The use of tamsulozin as adjunctive treatment after ESWL in patients with distal ureteral stone: do we really need it?

Abstract

Our study aimed to define the position of tamsulosin as adjunctive therapy in patients with stones of the distal ureter who had undergone extracorporeal shock wave lithotripsy (ESWL). In total, 61 consecutive patients (38 men and 23 women) with single distal radiopaque ureteral stone of > or =6 mm of diameter were enrolled. After ESWL patients were randomized in two groups. Non-steroidal anti-inflammatory drug (supp. diclofenac 50 mg) was given to both groups upon demand. In group B, all patients (30) received additionally tamsulozin 0.4 mg every day. Follow-up visits were performed 1, 2, 3 and 4 weeks after ESWL. Evaluation included a KUB plain film and an ultrasound examination. Efficacy was evaluated in terms of success rate, stone-free rate, expulsion time of the fragments and use of diclofenac. Two patients from the tamsulosin group experienced dizziness and one was withdrawn. The success rate was 58.06 and 66.66% for the control and the tamsulosin group, respectively, while the corresponding values for stone-free rate were 51.6 and 63.33%, respectively. The mean expulsion time of the fragments was 13.22 days for group A and 12.95 days for group B. These results did not achieve statistically significant difference (P > 0.05). The mean diclofenac dose was 118.9 mg in group A and 56.9 mg in group B. This difference was statistically significant (P = 0.02). Despite the relatively small number of patients, our data indicate that the use of tamsulosin after ESWL in this specific subgroup of patients does not result in improved success and stone-free rate and expulsion time. In contrast, a significantly reduced need for analgesics was found.

CUA Guideline: Management of ureteral calculi

“…The authors identified seven trials that met the inclusion criteria and found that the use of alpha-blockers, which was tamsulosin in all seven studies, improved SWL success by 16%. 47,[51][52][53][54][55][56][57] The authors also reported reduced time to fragment passage, reduced pain, and required less analgesia.…”

Lower Ureteric Stones Expulsion; Comparison of Tamsulosin Versus Extracorporeal Shock Wave Lithotripsy (Eswl)

“…18 He also studied that tamsulosin is beneficial in terms that it reduces the needs of pain killers in ESWL. 18 This study showed that tamsulosin alone as medical expulsive therapy significantly reduced need of pain killers. 19 Tamsolosin showed excellent results for reduction in need of analgesia in combination with lithotripsy or alone.…”

Steinstrasse predictive factors and outcomes after extracorporeal shockwave lithotripsy

“…Even in cases with a larger number of stones, this trend was observed, as previously reported (5,7). When treating patients with an increased risk of SS, as those with large pelvic stones, preventive treatment for SS such as alpha-blockers could be prescribed (8)(9)(10). Further studies should be conduced to evaluate its effects.…”