Facilitation of expulsion of ureteral stones by addition of α 1 -blockers to conservative therapy

Bashir

BMC Complement Altern Med

et al. 2011

BackgroundOriganum vulgare Linn has traditionally been used in the treatment of urolithiasis. Therefore, we investigated the crude extract of Origanum vulgare for possible antiurolithic effect, to rationalize its medicinal use.MethodsThe crude aqueous-methanolic extract of Origanum vulgare (Ov.Cr) was studied using the in vitro and in vivo methods. In the in vitro experiments, supersaturated solution of calcium and oxalate, kidney epithelial cell lines (MDCK) and urinary bladder of rabbits were used, whereas, in the in vivo studies, rat model of urolithiasis was used for the study of preventive and curative effect.ResultsIn the in vitro experiments, Ov.Cr exhibited a concentration-dependent (0.25-4 mg/ml) inhibitory effect on the slope of nucleation and aggregation and also decreased the number of calcium oxalate monohydrate crystals (COM) produced in calcium oxalate metastable solutions. It also showed concentration-dependent antioxidant effect against DPPH free radical and lipid peroxidation induced in rat kidney tissue homogenate. Ov.Cr reduced the cell toxicity using MTT assay and LDH release in renal epithelial cells (MDCK) exposed to oxalate (0.5 mM) and COM (66 μg/cm2) crystals. Ov.Cr relaxed high K+ (80 mM) induced contraction in rabbit urinary bladder strips, and shifted the calcium concentration-response curves (CRCs) towards right with suppression of the maximum response similar to that of verapamil, a standard calcium channel blocker. In male Wistar rats receiving lithogenic treatment comprising of 0.75% ethylene glycol in drinking water given for 3 weeks along with ammonium chloride (NH4Cl) for the first 5 days, Ov.Cr treatment (10-30 mg/kg) prevented as well as reversed toxic changes including loss of body weight, polyurea, crystalluria, oxaluria, raised serum urea and creatinine levels and crystal deposition in kidneys compared to their respective controls.ConclusionThese data indicating the antiurolithic activity in Ov.Cr, possibly mediated through inhibition of CaOx crystallization, antioxidant, renal epithelial cell protective and antispasmodic activities, rationalizes its medicinal use in urolithiasis.

Section: Discussionmentioning

confidence: 99%

Antiurolithic activity of Origanum vulgare is mediated through multiple pathways

Bashir

BMC Complement Altern Med

et al. 2011

“…Sun et al reported that daily administration of 50 mg naftopidil, a selective α1D-blocker, increased the distal ureteral stone expulsion rate 5.263-fold compared to the control [6]. Ohgaki et al showed that 50 mg naftopidil in combination with 240 mg flopropione and 1,350 mg QS extract once daily compared with 0.2 mg tamsulosin or 30 mg urapidil with these drugs significantly increased the ureteral stone expulsion rate 2.38-fold compared to 240 mg flopropione and 1,350 mg QS extract once daily [12]. Kohjimoto et al showed that 75 mg naftopidil once daily significantly increased distal ureteral stone expulsion rate to 1.78 times that of 240 mg flopropione once daily [10].…”

Section: Discussionmentioning

confidence: 99%

“…Some reports have described the effectiveness of naftopidil for ureteral stone expulsion [6-11]. When various α1-blockers, such as urapidil, tamsulosin and naftopidil, were administered to patients with ureteral stones to determine their efficacy for stone expulsion, naftopidil in combination with an antispasmodic agent and a supplement that facilitates stone expulsion produced a significantly increased rate of ureteral stone expulsion [12]. However, one study reported that naftopidil did not increase spontaneous stone passage rates or reduce analgesic use [13].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Naftopidil as a Medical Expulsive Therapy in Japanese Men With Ureteral Stones: A Prospective Randomized Controlled Study

