichotomous and continuous outcome measures, respectively. RESULTS Sixty-seven studies randomising 6654 patients were included in the meta-analysis. Stone expulsion rates improved with α-blockers (RR, 1.49; 95% CI 1.38-1.61). Contrast enhanced funnel showed evidence of publication bias. Stone expulsion time was 3.99 days (CI -4.75 to -3.23) shorter with α-blockers. Similarly, patients required 106.53 mg [CI -148.20 to -64.86] less diclofenac compared with control/placebo, and had 0.80 [CI -1.07 to -0.54] fewer pain episodes. Visual Analogue Scores were also reduced, -2.43 [CI -3.87 to -0.99]. All formulations of α-antagonists all demonstrated beneficial effects over conservative treatment/placebo. Sensitivity analysis demonstrated significant effects of stone location, stone size and study design. CONCLUSIONS AND RELEVANCE Despite the opposing results of recently published trial, current evidence continues to demonstrate a potential benefit of α-blocker treatment particularly for distal stones over 5 mm.
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Affiliation(s)
- Nicholas Raison
- MRC Centre for Transplantation, Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital, London, UK
| | - Oliver Brunckhorst
- GKT School Of Medical Education, King's College London, The Strand, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, Division of Transplantation Immunology & Mucosal Biology, Faculty of Life Sciences & Medicine, King's College London, Guy's Hospital, London, UK
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Hollingsworth JM, Canales BK, Rogers MAM, Sukumar S, Yan P, Kuntz GM, Dahm P. Alpha blockers for treatment of ureteric stones: systematic review and meta-analysis. BMJ 2016; 355:i6112. [PMID: 27908918 PMCID: PMC5131734 DOI: 10.1136/bmj.i6112] [Citation(s) in RCA: 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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Kc HB, Shrestha A, Acharya GB, Basnet RB, Shah AK, Shrestha PM. Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study. Investig Clin Urol 2016; 57:351-6. [PMID: 27617317 PMCID: PMC5017565 DOI: 10.4111/icu.2016.57.5.351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/22/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study aimed to compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones. MATERIALS AND METHODS This prospective randomized study was conducted at the Department of Urology of Bir Hospital over a period of 12 months in patients with distal ureteral stones sized 5 to 10 mm. Patients were randomly divided into 2 groups: group A received tamsulosin 0.4 mg and group B received tadalafil 10 mg at bedtime for 2 weeks. Stone expulsion rate, number of ureteric colic episodes and pain score, analgesic requirements, and adverse drug effects were noted in both groups. Statistical analyses were performed by using Student t-test and chi-square test. RESULTS Altogether 85 patients, 41 in group A and 44 in group B, were enrolled in the study. The patients' average age was 31.72±12.63 years, and the male-to-female ratio was 1.5:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. The stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (84.1% vs. 61.0%, p=0.017). Although the occurrence of side effects was higher with tadalafil, this difference was not significant (p=0.099). There were no serious adverse effects. CONCLUSIONS Tadalafil has a significantly higher stone expulsion rate than tamsulosin when used as a medical expulsive therapy for distal ureteral stones sized 5-10 mm. Both drugs are safe, effective, and well tolerated with minor side effects.
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Affiliation(s)
- Hari Bahadur Kc
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Anil Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Ganesh Bhakta Acharya
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Robin Bahadur Basnet
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Arvind Kumar Shah
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Parash Mani Shrestha
- Department of Urology, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
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Shafi H, Moazzami B, Pourghasem M, Kasaeian A. An overview of treatment options for urinary stones. CASPIAN JOURNAL OF INTERNAL MEDICINE 2016; 7:1-6. [PMID: 26958325 PMCID: PMC4761115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Urolithiasis has become a worldwide problem with the prevalence of the disease increasing over the past few decades. While various treatment modalities have evolved over the years, discrepancies exist regarding the clinical indications and the efficacy of each of these treatment options. In the present review, we aim to review the current treatment modalities for urinary tract stones to provide a better understanding on the therapeutic approaches as well as their clinical indications.
