Korean J Urol.  2008 Feb;49(2):150-154.

The Effect of Tamsulosin and Nifedipine on Expulsion of Ureteral Stones after Extracorporeal Shock Wave Lithotripsy

• Choi NY
• Ahn SH
• Han JH
• Jang IH

Abstract

PURPOSE
We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith- 3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room(ER) visits for pain control. RESULTS: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1(84.4%) compared with group 3(60.6%)(p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate(94.1%) than those of group 3(66.7%)(p=0.042). There was no difference in stone expulsion rates between group 2(67.7%) and group 3(60.6%). CONCLUSIONS: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones.

Keyword

Ureteral stones; Extracorporeal shockwave lithotripsy; Tamsulosin; Nifedipine

MeSH Terms

Benzilates
Emergencies
Humans
Lithotripsy
Nifedipine
Nortropanes
Shock
Sulfonamides
Ureter
Benzilates
Nifedipine
Nortropanes
Sulfonamides

Reference

1. Parmar MS. Kidney stones. BMJ. 2004. 328:1420–1424.

2. Peschel R, Janetschek G, Bartsch G. Extracorporeal shock wave lithotripsy versus ureteroscopy for distal ureteral calculi: a prospective randomized study. J Urol. 1999. 162:1909–1912.

3. Lingeman JE. Extracorporeal shock wave lithotripsy. Development, instrumentation, and current status. Urol Clin North Am. 1997. 24:185–211.

4. Ehreth JT, Drach GW, Arnett ML, Barnett RB, Govan D, Lingeman J, et al. Extracorporeal shock wave lithotripsy: multicenter study of kidney and upper ureter versus middle and lower ureter treatment. J Urol. 1994. 152:1379–1385.

5. Muslumanoglu AY, Tefekli A, Sarilar O, Binbay M, Altunrende F, Ozkuvanci U. Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis. J Urol. 2003. 170:2405–2408.

6. Lotan Y, Gettman MT, Roehrborn CG, Cadedde JA, Pearle MS. Management of ureteral calculi: a cost comparison and decision making analysis. J Urol. 2002. 167:1621–1629.

7. Pace KT, Weir MJ, Tariq N, Honey RJ. Low success rate of repeat shock wave lithotripsy for ureteral stones after failed initial treatment. J Urol. 2000. 164:1905–1907.

8. Anderson KR, Keetch DW, Albala DM, Chandhoke PS, McClennan BL, Clayman RV. Optimal therapy for the distal ureteral stone: extracorporeal shock wave lithotripsy versus ureteroscopy. J Urol. 1994. 152:62–65.

9. Porpiglia F, Ghignone G, Fiori C, Fontana D, Scarpa RM. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol. 2004. 172:568–571.

10. Hussain Z, Inman RD, Eleves AW, Shipstone DP, Ghiblawi S, Coppinger SW. Use of glyceryl trinitrate patches in patients with ureteral stones: a randomized, double-blind, placebo-controlled study. Urology. 2001. 58:521–525.

11. Han MC, Jeong WS, Shin BS. Additive expulsion effect of tamsulosin after shock wave lithotripsy for upper ureteral stones. Korean J Urol. 2006. 47:813–817.

12. Chaussy C, Brendel W, Schmiedt E. Extracorporeally induced destruction of kidney stones by shock waves. Lancet. 1980. 2:1265–1268.

13. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral stones Clinical Guidelines Panel summary report on the management of ureteral calculi. The American Urological Association. J Urol. 1997. 158:1915–1921.

14. Scarpa RM, De Lisa A, Porru D, Usai E. Holmium:YAG laser lithotripsy. Eur Urol. 1999. 35:233–238.

15. Porpiglia F, Destefanis P, Fiori C, Fontana D. Effectiveness of nifedifine and deflazacort in the management of distal ureter stones. Urology. 2000. 56:579–582.

16. Cooper JT, Stack GM, Cooper TP. Intensive medical management of ureteral calculi. Urology. 2000. 56:575–578.

17. Morita T, Wada I, Saeke H, Tsuchida S, Weiss RM. Ureteral urine transport: changes in bolus volume, peristaltic frequency, intraluminal pressure and volume of flow resulting from autonomic drugs. J Urol. 1987. 137:132–135.

18. Morita T, Ando M, Kihara K, Oshima H. Function and distribution of autonomic receptors in canine ureteral smooth muscle. Neurourol Urodyn. 1994. 13:315–321.

19. Obara K, Takeda M, Shimura H, Kanai T, Tshutsui T, Komeya-ma T, et al. Alpha-1 adrenoreceptor subtypes in the human ureter: characterization by RT-PCR and in situ hybridization. J Urol. 1996. 155:Suppl. 472A. abstract 646.

20. Micali S, Grande M, Sighinolfi C, De Stefani S, Bianchi G. Efficacy of expulsive therapy using nifedipine or tamsulosin, both associated with ketoprofene, after shock wave lithotripsy of ureteral stones. Urol Res. 2007. 35:133–137.

21. Lam JS, Greene TD, Grupta M. Treatment of proximal ureteral calculi: holmium:YAG laser ureterolithotripsy vursus extracorporeal shock wave lithotripsy. J Urol. 2002. 167:1972–1976.

22. Porpiglia F, Destefanis P, Fiori C, Scarpa RM, Fontana D. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology. 2002. 59:835–838.