Tamsulosin Facilitates Earlier Clearance of Stone Fragments and Reduces Pain After Shockwave Lithotripsy for Renal Calculi: Results From an Open-Label Randomized Study

• Published in: Urology (Ridgewood, N.J.) Vol. 72; no. 5; pp. 1006 - 1011
• Main Authors: Naja, Vineet, Agarwal, Mayank Mohan, Mandal, Arup K, Singh, Shrawan K, Mavuduru, Ravimohan, Kumar, Santosh, Acharya, Naveen C, Gupta, Nitin
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2008; Elsevier Science
• Subjects: Adrenergic alpha-Antagonists - therapeutic use; Aged; Biological and medical sciences; Female; Follow-Up Studies; Humans; Kidney Calculi - therapy; Lithotripsy - adverse effects; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Pain - etiology; Pain - prevention & control; Pain Measurement; Prospective Studies; Sulfonamides - therapeutic use; Treatment Outcome; Urinary lithiasis; Urology; Kidney disease; Nephrology; Urinary system disease; α1-Adrenergic receptor; Instrumentation therapy; Clearance; Fragment; Shock wave; Urology; Urinary stone; Fragmentation; Randomization; Tamsulosin; Alpha blocking agent; Pain; Renal lithiasis; Sulfonamides; Lithotripsy; Antagonist
• DOI: 10.1016/j.urology.2008.05.035
• ISSN: 0090-4295

Objectives To evaluate the role of tamsulosin in the clearance of fragments after extracorporeal shock wave lithotripsy (ESWL) to treat renal calculi. Methods In this open-label prospective randomized study conducted at our institute from 2006 to 2007, 139 patients with normal renal function and a single radiopaque renal calculus, 5-20 mm, undergoing ESWL were enrolled. All patients underwent ESWL every 3 weeks until success or for ≤3 months, whichever was earlier. They were randomly assigned to 2 groups with respect to whether they had received tamsulosin, 0.4 mg/d. The primary endpoint was the success rate, and the secondary endpoints were clearance time, sessions required for clearance, pain intensity, incidence of steinstrasse, and the need for auxiliary procedures. Results Of the 139 patients, 51 in group 1 and 65 in group 2 completed the requisite follow-up. The demographic profile of both groups was comparable. The success rate after 1, 2, and 3 ESWL sessions was greater in group 1 than in group 2 (52.9%, 78.4%, and 94.1% vs 30.8%, 52.3%, and 75.4%; P = .016, P = .004, and P = .007, respectively). The total days required for success (35.53 ± 19.47 vs 47.22 ± 23.64; P = .006), total ESWL sessions required for success (1.66 vs 2.16; P = .005), and the pain experienced (visual analog scale score 28.67 ± 20.35 vs 47.30 ± 24.98, respectively; P = .0001) were significantly less in group 1. Two patients in group 1 and 9 in group 2 developed steinstrasse ( P = .10); conservative management was successful in 1 patient in each group ( P = .345). Three patients in group 1 and 10 in group 2 required auxiliary procedures ( P = .14). Conclusions The results of our study have shown that tamsulosin facilitates earlier clearance of fragments after ESWL to renal calculi and helps reduce the severity of the pain. It tended to facilitate spontaneous clearance of steinstrasse; however, this requires additional evaluation.