Ohgaki¹

2019

J Clin Med Res

Self Cite

Background Naftopidil combined with an antispasmodic agent and a supplement that facilitates stone expulsion has reportedly produced an increased rate of ureteral stone expulsion. A randomized controlled study was conducted to determine the efficacy of naftopidil as a medical expulsive therapy for male patients with ureteral stones. Methods Male patients (n = 500) with stones from the upper to the lower ureter were randomized to one of four groups and followed for 1 month to assess spontaneous passage of stones. The control group received only analgesics. The other three groups received daily doses of 240 mg flopropione, an antispasmodic agent and 1,350 mg extract of Quercus salicina Blume/ Quercus stenophylla Makino (QS), a supplement that facilitates stone expulsion; 50 mg naftopidil; or 50 mg naftopidil in combination with 240 mg flopropione and 1,350 mg QS. Stone expulsion and characteristics were evaluated by urinalysis; kidney, ureter and bladder X-ray; ultrasound; and computed tomography. Results The probability of expulsion of ureteral stones < 6 mm increased 1.570-fold (95% confidence interval (CI): 1.039 - 2.374, P < 0.05) with naftopidil compared to control; the probability of expulsion of a lower ureteral stone < 6 mm increased 1.778-fold (95% CI: 1.066 - 2.965, P < 0.05) with naftopidil compared to control. None of the stones > 6 mm spontaneously passed. Conclusions For relatively small ureteral stones < 6 mm, analgesic treatment combined with naftopidil would be the first choice. However, for relatively large ureteral stones > 6 mm, it appears that analgesia is sufficient for initial treatment of ureteral stone.

Journal of Pharmacy Technology

“…The most commonly studied primary endpoint was clearance or expulsion rate, which was successful passing of the stone. [8][9][10][11][12][13][14][15][16][17][18][19][20][21] A summary of studies can be found in Table 2.…”

Section: Summary Of Studiesmentioning

confidence: 99%

“…The authors acknowledged that 0.4 mg is the accepted tamsulosin MET dose, but only the 0.2 mg for benign prostatic hyperplasia is covered by the Japanese health insurance system. 8 A Chinese study found both tamsulosin 0.4 mg (82.2%) daily and naftopidil (72.1%) to be more effective than placebo (30.2%) at clearing stones. 9 There are published meta-analyses for each of the selective alpha-blockers (alfuzosin, silodosin, tamsulosin) and one that evaluated all alpha-blockers (selective and nonselective).…”

Section: Summary Of Studiesmentioning

confidence: 99%

Efficacy and Safety of Alpha-Blockers for Kidney Stones in Adults

Koski

Zufall

2017

Kidney stones are a common and growing problem in the United States. A recent survey found that 11% of men and 7% of women will experience at least one kidney stone in their lifetime. Recurrence is estimated to be ≤50% at 5 years. Risk factors include male gender, obesity, diabetes, gout, and income less than $75 000. Noncontrast computed tomography imaging is typically used to confirm diagnosis and estimate stone size. Pain is the most common symptom and occurs when the stone attempts to pass through the ureter. Kidney stones are often asymptomatic while growing and may take up to several months to grow to a detectable size. 1-3 Treatment of kidney stones depends on factors such as stone size and symptoms. Waiting for a stone to pass spontaneously is the recommended treatment for stones <5 mm with little to no pain. Management options for larger and painful stones include shockwave lithotripsy (SWL), ureteroscopy, surgical removal, and pharmacologic therapy. While the traditional role of pharmacologic therapy is for symptomatic relief or to prevent recurrence, some studies suggest using medications to promote the passage of stones and shorten the time it takes to pass the stone spontaneously. This is referred to as medical expulsive therapy (MET) and is where the use of alpha-blockers has been studied. MET can be used as monotherapy, post-lithotripsy, or with additional pharmacologic therapy. 2 A 2002 to 2009 survey found that MET use was infrequent before 2007, and from 2007 to 2009, it was prescribed in 14% of emergency department urolithiasis visits. 3 This article compiles and briefly reviews the studies, including metaanalyses, that examined the efficacy and safety of alphablockers as MET in the treatment of kidney stones.