ROLE OF ALPHA-1 BLOCKER IN EXPULSION OF STONE FRAGMENTS AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR RENAL STONES
Abstract
Background: Renal stone disease is a significant and worldwide health problem. Recent advances instone management have allowed kidney stones to be treated using extracorporeal shock wave
lithotripsy (ESWL), uretero-renoscopy (URS), and percutaneous nephrostolithotomy (PCNL).
Recently, medical expulsion therapy (MET) has been investigated as a supplement to observation in an
effort to improve spontaneous stone passage rates. Patients and Methods: This study was a
randomized, controlled, prospective study to determine whether the administration of Alpha-1-
adrenergic receptor antagonists as an adjunctive medical therapy, increases the efficacy of ESWL to
treat renal stones. Sixty patients with renal stones of 0.5-1.5 Cm in size (average size 1.2 Cm) were
included in this study underwent ESWL followed by administration of Alpha-1-adrenergic receptor
antagonists at department of Urology Liaquat National Hospital Karachi from Feb 2008 to Sept 2008.
This was a comparative study and patients were divided into two groups. In group A patients received
conventional treatment Diclofenac sodium, Anti Spasmodic (Drotverine HCl) as required and Proton
Pump inhibitor (Omeprazole 20 mg) once daily after shock wave lithotripsy. In group B patients
received alpha-1 blocker, Alfuzosin HCl 5 mg twice daily in addition to conventional treatment. All
patients were instructed to drink a minimum of 2 litres water daily. Ultrasound guided Dornier Alpha
Impact Lithotripter was utilised for shock wave lithotripsy. Results: Of the 60 patients, 76.7% of those
receiving Alfuzosin and 46.7% of controls had achieved clinical success at 1 month (p=0.01). The
mean cumulative diclofenac dose was 485 mg per patient in the Alfuzosin group and 768 mg per
patient in the control group (p=0.002). This difference was statistically significant. Conclusion:
Alfuzosin therapy as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone
for the treatment of patients with large renal stones and is equally safe. It increases the expulsion rates
of stones, decreases time to expulsion, and decreases need for analgesia during stone passage.
Keywords: Alpha-blockers, Ureteral stones, Kidney stones, ESWL
References
Gravina G L, Costa A M, Ronchi P, Galatioto G P, Angelucci A,
Castellani D, et al. Tamsulosin treatment increases clinical
success rate of single extracorporeal shock wave lithotripsy of
renal stones. Urology 2005;66:24-8.
Chaussy C, Schiedt, Jocham D, Brendel W, Forssmann B,
Walther V. First Clinical experience with extracorporeal induced
destruction of kidney stones by shock waves. J Urol
;127:417-9.
Newsame JE, Rintoul RF. The kidney, adrenal and ureter.
Farquharson's text book of operative surgery. 7th ed. New York
(NY): Churchill Livingstone; 1986.p 528-73.
Marshall FF, Weiskopf F, Singh A, Mark F, Leo F, Sanders R, et
al. A prototype device for nomimmersion shock wave lithotripsy
using ultrasonography for calculus localization. J Urol
;140:249-53.
Khan FA. Basic data on urinary stones in Pakistan. Bulletin
;12:79-83.
Conort P, Dore B, Saussine C. Guidelines for the urological
management of renal and ureteric stones in adults. Prog Urol
;14:1095-102.
Bajwa IA, Mahmood S, Ahmad I, Hussain S. In Situ
Extracorporeal Shock Wave Lithotripsy in the Management of
Ureteric Calculi. Ann King Edward Med Coll 2002;8:113-6.
Malin JM, Deane RF, Boyarsky S. Characterisation of adrenergic
receptors in human ureter. Br J Urol 1970;42:171-4.
Hollingsworth JM, Rogers MA, Kaufman SR, Bradford TJ, Saint
S, Wei JT, et al. Medical therapy to facilitate urinary stone
passage: a meta-analysis. Lancet 2006;368:1171-9.
Teichman JM Clinical practice. Acute renal colic from ureteral
calculus. N Engl J Med 2004;350(7):684-93.
Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin
in the medical management of juxtavesical ureteral stones. J Urol
;170:2202.
Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive
therapy for distal ureterolithiasis: randomized prospective study
on role of corticosteroids used in combination with tamsulosinsimplified treatment regimen and health-related quality of life.
Urology 2005;66:712.
Lepor H. Advances in Alpha-Blocker Therapy in the
Management of Urological Disorders Rev Urol 2006;8(4):S1-2.
Kupeli B, Irkilata L, Gurocak S, Tunc L, Kirac M, Karaoglan U, et
al. Does tamsulosin enhance lower ureteral stone clearance with or
without shock wave lithotripsy? Urology 2004;65:1111-5.
Gravina GL, Costa AM, Ronchi P, Galatioto GP, Angelucci A,
Castellani D, et al. Tamsulosin treatment increases clinical
success rate of single extracorporeal shock wave lithotripsy of
renal stones. Urology 2005;66:24-8.
Deliveliotis C, Chrisofos M, Gougousis E, Papatsoris A, Dellis
A, Varkarakis IM. Is there a role for alpha1-blockers in treating
double-J stent-related symptoms? Urology 2006;67:35-9.
J Ayub Med Coll Abbottabad 2011;23(2)
http://www.ayubmed.edu.pk/JAMC/23-2/Pirzada.pdf 129
Coll DM, Varanelli MJ, Smith RC: Relationship of spontaneous
passage of ureteral calculi to stone size and location as revealed
by unenhanced helical CT. AJR Am J Roentgenol 2002;178:101.
Borghi L, Meschi T, Amato F, Novarini A, Giannini A,
Quarantelli C, et al. Nifedipine and methylprednisolone in
facilitating ureteral stone passage. J Urol 1994;152:1095-8.
Blair B, Fabrizio M. Pharmacology for renal calculi. Expert Opin
Pharmacother 2000;1:435-41.
Cervenakov I, Fillo J, Mardiak J. Speedy elimination of
ureterolithiasis in lower part of ureter with the alpha-1-blockertamsulosin. Int Urol Nephrol 2002;34:25-9.
Sigala S, Dellabella M, Milanese G, Fornari S, Faccoli S,
Palazzolo F, et al. Evidence for the presence of alpha1
adrenoceptor subtypes in the human ureter. Neurourol
Urodynamics. 2005;24:142-8.
Lingeman JE, Siegel YI, Steele B, Nyhuis AW, Woods JR.
Management of lower pole nephrolithiasis: a critical analysis. J
Urol 1994;151:663-7.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
