Alpha-blockers as medical expulsive therapy for ureteral stones

Campschroer, Thijs; Zhu, Xiaoye; Vernooij, Robin W.M.; Lock, M.T.W.T.

doi:10.1002/14651858.cd008509.pub3

Cited by 39 publications

(24 citation statements)

References 133 publications

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“…The use of tamsulosin, initially utilized post-ESWL, was extended and others procedures as well during the following years. 65 In contrast with those findings, however, recent studies report no differences between tamsulosin and placebo in expulsion rate of fragments <9 mm, [66][67][68] questioning the validity of the use of αblockers after the procedures themselves. Moreover, in Italy, as well as in other European nations, alpha blockers for this indication are not reimbursed, leading to off-label prescriptions.…”

Section: Medical and Experimental Therapy In Rfs Management: New Horimentioning

confidence: 94%

Stone residual fragments: A thorny problem

et al. 2019

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Urolithiasis represents a widespread and common disorder among the world population, with a predicted increase in affected patients in the coming years. Treatment of renal and ureteral stones varies widely, and achieving true stone-free status in all patients is still difficult. Moreover, imaging used to assess residual fragments following procedure impacts the diagnosed stone-free rate percentage considerably. In particular, the use of computed tomography scans has led to a better evaluation of residual fragments as well as so-called clinically insignificant residual fragments, which in a considerable number of cases are, despite their definition, causes of adverse urological events, thus creating a thorny problem for both patients and urologists. Currently, there is no gold standard or validated protocol regarding the management, clearance and prevention of residual fragments. In this article, we review the current literature regarding residual fragments, clinically insignificant residual fragments and their natural history, reporting on diagnostic methods, incidence, complications and outcome with the use of less invasive procedures, taking into consideration viable treatment and management of patients affected.

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Section: Medical and Experimental Therapy In Rfs Management: New Horimentioning

confidence: 94%

Stone residual fragments: A thorny problem

et al. 2019

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“…α-blockers are drugs that cause relaxation of the smooth muscles in the urinary tract's wall and may additionally facilitate passing of the stones which formed in the ureter to the bladder, α 1 -AR was significantly activated in the renal artery and the blockers of the α-adrenergic receptors, as tamsulosin, consequently they typically used to improve passing of the stones through medical expulsive therapy (MET) [1,2]. Currently, the two most common drug classes used in medical expulsive therapy are calcium channel blockers and α 1 -adrenoceptor antagonists, both are thought to act by inducing relaxation of the smooth muscle in the most common location of stone formation, the distal ureters and pelvic-ureteric junction to allow stone passage to the bladder [3,4].…”

Section: Introductionmentioning

confidence: 99%

The relaxant effect of Tamsulosin in the vascular reactivity of goat isolated renal artery

Asaad

Kakey

2019

KJAR

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Alpha-blockers including tamsulosin, are medications that relax muscles in the urinary tract to facilitate stone passage into the bladder. This research aimed to investigate the possible action of tamsulosin (1 × 10 -3 -10 -8 M), in the vascular reactivity of goat isolated renal artery by using the organ bath and PowerLab data acquisition system. The results of recording and analysing showed that tamsulosin caused a concentrated-dependent relaxation of endothelium intact renal artery rings precontracted with a high level of KCl (60 mM) or phenylephrine (PE) (10 -5 M), also tamsulosin exhibited potent inhibitory effects on PE, and less potent on KCl-induced contractions. Renal artery rings preincubated with potassium (K + ) channels blocker glibenclamide (GLIB), 4-aminopyridine (4-AP), prostaglandin I2 (PGI2) inhibitor (indomethacin) and epoxyeicosatrienoic acid (EET) inhibitor (Clotrimazole) have a significant effect in relaxation induced by tamsulosin. On the other side, subtype blockers from other K + channels (tetraethylammonium, TEA), barium chloride (BaCl2) and inhibitor of nitric oxide (NO) synthase (L-Name) not exhibited any role in the relaxation effect of tamsulosin. Furthermore, the role of L-type of calcium channels (nifedipine) and tamsulosin, suggesting a Ca ++ channel blocking mechanism has a relaxant effect in the urinary tract smooth muscles. Thus, from these results, it can be concluded that both potassium and calcium channels play an important role in relaxation effect of tamsulosin, which is mediated possibly through blocking of KV, KATP, PGI2, EET and voltage-dependent calcium channels.

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“…Additional information is provided in an analysis stratified by stone size, which is a well-established predictor of stone passage as derived from the control arms of randomized controlled trials of medical expulsive therapy (MET). 2,3 In the recent trial by Meltzer and colleagues, which stands out for having been conducted in a similar healthcare setting that included routine CTimaging both in making the initial diagnosis and for subsequent follow-up, the average stone size was 3.8 mm, and the spontaneous stone passage rate in the placebo group was 47%. 4 The clinical practice guideline of the Canadian Urological Association (CUA) states that 95% of ureteral stones of 2 to 4 mm in size will pass spontaneously.…”

Section: Introductionmentioning

confidence: 99%

“…9 A recent "Rapid Recommendation" based on the recent Cochrane review on MET using rigorous guideline methodology has also recommended a trial of alpha-blockers ("conditional recommendation for") in patients with an uncomplicated ureteral stone, even if the diagnosis is not confirmed by imaging. 2,10 The high rates of primary intervention in patients with uncomplicated ureteral stones in Calgary suggest overtreatment as well as likely overutilization of scarce healthcare resources. The importance of these findings is further underscored by the observation that these patients subsequently experienced more, rather than fewer return visits to the ED and hospital readmissions.…”

Section: Introductionmentioning

confidence: 99%