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Affiliation(s)
- Hamid Shafi
- Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran.
| | - Bobak Moazzami
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mohsen Pourghasem
- Cellular and Molecular Biology Research Center (CMBRC), Babol University of Medical Sciences, Babol, Iran,Correspondence: Mohsen Pourghasem, Cellular and Molecular Biology Research Center (CMBRC), Babol University of Medical Sciences, Babol, Iran ,E-mail: , Tel: 0098 11 32274881 ,Fax: 0098 11 32274880
| | - Aliakbar Kasaeian
- Fatemeh Zahra Infertility and Reproductive Health Research Center, Babol University of Medical Sciences, Babol, Iran.
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Huang W, Xue P, Zong, H, Zhang Y. Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis. Br J Clin Pharmacol 2016; 81:13-22. [PMID: 26255996 PMCID: PMC4693578 DOI: 10.1111/bcp.12737] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/06/2015] [Accepted: 08/03/2015] [Indexed: 11/29/2022] Open
Abstract
AIMS Using a selective α-adrenoceptor blocker for medical expulsive therapy (MET) is an effective treatment approach widely used for ureteral stones. The aim of the review was to assess the efficacy and safety of silodosin in medical expulstion therapy compared with placebo and tamsulosin. METHODS A systematic search was performed in PubMed, Cochrane Library and Embase to identify randomized controlled trials that compared silodosin with a placebo or tamsulosin for ureteral calculi. RESULTS Eight publications involving a total of 1048 patients were used in the analysis, which compared silodosin with placebo and tamsulosin. We found that silodosin was effective in treating ureteral calculi in our meta-analysis and was superior to tamsulosin in its efficacy. The expulsion rate of all ureteral stones (OR 1.59, 95% CI 1.08, 2.36, P = 0.02), the expulsion rate of distal ureteral stones (OR 2.82, 95% CI 1.70, 4.67, P < 0.0001) and the expulsion time (days) of distal ureteral stones (standard mean difference (SMD) -4.71, 95% CI -6.60, -2.83, P < 0.00001) indicated that silodosin was more effective than the placebo. Moreover, expulsion rate (OR 2.54, 95% CI 1.70, 3.78, P < 0.00001), expulsion time (days) (SMD -2.64, 95% CI -3.64, -1.64, P < 0.00001) and pain episodes (P < 0.00001) indicated that silodosin was more effective than the tamsulosin. Even though silodosin had a significant increase in abnormal ejaculation compared with tamsulosin, no significant differences were observed for complications (OR 1.00, 95% CI 0.58, 1.74, P = 1.00). CONCLUSIONS This meta-analysis indicated that silodosin was superior to placebo or tamsulosin in the efficacy for distal ureteral calculi with better control of pain. The safety profile of silodosin was similar to tamsulosin though retrograde ejaculation was worse for silodosin use. We conclude that silodosin might have potential as a MET for ureteral stones.
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Affiliation(s)
- Wei Huang
- Urology Department, Beijing Tian Tan HospitalCapital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological DiseaseBeijingChina
| | - Peng Xue
- Urology Department, Beijing Tian Tan HospitalCapital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological DiseaseBeijingChina
| | - Huantao Zong,
- Urology Department, Beijing Tian Tan HospitalCapital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological DiseaseBeijingChina
| | - Yong Zhang
- Urology Department, Beijing Tian Tan HospitalCapital Medical University, Neurourology Research Division, China National Clinical Research Center for Neurological DiseaseBeijingChina
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Elgalaly H, Sakr A, Fawzi A, Salem EA, Desoky E, Shahin A, Kamel M. Silodosin vs tamsulosin in the management of distal ureteric stones: A prospective randomised study. Arab J Urol 2015; 14:12-7. [PMID: 26966587 PMCID: PMC4767790 DOI: 10.1016/j.aju.2015.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 11/02/2015] [Accepted: 11/26/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the efficacy of silodosin (8 mg) vs tamsulosin (0.4 mg), as a medical expulsive therapy, in the management of distal ureteric stones (DUS) in terms of stone clearance rate and stone expulsion time. PATIENTS AND METHODS A prospective randomised study was conducted on 115 patients, aged 21-55 years, who had unilateral DUS of ⩽10 mm. Patients were divided into two groups. Group 1 received silodosin (8 mg) and Group 2 received tamsulosin (0.4 mg) daily for 1 month. The patients were followed-up by ultrasonography, plain abdominal radiograph of the kidneys, ureters and bladder, and computed tomography (in some cases). RESULTS There was a significantly higher stone clearance rate of 83% in Group 1 vs 57% in Group 2 (P = 0.007). Group 1 also showed a significant advantage for stone expulsion time and analgesic use. Four patients, two in each group, discontinued the treatment in first few days due to side-effects (orthostatic hypotension). No severe complications were recorded during the treatment period. Retrograde ejaculation was recorded in nine and three patients in Groups 1 and 2, respectively. CONCLUSION Our data show that silodosin is more effective than tamsulosin in the management of DUS for stone clearance rates and stone expulsion times. A multicentre study on larger scale is needed to confirm the efficacy and safety of silodosin.
