Efficiency of Tamsulosin after Shockwave Lithotripsy for the Treatment of Lower Ureteric Stone: Alkaramah Teaching Hospital Experience, Iraq

Yarub Fadhil Hussein¹, Basim Jasim Abdulhussein², Abdulsalam Hatem Nawar¹, Redhwan Ahmed Al-Naggar³

¹Department of Urology, Al Karamaha Teaching Hospital, Karkh, Baghdad, Iraq.
²Department of Surgery, Al Karamaha Teaching Hospital, Karkh, Baghdad, Iraq.
³Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia.

DOI: 10.4236/oju.2015.55011                

Abstract

Background: Stone disease is a wide health problem; certain drugs have been used as supplement with ESWL for the treatment of symptomatic uncomplicated lower ureteric stone like Nefidipine, Alfuzosin and Tamsulosin. The purpose of this study is to evaluate the efficacy of Tamsulosin for the treatment of lower ureteric stone of 5 - 10 mm diameter after ESWL. Methods: A total of 105 patients with lower ureteric stone of less than 10 mm diameters were divided into two groups. Group 1 including 48 patients received 0.4 mg Tamsulosin and diclofenac sodium analgesia as needed immediately after ESWL and continued until stone expulsion was confirmed up to maximum of 30 days. Group 2 including 47 patients was given diclofenac sodium only as needed after ESWL. Result: 46 of 49 patients in group 1 and 44 of 48 patients in group 2 ultimately passed stones. The number of ESWL sessions was 1.4 ± 0.6 in group 1 & 1.42 ± 0.75 in group 2. There were 10 patients who needed analgesia after ESWL in group 1 and 17 patients in group 2. Visual analogue scale pain severity score was 5.32 ± 1.23 and 6.41 ± 1.26 in group 1 and 2, respectively. The time to stone expulsion in group 1 and 2 was 8 ± 5.4 days and 12 ± 10.3 days, respectively. No significant complications or side effects occurred. Conclusion: The use of Tamsulosin in combination with ESWL in patients with lower ureteric stone of 5 - 10 mm was effective for reducing the time to stone expulsion, decreasing need for analgesia, and facilitating stone passage without significant improvement in stone free rate.

