Tamsulosin or Silodosin Adjuvant Treatment Is Ineffective in Improving Shockwave Lithotripsy Outcome: A Short-Term Follow-Up Randomized, Placebo-Controlled Study

Nunzio, Cosimo De; Brassetti, Aldo; Bellangino, M.; Trucchi, Alberto; Petta, S; Presicce, Fabrizio; Tubaro, Andrea

doi:10.1089/end.2016.0113

Cited by 14 publications

(6 citation statements)

References 23 publications

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“…In the present randomized nonplacebo-controlled study, the results did not show a significant difference in the stonefree rate after a single ESWL session between the patients treated with tamsulosin and the patients in the control group (53.57% vs. 48.27%; p � 0.680) over eight weeks for patients with a single renal stone (located in the renal pelvis, upper calix, or middle calix) and with the stone size between 5 and 20 (mm) in diameter. We observed results similar to those described by De Nunzio et al [17], who identified 58% stonefree rate in the tamsulosin group, 47% in the silodosin group, and 55% in the control group, with no statistically significant difference (p � 0.399) between patients treated over 21 days after a single ESWL session. In concordance, Ahmed et al [18] also did not find a significant difference in the stone-free rate between patients in the tamsulosin group and the control group (78% vs. 69%, respectively, p � 0.108) in an up to 12-week study.…”

Section: Discussionsupporting

confidence: 91%

“…However, other studies reported different complication-rate values. De Nunzio et al [ 17 ] reported that 20% (12 of 60) of the patients had complications; 11 of them presented with acute pain requiring only analgesic treatment, and one patient underwent an additional procedure (ureteroscopy). The authors reported a statistically significant difference in the complication rate in favor of the tamsulosin group ( p = 0.008).…”

Section: Discussionmentioning

confidence: 99%

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

Maldonado-Valadez

Vargas

Álvarez

et al. 2022

International Journal of Clinical Practice

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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 ( p = 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.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

Maldonado-Valadez

Vargas

Álvarez

et al. 2022

International Journal of Clinical Practice

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“…A limitation of this study is that a placebo arm was not considered because sufficient evidence to support the use of tamsulosin as an adjunct to SWL exists [4,7,25]. However, as there are conflicting results from previous studies, a placebo arm might have added value [26]. In addition, according to Roehrborn et al [16], a clinically significant effect of tadalafil 5 mg is usually seen to be as effective as 10 and 20 mg at 12 weeks.…”

Section: Discussionmentioning

confidence: 98%

Is low‐dose tadalafil better than tamsulosin? A randomized controlled trial in shockwave lithotripsy for solitary upper tract calculi

et al. 2023

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ObjectiveTo ascertain whether low‐dose tadalafil (5 mg) is more efficient than tamsulosin (0.4 mg) in facilitating calculus expulsion in those receiving extracorporeal shockwave lithotripsy for solitary upper urinary tract calculi.Patients and MethodsThis was a triple‐blinded, prospective, superiority, randomized controlled, single‐centre trial. A total of 250 patients with solitary renal or ureteric calculus measuring 6–24 mm were randomized (1:1) to receive either 0.4 mg tamsulosin or 5 mg tadalafil daily for 30 days or until calculus clearance, whichever was earlier.ResultsThere was no difference in the primary outcome, namely, calculus expulsion rate at 30 days (tamsulosin vs tadalafil, n (%) 99 [81.1%] vs 98 [80.3%] respectively, 95% confidence interval = 0.8% [−9.0, 10.7], P = 0.874). Similarly, a lack of difference was also noted in the secondary outcome, number of days to expulsion (tamsulosin vs tadalafil, geometric mean [SD] 13.59 [2.39] vs 13.74 [2.39] respectively, P = 0.928). Four patients discontinued the drug due to adverse drug reactions in the tadalafil group.ConclusionsLow‐dose tadalafil is not superior to tamsulosin in improving calculus expulsion when used as an adjunct to shockwave lithotripsy. In this study, we also noted that tadalafil was less tolerated.

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“…Overall, there were 21 RCTs [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], covering 1445 patients and 1478 controls. Patient demographics are detailed in Table 1, whilst lithotripter/stone free definitions are detailed in Table 2.…”

Section: Demographics Of Included Studiesmentioning

confidence: 99%

Outcomes of alpha‐blockers as medical expulsive therapy following shockwave lithotripsy: a systematic review and meta‐analysis

et al. 2022

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To determine stone-free rate following shockwave lithotripsy (SWL) with/without alpha-blockers as well as complication rates (individual and classified using the Clavien-Dindo system). Materials and MethodsWe performed a systematic review of all randomized controlled trials that included more than 20 patients (age > 18 years) and examined the use of alpha-blockers after SWL. Meta-analysis was performed using 'metafor' in R. We report risk ratios (RRs) with 95% confidence intervals (95% CIs). The PROSPERO ID for the trial was: CRD42021248108. ResultsWe assessed 158 full-text articles and included a total of 21 studies in our review. There were 1445 patients receiving alphablockers and 1478 control patients. Those receiving alpha-blockers were significantly more likely to be stone-free (RR 1.12, 95% CI 1.07-1.16; P < 0.001). This effect was robust to 'trim-and-fill' adjustment. In those taking alpha-blockers there was a significant reduction in Clavien III-V complications and, on trim-and-fill adjustment, a significant reduction in Clavien I-II complications. There were also significant reduction in rates of steinstrasse, pain and requirement for auxiliary procedures. There was no significant difference in retreatment rates. These effects were robust to trim-and-fill adjustment. ConclusionsThere is a modest increase in stone-free rates in those receiving alpha-blockers following SWL, with a reciprocal modest risk reduction for steinstrasse, pain and auxiliary procedures. However, alpha-blockers do not reduce the risk of requiring retreatment.

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Tamsulosin or Silodosin Adjuvant Treatment Is Ineffective in Improving Shockwave Lithotripsy Outcome: A Short-Term Follow-Up Randomized, Placebo-Controlled Study

Abstract: Tamsulosin and silodosin are ineffective in increasing stone-free rate as well as early patients' discomfort after extracorporeal lithotripsy.

Cited by 14 publications

References 23 publications

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

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

Is low‐dose tadalafil better than tamsulosin? A randomized controlled trial in shockwave lithotripsy for solitary upper tract calculi

Outcomes of alpha‐blockers as medical expulsive therapy following shockwave lithotripsy: a systematic review and meta‐analysis

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