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Affiliation(s)
| | | | | | | | | | | | - Mostafa Kamel
- Corresponding author at: Zagazig University Hospital, Department of Urology, El Mohafza Street, Zagazig, Egypt. Tel./fax: +20 552 300150.Zagazig University HospitalDepartment of UrologyEl Mohafza StreetZagazigEgypt
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Yuksel M, Yilmaz S, Tokgoz H, Yalcinkaya S, Baş S, Ipekci T, Yildiz A, Ates N, Savas M. Efficacy of silodosin in the treatment of distal ureteral stones 4 to 10 mm in diameter. Int J Clin Exp Med 2015; 8:19086-92. [PMID: 26770537 PMCID: PMC4694437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Few studies have investigated the efficacy of silodosin, a recently introduced selective alpha 1-A adrenoceptor antagonist, in medical expulsive therapy (MET) for ureteral calculi. The results of these studies, which all evaluated the efficacy of 8 mg/day, indicate that silodosin is a potential treatment for ureteral calculi. This study investigated the efficacy of 4 mg/day of silodosin for MET of distal ureteral stones 4 to 10 mm in diameter. MATERIAL AND METHOD After 70 patients had been randomized into 2 groups of 35 patients each, both the control and experimental groups (groups 1 and 2, respectively) were advised to take 75 mg/day of diclofenacsodiumas needed for pain relief but only the experimental group to take 4 mg/day of silodosin. After 21 days, the groups were compared regarding the stone expulsion rate and duration, number of renalcolicepisodes, and analgesicdosage. RESULTS The median expulsion rates were 71.4% and 91.4% in groups 1 and 2, respectively, and the difference between them was significant (P=0.031). The median expulsion durations were 12.91±6.14 and 8.03±4.99 days, respectively, and the difference between them was significant (P<0.001). No significant differences were found regarding the median number of renal colic episodes or median analgesic dosage. While no patients in group 1 experienced side effects, 5 patients (14%) in group 2 experienced retrograde ejaculation. CONCLUSION These results indicate that 4 mg/day of silodos in facilitates the expulsion of distal ureteral stones 4 to 10 mm in diameter but does not significantly reduce the number of renal colic episodes or analgesic dosage.
