Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial

Abstract

Alpha-blockers have been established as medical expulsive therapy for urolithiasis. We aimed to assess the effect of tamsulosin and doxazosin as adjunctive therapy following SWL for renal calculi. We prospectively included 150 patients who underwent up to four SWL sessions for renal stones from June 2008 to 2009. Patients were randomized into three groups of 50 patients each, group A (phloroglucinol 240 mg daily), group B (tamsulosin 0.4 mg once daily plus phloroglucinol), and group C (doxazosin 4 mg plus phloroglucinol). The treatment continued up to maximum 12 weeks. Patients were evaluated for stone expulsion, colic attacks, amount of analgesics and side-effects of alpha-blockers. There were no significant differences between the groups regarding stone expulsion rates (84; 92 and 90%, respectively). The mean expulsion time of tamsulosin was significantly shorter than both control group (p = 0.002) and doxazosin (p = 0.026). Both number of colic episodes and analgesic dosage were significantly lower with tamsulosin as compared to control and doxazosin. Steinstrasse was encountered in 10 (6.7%) patients with no significant difference between the groups. 16 patients on tamsulosin and 21 on doxazosin experienced adverse effects related to postural hypotension. Moreover, 2 (4%) patients in the tamsulosin group reported ejaculatory complaints. In conclusion, adjunction of tamsulosin or doxazosin after SWL for renal calculi decreases the time for stone expulsion, amount of the analgesics and number colic episodes. There was no benefit regarding the overall stone expulsion rate. The side-effects of these agents are common and should be weighted against the benefits of their usage.

Role of Tamsulosin Therapy after Extracorporeal Shockwave Lithotripsy for Renal Stones: Randomized Controlled Trial

“…Contrary to our findings, most of the investigators [12,25,26] have shown that tamsulosin facilitates earlier clearance of stone fragments. We have no proper explanation for this finding.…”

“…The main benefit of adjunctive tamsulosin after renal SWL in our study as well as in most previous studies [13,15,25] is the significant reduction of the post-SWL pain episodes and subsequently the need for additional analgesia. The frequency of pain episodes and cumulative and additional analgesia dosage were consistently lower with adjunctive tamsulosin.…”

“…In the present series, the overall steinstrasse rate was 5.6% with no significant difference being observed between patients on tamsulosin therapy and controls. On the basis of our findings, Zaytoun et al [25] reported an overall steinstrasse rate of 6.6% after renal SWL and the use of tamsulosin or doxazosin therapy did not significantly decrease the risk of steinstrasse.…”

“…Gravina et al [15] in 2005, Losek and Mauro [14] in 2008, and Hossain et al [13] in 2011 found that renal SWL with adjunctive tamsulosin enhances the SFR. On the other hand, Micali et al [22] in 2007, Gravas et al [23] in 2007, Wang et al [24] in 2009, Falahatkar et al [12] in 2011, Zaytoun et al [25] in 2012 did not find any benefits of tamsulosin in increasing the SFR.…”

Avaliação dos fatores preditivos dos resultados da litotripsia extracorpórea por ondas de choque em cálculos renais de cálice inferior

“…Em um outro estudo randomizado com 150 doentes avaliando os resultados da tamsulosina e da doxazosina após LECO, também não se encontrou vantagens na taxa de doentes livres de cálculos (84% placebo, 92% tamsulosina, 90% doxazosina), porém pacientes em uso de tamsulosina tiveram um significativo menor tempo para expulsão dos cálculos tanto em relação à doxazosina (p=0,026) como em relação ao placebo (p=0,002), e uma menor incidência de episódios de cólicas em relação aos outros dois grupos [79] . Complementando estes estudos, recente metanálise foi publicada avaliando a real eficácia do uso da tamsulosina em pacientes submetidos a LECO [80] .…”