Adjunctive Tamsulosin Improves Stone Free Rate After Ureteroscopic Lithotripsy of Large Renal and Ureteric Calculi: A Prospective Randomized Study

John, Tony T.; Razdan, Sanjay

doi:10.1016/j.urology.2009.07.1257

“…20,21 In addition to the size of the stones, factors that can predict the chances of success of MET are: the condition of the renal reserve, the severity of mucosal odema-inflammation and the anatomic structure of the urinary system. 20,21 In our study, the usability of the HU value in predicting MET success was investigated. Our expectation prior to conducting the study was that calculus with higher HU values would be more compact.…”

Section: Discussionmentioning

confidence: 99%

Can the Hounsfield unit predict the success of medically expulsive therapy

Erturhan

¹

,

Bayrak

²

,

Mete

³

et al. 2013

CUAJ

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Background: We investigate the predictability of medical expulsive therapy (MET) success with alpha blockers based on Hounsfield unit (HU) values and Hounsfield density (HD) values measured by computed tomography (CT) for distal ureteral stones. Methods: Between July 2011 and May 2012, 44 patients (19 female and 25 male) with 5-to 10-mm stones in the distal ureters were included in this randomized prospective study. Non-contrast CT examinations were performed in these patients. HU and HD values of stones were calculated. Doxazosine, 4 mg/day orally, was administered as a single dose to all patients for MET. Results: Patients were divided into 2 groups. Group 1 included 18 patients (43.9%) with dropped stones with MET. Group 2 included 23 patients (56.1%) with no stone passage with MET. In Group 1, the mean stone size was 7.7 mm, the mean HU was 507, and the HD was 53.04/mm. In Group 2, the mean stone size was 8.25 mm, the mean HU was 625, and the mean HD was 61.54/mm. The HU and HD values in Group 2 were higher than in Group 1. However, there was no statistically significant difference (p = 0.85 and 0.93 for HU and HD, respectively). Interpretation: We found that HU and HD values cannot be used to predict the chances of success for MET. Although the sample size is appropriate for the study, further comparative studies involving more patients are warranted.

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“…Their findings imply that α-blocker treatment could facilitate kidney stone passage and help decrease pain, as used in ureteral stones [11]. Several updated randomized clinical trials also confirmed the adjuvant effect of αblockers on improving stone free rates after surgical intervention of renal stones [23][24][25]. All studies consistently suggested the beneficial effect of α-blocker on stone recurrence; the possible mechanism may be due to the prevention of stone retention in the kidney and facilitation of stone passage via ureter.…”

Section: Discussionmentioning

confidence: 92%

391 Long-term prescription of α-blockers decrease the risk of recurrent urolithiasis needed for surgical intervention – a nationwide population-based study

Cc¹,

Hsieh²,

Cf³

et al. 2015

European Urology Supplements

0

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Purpose α1 receptors and subtypes have been confirmed to distribute in human pelvis and calyces recently. As used in ureteral stones, α-blocker treatment may facilitate kidney stone passage and long-term prescription of α-blocker may decrease the risk of recurrent urolithiasis. The aim of this study is to determine if use of α-blockers 180 days or more can decrease the risk of recurrent urolithiasis needed for surgical intervention. Materials and Methods A representative database of 1,000,000 patients from Taiwan's National Health Insurance was analyzed. Eligible patients were those who had received the first-time procedure for upper urinary stone removal, including extracorporeal shock-wave lithotripsy, ureterorenoscopic lithotripsy, or both, between 2000 and 2010. After completing a 180-day treatment for first event, patients were prospectively followed-up until a second set of stone procedures was performed (proxy of stone recurrence), loss to follow-up, or end of study. The effect of percentage of total number of days of α-blocker use on need for second set of stone procedures within a post treatment 180-day follow-up period was analyzed by quartile. A nested case-control study was also performed.

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“…Their findings imply that α-blocker treatment could facilitate kidney stone passage and help decrease pain, as used in ureteral stones [ 11 ]. Several updated randomized clinical trials also confirmed the adjuvant effect of α-blockers on improving stone free rates after surgical intervention of renal stones [ 23 – 25 ]. All studies consistently suggested the beneficial effect of α-blocker on stone recurrence; the possible mechanism may be due to the prevention of stone retention in the kidney and facilitation of stone passage via ureter.…”

Section: Discussionmentioning

confidence: 96%

Long-Term Prescription of α-Blockers Decrease the Risk of Recurrent Urolithiasis Needed for Surgical Intervention-A Nationwide Population-Based Study

Liu

¹

,

Hsieh

²

,

Hsieh

³

et al. 2015

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Purposeα1 receptors and subtypes have been confirmed to distribute in human pelvis and calyces recently. As used in ureteral stones, α-blocker treatment may facilitate kidney stone passage and long-term prescription of α-blocker may decrease the risk of recurrent urolithiasis. The aim of this study is to determine if use of α-blockers 180 days or more can decrease the risk of recurrent urolithiasis needed for surgical intervention.Materials and MethodsA representative database of 1,000,000 patients from Taiwan’s National Health Insurance was analyzed. Eligible patients were those who had received the first-time procedure for upper urinary stone removal, including extracorporeal shock-wave lithotripsy, ureterorenoscopic lithotripsy, or both, between 2000 and 2010. After completing a 180-day treatment for first event, patients were prospectively followed-up until a second set of stone procedures was performed (proxy of stone recurrence), loss to follow-up, or end of study. The effect of percentage of total number of days of α-blocker use on need for second set of stone procedures within a post treatment 180-day follow-up period was analyzed by quartile. A nested case-control study was also performed.Results1,259 patients were eligible for final analyses. During 3,980 person-years follow-up, 167 patients had recurrent urolithiasis needed for surgical intervention. From first to fourth quartile of drug exposure, recurrence rates were 45.64, 47.19, 43.11, and 18.52 per 1,000 person-years. The adjusted hazard ratio was 0.46 (95% CI = 0.24 to 0.89) for the fourth quartile (vs. quartile 1). In the nested case-control study, adjusted ORs was 0.23 (95% CI = 0.10 to 0.53) in the fourth quartile (vs. quartile 1). The results remained similar even in patients categorized by cumulative defined daily dose (cDDD) quartiles and average cDDD per day quartiles.ConclusionUse of α-blockers for 180 days or more decrease the risk of recurrent urolithiasis needed for surgical intervention. In patients at higher risk of recurrent urolithiasis, long term prescription of α-blockers might help them prevent further surgical intervention.

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Adjunctive Tamsulosin Improves Stone Free Rate After Ureteroscopic Lithotripsy of Large Renal and Ureteric Calculi: A Prospective Randomized Study

Cited by 40 publications

References 14 publications

Can the Hounsfield unit predict the success of medically expulsive therapy

Can the Hounsfield unit predict the success of medically expulsive therapy

391 Long-term prescription of α-blockers decrease the risk of recurrent urolithiasis needed for surgical intervention – a nationwide population-based study

Long-Term Prescription of α-Blockers Decrease the Risk of Recurrent Urolithiasis Needed for Surgical Intervention-A Nationwide Population-Based Study

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