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Affiliation(s)
- Mustafa Yuksel
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
| | - Serdar Yilmaz
- Department of Urology, Konya Training and Research HospitalKonya, Turkey
| | - Husnu Tokgoz
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
| | - Soner Yalcinkaya
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
| | - Serkan Baş
- Department of Urology, Babaeski State HospitalAntalya, Turkey
| | - Tümay Ipekci
- Department of Urology, Baskent University Medical Faculty, Alanya Practice and Research CenterAntalya, Turkey
| | - Ali Yildiz
- Department of Urology, Antalya Training and Research HospitalAntalya, Turkey
| | - Nihat Ates
- Department of Urology, Antalya State HospitalAntalya, Turkey
| | - Murat Savas
- Department of Urology, Antalya Training and Research HospitalAntalya, 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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Türk C, Petřík A, Sarica K, Seitz C, Skolarikos A, Straub M, Knoll T. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol 2015; 69:468-74. [PMID: 26318710 DOI: 10.1016/j.eururo.2015.07.040] [Citation(s) in RCA: 468] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 07/16/2015] [Indexed: 01/16/2023]
Abstract
CONTEXT Low-dose computed tomography (CT) has become the first choice for detection of ureteral calculi. Conservative observational management of renal stones is possible, although the availability of minimally invasive treatment often leads to active treatment. Acute renal colic due to ureteral stone obstruction is an emergency that requires immediate pain management. Medical expulsive therapy (MET) for ureteral stones can support spontaneous passage in the absence of complicating factors. These guidelines summarise current recommendations for imaging, pain management, conservative treatment, and MET for renal and ureteral stones. Oral chemolysis is an option for uric acid stones. OBJECTIVE To evaluate the optimal measures for diagnosis and conservative and medical treatment of urolithiasis. EVIDENCE ACQUISITION Several databases were searched for studies on imaging, pain management, observation, and MET for urolithiasis, with particular attention to the level of evidence. EVIDENCE SYNTHESIS Most patients with urolithiasis present with typical colic symptoms, but stones in the renal calices remain asymptomatic. Routine evaluation includes ultrasound imaging as the first-line modality. In acute disease, low-dose CT is the method of choice. Ureteral stones <6mm can pass spontaneously in well-controlled patients. Sufficient pain management is mandatory in acute renal colic. MET, usually with α-receptor antagonists, facilitates stone passage and reduces the need for analgesia. Contrast imaging is advised for accurate determination of the renal anatomy. Asymptomatic calyceal stones may be observed via active surveillance. CONCLUSIONS Diagnosis, observational management, and medical treatment of urinary calculi are routine measures. Diagnosis is rapid using low-dose CT. However, radiation exposure is a limitation. Active treatment might not be necessary, especially for stones in the lower pole. MET is recommended to support spontaneous stone expulsion. PATIENT SUMMARY For stones in the lower pole of the kidney, treatment may be postponed if there are no complaints. Pharmacological treatment may promote spontaneous stone passage.
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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
| | - Christian Seitz
- Department of Urology, Medical University Vienna, Vienna, Austria
| | - 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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Liu C, Zeng G, Kang R, Wu W, Li J, Chen K, Wan SP. Efficacy and Safety of Alfuzosin as Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0134589. [PMID: 26244843 PMCID: PMC4526635 DOI: 10.1371/journal.pone.0134589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 07/11/2015] [Indexed: 02/01/2023] Open
Abstract
Background Alfuzosin has been widely used to treat benign prostatic hyperplasia and prostatitis, and is claimed to be a selective agent for the lower urinary tract with low incidence of adverse side-effects and hypotensive changes. Recently, several randomized controlled trials have reported using Alfuzosin as an expulsive therapy of ureteral stones. Tamsulosin, another alpha blocker, has also been used as an agent for the expulsive therapy for ureteral stones. It is unclear whether alfuzosin has similar efficacy as Tamsulosin in the management of ureteral stones. Objective To perform a systematic review and analysis of literatures comparing Alfuzosin with Tamsulosin or standard conservative therapy for the treatment of ureteral stones less than 10 mm in diameter. Methods A systematic literature review was performed in December 2014 using Pubmed, Embase, and the Cochrane library databases to identify relevant studies. All randomized and controlled trials were included. A subgroup analysis was performed comparing Alfuzosin with control therapy on the management of distal ureteral stones. Results Alfuzosin provided a significantly higher stone-free rate than the control treatments (RR: 1.85; 95% confidence interval [CI], 1.35–2.55; p<0.001), and a shorter stone expulsion time (Weighted mean difference [WMD]: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001), but it has a higher complication rate (RR: 2.02; 95% CI, 1.30–3.15; p<0.01). When Alfuzosin was compared to Tamsulosin, there was no significant difference in terms of stone-free rate (RR: 0.90; 95% CI, 0.79–1.02; p = 0.09) as well as the stone expulsion time (WMD: 0.52 d, 95%CI, -1.61 to 2.64; p = 0.63). The adverse effects of Alfuzosin were similar to those of Tamsulosin (RR: 0.88; 95% CI, 0.61–1.26; p = 0.47). Conclusions Alfuzosin is a safe and effective agent for the expulsive therapy of ureteral stones smaller than 10 mm in size. It is more effective than therapeutic regiment without alpha blocker. It is equivalent to Tamsulosin in its effectiveness and safety profile. Adverse effects should always be kept in mind when use this class of drugs.