Keywords

Tamsulosin, Shockwave, Lithotripsy, Ureteric Stone, Iraq

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Segura, J.W., Preminger, G.M., Assimos, D.G., Dretler, S.P., Kahn, R.I., Lingeman, J.E., et al. (1997) Ureteral Stones Clinical Guidelines Panel Summary Report on the Management of Ureteral Calculi. The Journal of Urology, 158, 1915-1921. http://dx.doi.org/10.1016/S0022-5347(01)64173-9
[2]	Lam, J.S., Greene, T.D. and Gupta, M. (2002) Treatment of Proximal Ureteral Calculi:Holmium:YAG Laser Ureterolithotripsy versus Extracorporeal Shock Wave Lithotripsy. The Journal of Urology, 167, 1972-1976.http://dx.doi.org/10.1016/S0022-5347(05)65065-3
[3]	Dellabella, M., Milanese, G. and Muzzonigro, G. (2003) Efficacy of Tamsulosin in the Medical Management of Juxtavesical Ureteral Stones. The Journal of Urology, 170, 2202-2205. http://dx.doi.org/10.1097/01.ju.0000096050.22281.a7
[4]	Dellabella, M., Milanese, G. and Muzzonigro, G. (2005) Randomized Trial of the Efficacy of Tamsulosin, Nifedipine and Phloroglucinol in Medical Expulsive Therapy for Distal Ureteral Calculi. The Journal of Urology, 174, 167-172.http://dx.doi.org/10.1097/01.ju.0000161600.54732.86
[5]	Cervenakov, I., Fillo, J., Mardiak, J., Kopecnú, M., Smirala, J. and Labas, P. (2002) Speedy Elimination of Ureterolithiasis in Lower Part of Ureters with the Alpha 1-Blocker-Tamsulosin. International Urology and Nephrology, 34, 25-29. http://dx.doi.org/10.1023/A:1021368325512
[6]	Yilmaz, E., Batislam, E., Basar, M.M., Tuglu, D., Ferhat, M. and Basar, H. (2005) The Comparison and Efficacy of 3 Different α1-Adrenergic Blockers for Distal Ureteral Stones. The Journal of Urology, 173, 2010-2012. http://dx.doi.org/10.1097/01.ju.0000158453.60029.0a
[7]	Küpeli, B., Irkilata, L., Gürocak, S., Tunç, L., Kiraç, M., Karaoglan, ü., et al. (2004) Does Tamsulosin Enhance Lower Ureteral Stone Clearance with or without Shock Wave Lithotripsy? Urology, 64, 1111-1115. http://dx.doi.org/10.1016/j.urology.2004.07.020
[8]	Hawker, G.A., Mian, S., Kendzerska, T. and French, M. (2011) Measures of Adult Pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), Mcgill Pain Questionnaire (MPQ), Short-Form Mcgill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care & Research, 63, S240-S252.http://dx.doi.org/10.1016/j.urology.2004.07.020
[9]	Kobayashi, M., Naya, Y., Kino, M., Awa, Y., Nagata, M., Suzuki, H., et al. (2008) Low Dose Tamsulosin for Stone Expulsion after Extracorporeal Shock Wave Lithotripsy: Efficacy in Japanese Male Patients with Ureteral Stone. International Journal of Urology, 15, 495-498. http://dx.doi.org/10.1111/j.1442-2042.2008.02033.x
[10]	Resim, S., Ekerbicer, H.C. and Ciftci, A. (2005) Role of Tamsulosin in Treatment of Patients with Steinstrasse Developing after Extracorporeal Shock Wave Lithotripsy. Urology, 66, 945-948. http://dx.doi.org/10.1016/j.urology.2005.05.029
[11]	Falahatkar, S., Khosropanah, I., Vajary, A.D., Bateni, Z.H., Khosropanah, D. and Allahkhah, A. (2011) Is There a Role for Tamsulosin after Shock Wave Lithotripsy in the Treatment of Renal and Ureteral Calculi? Journal of Endourology, 25, 495-498. http://dx.doi.org/10.1089/end.2010.0439
[12]	Wang, H.J., Liu, K., Ji, Z.G. and Li, H.Z. (2010) Effect of α1-Adrenergic Antagonists on Lower Ureteral Stones with Extracorporeal Shock Wave Lithotripsy. Asian Journal of Surgery, 33, 37-41. http://dx.doi.org/10.1016/S1015-9584(10)60007-3
[13]	Gravas, S., Tzortzis, V., Karatzas, A., Oeconomou, A. and Melekos, M. (2007) The Use of Tamsulozin as Adjunctive Treatment after ESWL in Patients with Distal Ureteral Stone: Do We Really Need It? Urological Research, 35, 231-235. http://dx.doi.org/10.1007/s00240-007-0106-4
[14]	Richardson, C.D., Donatucci, C.F., Page, S.O., Wilson, K.H. and Schwinn, D.A. (1997) Pharmacology of Tamsulosin: Saturation-Binding Isotherms and Competition Analysis Using Cloned α1-Adrenergic Receptor Subtypes. The Prostate, 33, 55-59. http://dx.doi.org/10.1002/(SICI)1097-0045(19970915)33:1<55::AID-PROS9>3.0.CO;2-8
[15]	Roehrborn, C., Van Kerrebroeck, P. and Nordling, J. (2003) Safety and Efficacy of Alfuzosin 10 mg Once-Daily in the Treatment of Lower Urinary Tract Symptoms and Clinical Benign Prostatic Hyperplasia: A Pooled Analysis of Three Double-Blind, Placebo-Controlled Studies. BJU international, 92, 257-261.http://dx.doi.org/10.1046/j.1464-410X.2003.04309.x
[16]	Höfner, K. and Jonas, U. (2002) Alfuzosin: A Clinically Uroselective α1-Blocker. World Journal of Urology, 19, 405- 412. http://dx.doi.org/10.1007/s00345-002-0244-9
[17]	Lepor, H. (1998) Phase III Multicenter Placebo-Controlled Study of Tamsulosin in Benign Prostatic Hyperplasia. Urology, 51, 892-900. http://dx.doi.org/10.1016/S0090-4295(98)00126-5
[18]	Narayan, P. and Bruskewitz, R. (2000) A Comparison of Two Phase III Multicenter, Placebo-Controlled Studies of Tamsulosin in BPH. Advances in Therapy, 17, 287-300. http://dx.doi.org/10.1007/BF02850012
[19]	Nasu, K., Moriyama, N., Fukasawa, R., Tsujimoto, G., Tanaka, T., Yano, J., et al. (1998) Quantification and Distribution of α1-Adrenoceptor Subtype mRNAs in Human Proximal Urethra. British Journal of Pharmacology, 123, 1289-1293. http://dx.doi.org/10.1038/sj.bjp.0701731
[20]	Giuliano, F., Allard, F., McKenna, K., Jardin, A., Benoit, G. and Bernabe, J. (2002) Tamsulosin Has More Deleterious Effects than Alfuzosin on Parameters Characterizing Ejaculation in Anaesthetized Rats. International Journal of Impotence Research, 14, S12.