Effect of alpha1-adrenergic antagonists on lower ureteral stones with extracorporeal shock wave lithotripsy

Abstract

Objective: To evaluate the efficiency of alpha1-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones.

Methods: A total of 107 patients with solitary lower ureteral stones and who underwent single ESWL sessions were divided into two groups. Group 1 received our standard medical therapy, and group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during treatment.

Results: Twenty-four of the 52 patients in group 1 (46.2%) and 41 of 55 patients in group 2 (74.5%) (p =0.002) were found to be stone-free. Among patients with stones 10-15 mm in diameter, the stone-free rate was 36.4% in group 1 and 73.0% in group 2 (p = 0.003). Average stone expulsion time was 11.6 days and 8.1 days in groups 1 and 2, respectively (p = 0.000). Ureteral colic occurred in 10 patients (19.2%) in group 1 but only 3 patients (5.5%) in group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 2 of the 55 (3.6%) patients in group 2.

Conclusion: Adjunctive therapy with alpha1-adrenergic antagonists after ESWL is more effective than, and equally as safe as lithotripsy alone in the treatment of patients with lower ureteral stones. The use of alpha1-adrenergic antagonists is more useful for stones with a large dimension, and can also reduce stone expulsion time and episodes of ureteral colic.