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Affiliation(s)
- Chenli Liu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China
| | - Guohua Zeng
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China
- * E-mail:
| | - Ran Kang
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China
| | - Wenqi Wu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China
| | - Jiasheng Li
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China
| | - Kang Chen
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China
| | - Show P. Wan
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangdong, China
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Özcan C, Aydoğdu O, Senocak C, Damar E, Eraslan A, Oztuna D, Bozkurt OF. Predictive Factors for Spontaneous Stone Passage and the Potential Role of Serum C-Reactive Protein in Patients with 4 to 10 mm Distal Ureteral Stones: A Prospective Clinical Study. J Urol 2015; 194:1009-13. [PMID: 25963189 DOI: 10.1016/j.juro.2015.04.104] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE We investigated possible predictive factors for spontaneous stone passage and the potential role of serum C-reactive protein and white blood count in patients with 4 to 10 mm distal ureteral stones. MATERIALS AND METHODS A total of 251 patients who presented with renal colic secondary to distal ureteral stone were included in study. Patients were grouped according to spontaneous stone passage. Serum C-reactive protein, white blood count and other possible factors were investigated for their potential predictive value for spontaneous stone passage at a followup of 5 weeks. Potential predictive factors for spontaneous stone passage were evaluated with univariate and multivariate analyses. ROC curve analysis was performed to find an optimal cutoff value for serum C-reactive protein according to spontaneous stone passage. Statistical significance was considered at p <0.05. RESULTS Spontaneous stone passage was observed in 135 patients (53.8%) in group 1 while 116 (46.2%) in group 2 did not expel the stone spontaneously. Median stone size was 5.7 mm. Stone size, serum C-reactive protein and white blood count were significantly higher in group 2 than in group 1. The number of patients with hydronephrosis and the number with spontaneous stone passage history were significantly lower in group 2 compared to group 1. The cutoff value of serum C-reactive protein provided by ROC analysis was 0.506 mg/l. Time to spontaneous stone passage was significantly higher in patients with serum C-reactive protein above the threshold and in patients with ureteral stones greater than 6 mm. CONCLUSIONS Stone size, previous spontaneous passage, hydronephrosis, serum C-reactive protein and white blood count can be used to predict spontaneous stone passage in patients with 4 to 10 mm distal ureteral stones. A serum C-reactive protein level of 0.506 mg/l can serve as a cutoff value to predict spontaneous stone passage.
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Affiliation(s)
- Cihat Özcan
- Department of Urology, Keçioren Training and Research Hospital, Ankara, Turkey.
| | - Ozgu Aydoğdu
- Department of Urology, İzmir Bozyaka Training and Research Hospital, İzmir, Turkey
| | - Cagri Senocak
- Department of Urology, Keçioren Training and Research Hospital, Ankara, Turkey
| | - Erman Damar
- Department of Urology, Keçioren Training and Research Hospital, Ankara, Turkey
| | - Asir Eraslan
- Department of Urology, Keçioren Training and Research Hospital, Ankara, Turkey
| | - Derya Oztuna
- Department of Biostatistics, Ankara University, Ankara, Turkey
| | - Omer Faruk Bozkurt
- Department of Urology, Keçioren Training and Research Hospital, Ankara, Turkey
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Silodosin to Facilitate Passage of Ureteral Stones: A Multi-institutional, Randomized, Double-blinded, Placebo-controlled Trial. Eur Urol 2015; 67:959-64. [DOI: 10.1016/j.eururo.2014.10.049] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/30/2014] [Indexed: 12/22/2022]
