Efficacy of Adjuvant Tamsulosin for Improving the Stone-Free Rate After Extracorporeal Shock Wave Lithotripsy in Renal Stones: A Randomized Controlled Trial

Overview

Journal Int J Clin Pract

Publisher Wiley

Specialty General Medicine

Date 2022 Jun 10

PMID 35685573

Authors

Rafael Edgardo Maldonado-Valadez

Angel David Valdez-Vargas

Jose Antonio Alvarez

Edel Rafael Rodea-Montero

Affiliations

Soon will be listed here.

Abstract

Introduction: Extracorporeal shock wave lithotripsy (ESWL) is an effective treatment for urolithiasis. Tamsulosin is capable of causing dilation and facilitating the migration of stones. The aim of this study is to evaluate the efficacy of adjuvant treatment with tamsulosin for improving the stone-free rate after a single session of ESWL in the treatment of kidney stones.

Methods: This is a randomized, nonplacebo-controlled study with a sample of 60 adults with a single radiopaque kidney stone of 5-20 mm in diameter. After the ESWL session, the patients were divided into two groups. The control group received standard treatment for analgesia consisting of oral diclofenac (75 mg/12 h) as needed. The tamsulosin group received standard treatment for analgesia plus oral tamsulosin (0.4 mg/day) for eight weeks. In both groups, stone-free status was determined using a CT scan eight weeks after ESWL. The protocol of this study was registered with ClinicalTrials.gov, identifier: NCT04819828.

Results: Only 57 patients completed the study (28 tamsulosin and 29 control). Overall, the average stone diameter was 11.42 ± 4.52 mm. The stone-free rate was 50.88% (29 of 57) overall, 53.57% (15 of 28) for the tamsulosin group, and 48.27% (14 of 29) for the control group ( = 0.680). The estimated relative risk in favor of the tamsulosin group to achieve a stone-free status was 1.11 (95% CI 0.67-1.9). The estimated number needed to treat to achieve a single patient with renal stone-free status after eight weeks of ESWL adjuvant treatment with tamsulosin was 19.

Conclusion: Our findings suggest that tamsulosin as adjuvant treatment after a single ESWL session is well tolerated and safe, but it does not increase the stone-free rate in patients with a single radiopaque renal stone of 5-20 mm in diameter. Our results may support the use of tamsulosin with ESWL in the case of patients with a single radiopaque renal stone of 11-20 mm in diameter based on an apparent higher stone-free rate and a low rate of complications.

References

Latifpour J, Kondo S, OHollaren B, Morita T, Weiss R . Autonomic receptors in urinary tract: sex and age differences. J Pharmacol Exp Ther. 1990; 253(2):661-7. View

Naja V, Agarwal M, Mandal A, Singh S, Mavuduru R, Kumar S . Tamsulosin facilitates earlier clearance of stone fragments and reduces pain after shockwave lithotripsy for renal calculi: results from an open-label randomized study. Urology. 2008; 72(5):1006-11. DOI: 10.1016/j.urology.2008.05.035. View

De Nunzio C, Brassetti A, Bellangino M, Trucchi A, Petta S, Presicce F . Tamsulosin or Silodosin Adjuvant Treatment Is Ineffective in Improving Shockwave Lithotripsy Outcome: A Short-Term Follow-Up Randomized, Placebo-Controlled Study. J Endourol. 2016; 30(7):817-21. DOI: 10.1089/end.2016.0113. View

Zaytoun O, Yakoubi R, Zahran A, Fouda K, Marzouk E, Gaafar S . Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial. Urol Res. 2011; 40(4):327-32. DOI: 10.1007/s00240-011-0410-x. View

Gravina G, Costa A, Ronchi P, Paradiso Galatioto G, Angelucci A, Castellani D . Tamsulosin treatment increases clinical success rate of single extracorporeal shock wave lithotripsy of renal stones. Urology. 2005; 66(1):24-8. DOI: 10.1016/j.urology.2005.01.013. View

Ahmed A, Shalaby E, El-Feky M, Kotb A, Elsotohi E, El-Kholy Jr M . Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial. Urol Int. 2016; 97(3):266-272. DOI: 10.1159/000445840. View

Lingeman J, Coury T, Newman D, Kahnoski R, MERTZ J, Mosbaugh P . Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol. 1987; 138(3):485-90. DOI: 10.1016/s0022-5347(17)43236-8. View

Stamatelou K, Francis M, Jones C, Nyberg L, Curhan G . Time trends in reported prevalence of kidney stones in the United States: 1976-1994. Kidney Int. 2003; 63(5):1817-23. DOI: 10.1046/j.1523-1755.2003.00917.x. View

Pak C . Kidney stones. Lancet. 1998; 351(9118):1797-801. DOI: 10.1016/S0140-6736(98)01295-1. View

10.

Hussein M . Does tamsulosin increase stone clearance after shockwave lithotripsy of renal stones? A prospective, randomized controlled study. Scand J Urol Nephrol. 2009; 44(1):27-31. DOI: 10.3109/00365590903359916. View

11.

Falahatkar S, Khosropanah I, Vajary A, Heidari Bateni Z, Khosropanah D, Allahkhah A . Is there a role for tamsulosin after shock wave lithotripsy in the treatment of renal and ureteral calculi?. J Endourol. 2010; 25(3):495-8. DOI: 10.1089/end.2010.0439. View

12.

Ramello A, Vitale C, Marangella M . Epidemiology of nephrolithiasis. J Nephrol. 2000; 13 Suppl 3:S45-50. View

13.

Richardson C, Donatucci C, Page S, WILSON K, Schwinn D . Pharmacology of tamsulosin: saturation-binding isotherms and competition analysis using cloned alpha 1-adrenergic receptor subtypes. Prostate. 1997; 33(1):55-9. DOI: 10.1002/(sici)1097-0045(19970915)33:1<55::aid-pros9>3.0.co;2-8. View

14.

Bhagat S, Chacko N, Kekre N, Gopalakrishnan G, Antonisamy B, Devasia A . Is there a role for tamsulosin in shock wave lithotripsy for renal and ureteral calculi?. J Urol. 2007; 177(6):2185-8. DOI: 10.1016/j.juro.2007.01.160. View

15.

Dellabella M, Milanese G, Muzzonigro G . Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol. 2003; 170(6 Pt 1):2202-5. DOI: 10.1097/01.ju.0000096050.22281.a7. View

16.

Cervenakov I, Fillo J, Mardiak J, Kopecny M, Smirala J, Lepies P . Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--Tamsulosin. Int Urol Nephrol. 2003; 34(1):25-9. DOI: 10.1023/a:1021368325512. View

17.

Chaussy C, Brendel W, SCHMIEDT E . Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980; 2(8207):1265-8. DOI: 10.1016/s0140-6736(80)92335-1. View

18.

Vicentini F, Mazzucchi E, Brito A, Chedid Neto E, Danilovic A, Srougi M . Adjuvant tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for renal stones: a double blind, randomized, placebo-controlled trial. Urology. 2011; 78(5):1016-21. DOI: 10.1016/j.urology.2011.04.062. View