Role of combined use of potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi

Abstract

In this article, we investigated the effect of the combined use of tamsulosin and potassium citrate (Uralyt-U(®)) for the treatment of uric acid stones in the distal ureter. The study was designed as a prospective, double blind randomized controlled trial. A total of 191 adult patients with radiolucent distal ureteral calculi were recruited. We included patients with solitary stones ≥5 mm with mild or moderate hydronephrosis and a normal contralateral tract. The patients were randomized into four equal groups (the placebo, tamsulosin, Uralyt-U(®), and the combined treatment groups). The patients were treated for a maximum duration of 4 weeks or until stone expulsion. The stone size in all groups ranged from 5 to 11 mm (7.69 ± 1.7 mm). The total expulsion rate of the stones was significantly lower in the control group (26.1%) compared with that of any of the other three groups (68.8, 58.7, and 84.8% respectively) (P < 0.05). Meanwhile, the difference between the Uralyt-U(®) group and the combined treatment group was also statistically significant (P < 0.05). When we studied the patients with stones >8 mm as a separate subgroup to find the effect of the used drugs on the relatively large stones, we detected that the expulsion rate of these stones was significantly higher in the patients who received the combined treatment in comparison with any of the other three groups (P < 0.05). In conclusion, the use of urinary alkalization with tamsulosin can increase the frequency of spontaneous passage of distal ureteral uric acid stones especially those of 8-11 mm.

CUA Guideline: Management of ureteral calculi

“…145 In addition, the combination of alpha blockers (such as tamsulosin) and potassium citrate have been associated with significantly higher stone-free rates when compared with either therapy alone or with placebo in patients with distal ureteric UA stones (84.4%, 68.8%, 58.7%, and 26.1%, respectively). 146 Although UA stones are easy to fragment by SWL, they are difficult to localize due to their radiolucency. Contrast media injection, either through the intravenous route, retrograde ureteropyelography through a ureteral catheter, or antegrade administration through a nephrostomy tube, can be used to localize the radiolucent UA stones.…”

Eficacia y seguridad de tamsulosina para el tratamiento conservador del cólico nefrítico: revisión sistemática con metaanálisis de ensayos clínicos aleatorizados

“…El tamañ o medio de las litiasis osciló entre 2,9 29 y 7,9 mm 48 . Cuatro de los artículos incluidos especifican que má s del 60% de los pacientes presentaron litiasis mayores de 5 mm 14,34,36,48 .…”

Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis

“…Two studies exclusively enrolled participants with a minimum stone size of 4 mm. 17,24 Large stone size definitions are listed in Figure 2. In the subgroup meta-analysis of large stone size, the I 2 statistic was 33.1% (P¼.…”

“…Among the 8 placebo-controlled, double-blinded, randomized trials of tamsulosin in patients with ureteral stones, only 1 included ureteral stones of all locations, 8 whereas the remaining studies included distal ureteral stones identified by CT or kidney, ureter, and bladder radiographs. Four studies were conducted in an emergency department (ED) setting, 8,9,19,23 and 4 were conducted in urology clinics in a number of different countries, 17,18,21,24 including Australia, Egypt, France, India, Qatar, Switzerland, the United Kingdom, and the United States.…”

“…25,26 There is substantial heterogeneity in the reported incidence of dizziness, with some studies reporting 20% of both cohorts experiencing dizziness and several other studies reporting no harm-related events. 17,18,24,27 Also, no included studies calculated the power to detect differences in adverse effects. These limitations should be taken into account when the reliability of the dizziness and postural hypotension findings is considered, even when combined in a meta-analysis.…”