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El Said NO, El Wakeel L, Kamal KM, Morad AER. Alfuzosin Treatment Improves The Rate and Time for Stone Expulsion in Patients with Distal Uretral Stones: A Prospective Randomized Controlled Study. Pharmacotherapy 2015; 35:470-476. [DOI: 10.1002/phar.1593] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Nouran O. El Said
- Department of Pharmacy Practice and Clinical Pharmacy; Faculty of Pharmacy; Future University; Cairo Egypt
| | - Lamia El Wakeel
- Department of Clinical Pharmacy; Faculty of Pharmacy; Ain Shams University; Cairo Egypt
| | - Khaled M. Kamal
- Department of Urology; Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - Abd El Reheem Morad
- Department of Clinical Pharmacy; Faculty of Pharmacy; Misr University for Science & Technology; Cairo Egypt
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Zhang LT, Lee SW, Park K, Chung WS, Kim SW, Hyun JS, Moon DG, Yang SK, Ryu JK, Yang DY, Moon KH, Min KS, Park JK. Multicenter, prospective, comparative cohort study evaluating the efficacy and safety of alfuzosin 10 mg with regard to blood pressure in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia with or without antihypertensive medications. Clin Interv Aging 2015; 10:277-86. [PMID: 25653511 PMCID: PMC4303366 DOI: 10.2147/cia.s74102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The objective of this study was to assess the efficacy and safety of alfuzosin 10 mg monotherapy or combined antihypertensive medication on blood pressure (BP) in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS) with or without antihypertensive medication. Methods This was a 3-month, multicenter, randomized, open-label study in 335 patients aged ≥45 years with a clinical diagnosis of BPH/LUTS by medical history and clinical examination, a total International Prostatic Symptom Score (IPSS) ≥8 points, a maximum flow rate >5 mL/sec and ≤15 mL/sec, and a voided volume ≥120 mL. Eligible subjects were randomized to receive alfuzosin 10 mg as monotherapy (group 1) or alfuzosin 10 mg + antihypertensive combination therapy (group 2). Based on baseline BP and hypertensive history with or without antihypertensive medications at first medical examination, group 1 was divided into two subgroups of normotensive and untreated hypertensive patients, and group 2 into two subgroups of controlled hypertensive and uncontrolled hypertensive patients. The primary study outcomes were change in IPSS, BP, and heart rate from baseline. Secondary outcomes were change in IPSS-quality of life score, maximum flow rate, average flow rate, voided volume, and post-voided volume. Results The overall BP change was not significantly different between groups 1 and 2 (systolic BP, P=0.825; diastolic BP, P>0.999). In patients with uncontrolled or untreated hypertension, alfuzosin 10 mg alone or combined with antihypertensive therapy significantly decreased systolic and diastolic BP. The mean difference in total IPSS and IPSS-quality of life scores from baseline between groups 1 and 2 was 0.45 (95% CI: −1.26, 2.16) and 0.12 (95% CI: −0.21, 0.45), respectively (both P>0.05). Maximum flow rate, average flow rate, voided volume, and post-voided volume at endpoint were numerically, but not significantly, changed from baseline (all P>0.05). Conclusion This study shows that alfuzosin 10 mg is effective and well tolerated in patients with BPH/LUTS with or without antihypertensive medications. However, in patients with uncontrolled or untreated hypertension, alfuzosin 10 mg alone or in combination with antihypertensive medication appears to decrease systolic and diastolic BP, and these patients should be warned about a decrease in BP on initiation of therapy.
