Korean J Urol.  2006 Aug;47(8):813-817. 10.4111/kju.2006.47.8.813.

Additive Expulsion Effect of Tamsulosin after Shock Wave Lithotripsy for Upper Ureteral Stones

• Han MC
• Jeong WS
• Shim BS

• KMID: 2294107
• DOI: http://doi.org/10.4111/kju.2006.47.8.813

Abstract

PURPOSE: We evaluates if the administration of tamsulosin increases the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the patients with upper ureteral stones and if this decreased the use of analgesic drugs after the procedure.
MATERIALS AND METHODS
A total of 45 patients with stones 6-12mm in size that were located in the upper ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=23) received 3 times a day oral treatment of 20mg caroverine (a spasmolytic drug). Group 2 (n=22) received one time a day oral therapy of 0.2mg tamsulosin. All the patients received oral treatment for 14 days. Both groups of patients were allowed to use 30mg ketorolac trimethamine intramuscular injections on demand. The endpoint of the study was the stone expulsion rate, the use of analgesics and the drug adverse effects during treatment.
RESULTS
The average stone size was 7.9+/-2.79mm for group 1 and 8.2+/-3.14mm for group 2. No statistical difference between the two groups was found for the stone size, age and gender distribution. The expulsion rate was significantly higher in group 2 (90.9%) compared with group 1 (65.2%) (p=0.038). The average number of pain control injections was 0.78 for group 1 and 0.23 for group 2, and there was a statistically significant difference between the two groups (p=0.042).
CONCLUSIONS
The use of tamsulosin proved to be effective and safe, as demonstrated by the increased stone expulsion rate and the lesser need for pain control than that when using just a spasmolytic drug for ESWL of upper ureter stones.

Keyword

Urinary calculi; Extracorporeal shockwave lithotripsy; Tamsulosin

MeSH Terms

Analgesics
Humans
Injections, Intramuscular
Ketorolac
Lithotripsy*
Shock*
Ureter*
Urinary Calculi
Analgesics
Ketorolac

Figure

• 

  Fig. 1 Comparison of stone size between the expulsion patients and no-expulsion patients in both groups. No statistically significant difference is found for the stone size (p-values are from chi-square tests).

Reference

1. Peschel R, Janetschek G, Bartsch G. Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective randomized study. J Urol. 1999. 162:1909–1912.

2. Lingeman JE. Extracorporeal shock wave lithotripsy. Development, instrumentation, and current status. Urol Clin North Am. 1997. 24:185–211.

3. Ehreth JT, Drach GW, Arnett ML, Barnett RB, Govan D, Lingeman J, et al. Extracorporeal shock wave lithotripsy: multicenter study of kidney and upper ureter versus middle and lower ureter treatments. J Urol. 1994. 152:1379–1385.

4. Cervenakov I, Fillo J, Mardiak J, Kopecny M, Smirala J, Lepies P. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha1-blocker tamsulosin. Int Urol Nephrol. 2002. 34:25–29.

5. Danuser H, Weiss R, Abel D, Walter B, Scholtysik G, Mettler D, et al. Systemic and topical drug administration in the pig ureter: effect of phosphodiesterase inhibitors alpha1, beta and beta2-adrenergic receptor agonists and antagonists on the frequency and amplitude of ureteral contractions. J Urol. 2001. 166:714–720.

6. Peters HJ, Parekh N, Popa G. Effect of adrenergic and cholinergic agents on ureteral functions in dogs. Urol Int. 1979. 34:137–146.

7. Hancock AA. α₁-Adrenoceptor subtypes: a synopsis of their pharmacology and molecular biology. Drug Dev Res. 1996. 39:54–107.

8. Zhong H, Minneman KP. α₁-adrenoceptor subtypes. Eur J Pharmacol. 1999. 375:261–276.

9. Gravina GL, Costa AM, Ronchi P, Galatioto GP, Angelucci A, Castellani D, et al. Tamsulosin treatment increases clinical success rate of single extracorporeal shock wave lithotripsy of renal stones. Urology. 2005. 66:24–28.

10. Chaussy C, Schmiedt E, Jocham D, Brendel W, Forssmann B, Walther V. First clinical experience with extracorporeally induced destruction of kidney stone by shock waves. J Urol. 1982. 127:417–420.

11. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral stones clinical guidelines panel summary report on the management of ureteral calculi. The American Urological Association. J Urol. 1997. 158:1915–1921.

12. Kang SC, Ryu JK, Yoon SM. Clinical outcome of Therasonic LTS and SDS-5000 for the treatment of urinary stones. Korean J Urol. 2005. 46:275–280.

13. Matin SF, Yost A, Streem SB. Extracorporeal shock-wave lithotripsy: a comparative study of electrohydraulic and electromagnetic units. J Urol. 2001. 166:2053–2056.

14. Kim HS, Kim YG. Clinical experience of extracorporeal shock wave lithotripsy (ESWL) using Dornier MPL 9200X lithotriptor. Korean J Urol. 2003. 44:430–435.

15. Lee GB, Rho J, Jang DS. Clinical experience of extracorporeal shock wave lithotripsy with the Dornier Compact Delta. Korean J Urol. 2003. 44:139–144.

16. Ng CF, McLornan L, Thompson TJ, Tolley DA. Comparison of 2 generations of piezoelectric lithotriptors using matched pair analysis. J Urol. 2004. 172:1887–1891.

17. Oh BS, Hwang EC, Chae MJ, Oh KJ, Kang TW, Kwon DD, et al. Efficacy of the 3rd generation extracorporeal shock wave lithotriptor (Piezolith 3000®) for treating patients with urinary tract calculi. Korean J Urol. 2005. 46:1278–1283.

18. Porpiglia F, Destefanis P, Fiori C, Fontana D. Effectiveness of nifedipine and deflazacort in the management of distal ureteral stones. Urology. 2000. 56:579–582.

19. Cooper JT, Stack GM, Cooper TP. Intensive medical management of ureteral calculi. Urology. 2000. 56:575–578.

20. Morita T, Wada I, Saeki H, Tsuchida S, Weiss RM. Ureteral urine transport: changes in bolus volume, peristaltic frequency, intraluminal pressure and volume of flow resulting from autonomic drugs. J Urol. 1987. 137:132–135.

21. Morita T, Ando M, Kihara K, Oshima H. Function and distribution of autonomic receptors in canine ureteral smooth muscle. Neurourol Urodyn. 1994. 13:315–321.

22. Obara K, Takeda M, Shimura H, Kanai T, Tsutsui T, Komeyama T, et al. Alpha-1 adrenoreceptor subtypes in the human ureter: characterization by RT-PCR and in situ hybridization. J Urol. 1996. 155:Suppl. 472A. abstract 646.

23. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol. 2003. 170:2202–2205.

24. Resim S, Ekerbicer H, Ciftci A. Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus. Int J Urol. 2005. 12:615–620.

25. Kupeli B, Irkilata L, Gurocak S, Tunc L, Kirac M, Karaoglan U, et al. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology. 2004. 64:1111–1115.

26. Ahn DW, Oh MM. Experience of extracorporeal shock wave lithotripsy (ESWL) with EDAP-LT01: a report of 660 cases. Korean J Urol. 2001. 42:483–488.

27. O'Leary MP. Tamsulosin: current clinical experience. Urology. 2001. 58:Suppl 6A. 42–48.