ROLE OF ALPHA-1 BLOCKER IN EXPULSION OF STONE FRAGMENTS AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR RENAL STONES

Authors

  • Abdul Jabbar Pirzada
  • Adeel Anwar
  • Atif Javed
  • Imran Memon
  • Ariz Mohammad

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 wavelithotripsy (ESWL), uretero-renoscopy (URS), and percutaneous nephrostolithotomy (PCNL).Recently, medical expulsion therapy (MET) has been investigated as a supplement to observation in aneffort to improve spontaneous stone passage rates. Patients and Methods: This study was arandomized, controlled, prospective study to determine whether the administration of Alpha-1-adrenergic receptor antagonists as an adjunctive medical therapy, increases the efficacy of ESWL totreat renal stones. Sixty patients with renal stones of 0.5–1.5 Cm in size (average size 1.2 Cm) wereincluded in this study underwent ESWL followed by administration of Alpha-1-adrenergic receptorantagonists 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 receivedconventional treatment Diclofenac sodium, Anti Spasmodic (Drotverine HCl) as required and ProtonPump inhibitor (Omeprazole 20 mg) once daily after shock wave lithotripsy. In group B patientsreceived alpha-1 blocker, Alfuzosin HCl 5 mg twice daily in addition to conventional treatment. Allpatients were instructed to drink a minimum of 2 litres water daily. Ultrasound guided Dornier AlphaImpact Lithotripter was utilised for shock wave lithotripsy. Results: Of the 60 patients, 76.7% of thosereceiving Alfuzosin and 46.7% of controls had achieved clinical success at 1 month (p=0.01). Themean cumulative diclofenac dose was 485 mg per patient in the Alfuzosin group and 768 mg perpatient 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 alonefor the treatment of patients with large renal stones and is equally safe. It increases the expulsion ratesof stones, decreases time to expulsion, and decreases need for analgesia during stone passage.Keywords: Alpha-blockers, Ureteral stones, Kidney stones, ESWL

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Published

2011-06-01