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Affiliation(s)
- Li Tao Zhang
- Department of Urology, Chonbuk National University, Medical School and Biomedical Research Institute and Clinical Trial Center for Medical Devices of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Sung Won Lee
- Department of Urology, College of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kwangsung Park
- Department of Urology, College of Medicine, Chonnam National University, Gwangju, Republic of Korea
| | - Woo Sik Chung
- Department of Urology, College of Medicine, Ewha Woman's University, Seoul, Republic of Korea
| | - Sae Woong Kim
- Department of Urology, College of Medicine, Catholic University, Seoul, Republic of Korea
| | - Jae Seog Hyun
- Department of Urology, College of Medicine, Kyungsang National University, Jinju, Republic of Korea
| | - Doo Geon Moon
- Department of Urology, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sang-Kuk Yang
- Department of Urology, Chungju Hospital, College of Medicine, Konkuk University, Chungju, Republic of Korea
| | - Ji Kan Ryu
- Department of Urology, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Dae Yul Yang
- Department of Urology, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Ki Hak Moon
- Department of Urology, College of Medicine, Youngnam University, Daegu, Republic of Korea
| | - Kweon Sik Min
- Department of Urology, College of Medicine, Inje University, Busan, Republic of Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University, Medical School and Biomedical Research Institute and Clinical Trial Center for Medical Devices of Chonbuk National University Hospital, Jeonju, Republic of Korea
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Malo C, Audette-Côté JS, Emond M, Turgeon AF. Tamsulosin for treatment of unilateral distal ureterolithiasis: a systematic review and meta-analysis. CAN J EMERG MED 2014; 16:229-42. [PMID: 24852587 DOI: 10.2310/8000.2013.131012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The lifetime prevalence of ureterolithiasis is approximately 13% for men and 7% for women in the United States. Tamsulosin, an α-antagonist, has been used as therapy to facilitate the expulsion of lithiasis. Whether it is a good treatment for distal lithiasis remains controversial. We conducted a systematic review and meta-analysis to evaluate the effect of tamsulosin on the passage of distal ureterolithiasis. METHODS A systematic search was conducted using MEDLINE, EMBASE, and Cochrane Central. Trial eligibility was evaluated by two investigators. All randomized controlled trials (RCTs) comparing tamsulosin to standard therapy or placebo for the treatment of a single distal ureterolithiasis ≤ 10 mm in adult patients with renal colic confirmed by radiographic imaging were included. Data extraction was conducted in duplicate. Primary outcome was the expulsion rate, and secondary outcomes were the mean time for ureterolithiasis expulsion, analgesic requirements, and side effects. Mantel-Haenszel random effect models were used, and heterogeneity was assessed using I² statistics. Data were presented with relative risks (RRs). RESULTS The search strategy identified 685 articles, of which 22 studies were included. Combined results suggested a benefit for the expulsion of ureterolithiasis (≤ 10 mm) when tamsulosin was used compared to a standard treatment (RR 1.50 [95% CI 1.31-1.71], I² = 70%). A decrease in the average time of expulsion of the ureterolithiasis of 3.33 days in favour of tamsulosin was observed (95% CI -4.23, -2.44], I² = 67%). CONCLUSION Tamsulosin increases the rate of spontaneous passage of distal ureterolithiasis (≤ 10 mm).
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Mohamed HI. The efficacy of tamsulosin therapy after extracorporeal shock-wave lithotripsy for ureteric calculi: A prospective randomised, controlled study. Arab J Urol 2013; 11:398-404. [PMID: 26558111 PMCID: PMC4443006 DOI: 10.1016/j.aju.2013.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Revised: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To evaluate whether tamsulosin hydrochloride is effective as an adjunctive medical therapy to increase the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) for treating ureteric stones, and minimises the use of analgesic drugs after the procedure. PATIENTS AND METHODS To treat single ureteric stones of 5-15 mm in diameter, 130 patients were treated with ESWL. After treatment, equal numbers of patients were randomly assigned to receive either the standard medical therapy alone (controls) or combined with 0.4 mg tamsulosin daily for ⩽12 weeks. All patients were followed up for 3 months or until an alternative treatment was offered. RESULTS At 3 months the treatment was considered to be clinically successful in 55/65 (85%) of those receiving tamsulosin and in 58/65 (89%) of the controls (P = 0.34). When patients were classified according to stone size the success rate was similar in both groups (P = 0.22) for those with a stone of >10 mm. However, ureteric colic was reported in 12% of patients treated with standard therapy but in only 5% of those treated with tamsulosin (P = 0.006). The mean cumulative diclofenac dose was 380 mg/patient in the tamsulosin group and 750 mg/patient in the control group (P = 0.004). CONCLUSIONS This study showed the effectiveness of tamsulosin as an adjunctive medical therapy after ESWL for ureteric stones, but it did not improve stone clearance when treating ureteric stones. However, it decreased the use of analgesics and reduced the complication rate, especially for steinstrasse.
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Ibrahim AK, Mahmood IH, Mahmood NS. Efficacy and safety of tamsulosin vs. alfuzosin as medical expulsive therapy for ureteric stones. Arab J Urol 2013; 11:142-7. [PMID: 26558072 PMCID: PMC4443000 DOI: 10.1016/j.aju.2013.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Revised: 02/18/2013] [Accepted: 02/22/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate and compare the efficacy of tamsulosin and alfuzosin as medical expulsive therapy for ureteric stones. PATIENTS AND METHODS In all, 112 patients with ureteric stones of ⩽10 mm, located along the ureter, were randomly divided into three groups. In group I, 32 patients received no α-blockers (controls), in group II 40 patients received tamsulosin 0.4 mg daily, and in group III 40 patients received alfuzosin 10 mg daily. All patients were given analgesia and antibiotics when indicated. The follow-up was weekly for 4 weeks. RESULTS The mean stone size and age were comparable in the three groups. The stone expulsion rate was 44%, 85% and 75% in groups I, II and III, respectively. Half of the stones in group II passed within 2 weeks, half in group III passed within 3 weeks, while more than half of the stones in group I did not pass even after 4 weeks. The mean number of painful episodes was 2.45, 1.38 and 1.64 in groups I, II and III, respectively. The drug-related side-effects reported by patients were mild and transient. CONCLUSION The use of tamsulosin or alfuzosin as medical expulsive therapy for ureteric stones in the three sections of the ureter (upper, middle and lower) was safe and effective, as shown by the increased overall stone expulsion rate, reduced stone expulsion time and fewer pain episodes. Tamsulosin was associated with a greater rate of stone expulsion than was alfuzosin.
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Affiliation(s)
- Ahmed K. Ibrahim
- Urology Division, Department of Surgery, University of Mosul, Mosul, Iraq
| | - Isam H. Mahmood
- Department of Pharmacology, College of Pharmacy, University of Mosul, Mosul, Iraq
| | - Nada S. Mahmood
- Department of Pharmacology, College of Medicine, University of Mosul, Mosul, Iraq
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Cho HJ, Shin SC, Seo DY, Min DS, Cho JM, Kang JY, Yoo TK. Efficacy of alfuzosin after shock wave lithotripsy for the treatment of ureteral calculi. Korean J Urol 2013; 54:106-10. [PMID: 23550174 PMCID: PMC3580299 DOI: 10.4111/kju.2013.54.2.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 10/20/2012] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We evaluated the efficacy of alfuzosin for the treatment of ureteral calculi less than 10 mm in diameter after extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS A randomized, single-blind clinical trial was performed prospectively by one physician between June 2010 and August 2011. A total of 84 patients with ureteral calculi 5 to 10 mm in diameter were divided into two groups. Alfuzosin 10 mg (once daily) and loxoprofen sodium 68.1 mg (as needed) were prescribed to group 1 (n=41), and loxoprofen sodium 68.1 mg (as needed) only was prescribed to group 2 (n=44). The drug administration began immediately after ESWL and continued until stone expulsion was confirmed up to a maximum of 42 days after the procedure. RESULTS Thirty-nine of 41 (95.1%) patients in group 1 and 40 of 43 (93.0%) patients in group 2 ultimately passed stones (p=0.96). The number of ESWL sessions was 1.34±0.65 and 1.41±0.85 in groups 1 and 2, respectively (p=0.33). The patients who required analgesics after ESWL were 8 (19.5%) in group 1 and 13 (30.2%) in group 2 (p=0.31). Visual analogue scale pain severity scores were 5.33±1.22 and 6.43±1.36 in groups 1 and 2, respectively (p=0.056). The time to stone expulsion in groups 1 and 2 was 9.5±4.8 days and 14.7±9.8 days, respectively (p=0.005). No significant adverse effects occurred. CONCLUSIONS The use of alfuzosin in combination with ESWL seems to facilitate stone passage and to reduce the time of stone expulsion but does not affect the stone-free rate.
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Affiliation(s)
- Hee Ju Cho
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Soon Cheol Shin
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Do Young Seo
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Dong Suk Min
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jeong Man Cho
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jung Yoon Kang
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Tag Keun Yoo
- Department of Urology, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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