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Kim, Cho, and Lee: Effect of Tamsulosin on the Expected Treatment of Upper and Lower Ureteral Stones
Original Article

Korean J Urol 2007;48(7):724-730.

Published online: 20 January 2007

DOI: https://doi.org/10.4111/kju.2007.48.7.724

Effect of Tamsulosin on the Expected Treatment of Upper and Lower Ureteral Stones

Jin Wook Kim, Dae Youn Cho, Jeong Gu Lee

From the Department of Urology, Korea University College of Medicine, Seoul, Korea

고려대학교 안암병원 비뇨기과 서울특별시 성북구 안암동 5가 126-1 ? 136-705 TEL: 02-920-5367 FAX: 02-928-7864 E-mail: jeongkl@korea. ac.kr

Received 27 February 2007       Accepted 16 May 2007

Copyright © 2007 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We evaluated the effect of tamsulosin on upper and lower ureteral stones that were smaller than 10mm to identify the patient groups for which tamsulosin was most applicable.

Materials and Methods

85 patients who were diagnosed with ureteral stones smaller than 10mm in size were enrolled in this randomized prospective study. The patients were diagnosed via intravenous pyelography and then they were followed with weekly plain abdomen films for 4 weeks. The control group (Group 1) was given an nonsteroidal antiinflammatory drug (NSAID) for pain medication, and they were instructed to ingest at least 2l of fluids daily. For the treatment group (Group 2) once daily 0.2mg tamsulosin was added. Both groups were compared for the size of stone and the days to expulsion and pain control, based upon the number of emergency room (ER) visits. The proximal and distal ureteral stones were separately evaluated, and the patients' gender, age, stone size and stone position were analyzed to identify treatment efficacy.

Results

The average stone size was 5.2±2.6mm in group 1 and 4.7±1.5mm in group 2 (p=0.344). The success rate was 42.9% in group 1 and 76.5% in group 2 (p=0.005). Group 2 showed a significant reduction for the time to stone expulsion at 12.7±6.6 days compared to 18.5±6.9 days for group 1 (p=0.008). Among the subset of patients, those with distal ureteral stones smaller than 5mm alone showed a significant increase in the expulsion rate (100%, p=0.047) and a decrease of the days to expulsion (12.1±5.1 days, p=0.018).

Conclusions

Tamsulosin increases the spontaneous expulsion rate and reduces the time to expulse ureteral stones, and it was most effective for distal stones less than 5mm in size.

Keywords: Urinary calculi, Treatment, Tamsulosin

References

1. Tiselius HG. Epidemiology and medical management of stone disease. BJU Int. 2003; 91:758–67.
crossref
2. Pak CY. Kidney stones. Lancet. 1998; 351:1797–801.
crossref
3. Carstensen HE, Hansen TS. Stones in ureter. Acta Chir Scand. 1973; 433(Suppl):66–71.
4. 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; 158:1915–21.
5. Sowter SJ, Tolley DA. The management of ureteric colic. Curr Opin Urol. 2006; 16:71–6.
crossref
6. Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide to patient education. J Urol. 1999; 162:688–90.
7. Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M, et al. Guidelines on urolithiasis. Eur Urol. 2001; 40:362–71.
8. Malin JM Jr, Deane RF, Boyarsky S. Characterisation of adrenergic receptors in human ureter. Br J Urol. 1970; 42:171–4.
9. Porpiglia F, Destefanis P, Fiori C, Fontana D. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology. 2000; 56:579–82.
crossref
10. Saita A, Bonaccorsi A, Marchese F, Condorelli SV, Motta M. Our experience with nifedipine and prednisolone as expulsive therapy for ureteral stones. Urol Int. 2004; 72:43–5.
crossref
11. Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urology. 2005; 66:712–5.
crossref
12. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol. 2003; 170:2202–5.
crossref
13. Porpiglia F, Ghignone G, Fiori C, Fontana D, Scarpa RM. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol. 2004; 172:568–71.
crossref
14. Kim HH, Noh JH. Comparison of cost and clinical outcome for ureteral stones larger than 1cm; extracorporeal shock wave lithotripsy versus ureteroscopic lithotripsy. Korean J Urol. 2005; 46:1141–6.
15. Lotan Y, Gettman MT, Roehrborn CG, Cadeddu JA, Pearle MS. Management of ureteral calculi: a cost comparison and decision making analysis. J Urol. 2002; 167:1621–9.
crossref
16. Ahmad M, Chaughtai MN, Khan FA. Role of prostaglandin synthesis inhibitors in the passage of ureteric calculus. J Pak Med Assoc. 1991; 41:268–70.
17. Hussain Z, Inman RD, Elves AW, Shipstone DP, Ghiblawi S, Coppinger SW. Use of glyceryl trinitrate patches in patients with ureteral stones: a randomized, double-blind, placebocontrolled study. Urology. 2001; 58:521–5.
crossref
18. Lang RJ, Exintaris B, Teele ME, Harvey J, Klemm MF. Electrical basis of peristalsis in the mammalian upper urinary tract. Clin Exp Pharmacol Physiol. 1998; 25:310–21.
crossref
19. Morita T, Wada I, Saeki 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; 137:132–5.
crossref
20. Lennon GM, Thornhill JA, Grainger R, McDermott TE, Butler MR. Double pigtail ureteric stent versus percutaneous nephrostomy: effects on stone transit and ureteric motility. Eur Urol. 1997; 31:24–9.
21. Lee JZ, Tillig B, Perkash I, Constantinou CE. Effect of alpha 1 adrenoceptor antagonist on the urodynamics of the upper and lower urinary tract of the male rat. Neurourol Urodyn. 1998; 17:213–29.
22. Sigala S, Dellabella M, Milanese G, Fornari S, Faccoli S, Palazzolo F, et al. Evidence for the presence of alpha 1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn. 2005; 24:142–8.
23. Davenport K, Timoney AG, Keeley FX. A comparative in vitro study to determine the beneficial effect of calcium-channel and alpha 1 adrenoceptor antagonism on human ureteric activity. BJU Int. 2006; 98:651–5.
24. Cervenakov I, Fillo J, Mardiak J, Kopecny M, Smirala J, Lepies P. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker tamsulosin. Int Urol Nephrol. 2002; 34:25–9.
25. Han MC, Park YY, Shim BS. Effect of tamsulosin on the expectant treatment of lower ureteral stones. Korean J Urol. 2006; 47:708–11.
crossref
26. Beach MA, Mauro LS. Pharmacologic expulsive treatment of ureteral calculi. Ann Pharmacother. 2006; 40:1361–8.
crossref

Table 1.
Patient characteristics at the initial diagnosis
  Group p-value
  Control (n=42) Tamsulosin (n=34)
Age (years)      
Overall 45.7±13.8 40.7±11.1 0.089
Proximal 47.2±16.4 36.5±14.0 0.051
Distal 44.2±10.4 43.3±8.1 0.767
Men/Women (number)∗      
Overall 24/18 24/10 0.224
Proximal 13/9 11/2 0.150
Distal 11/9 13/8 0.756
Stone location∗      
Rt/Lt 23/19 15/19 0.489
Proximal/Distal 22/20 13/21 0.253
Stone size (mm)      
Overall 5.2±2.9 4.7±1.5 0.344
Proximal 4.6±2.8 4.6±1.3 0.972
Distal 5.9±2.9 4.8±1.6 0.150

∗ Fisher's exact test

Table 2.
Comparison of results between the control and tamsulosin groups
  Group p-value
Control (n=42) Tamsulosin (n=34)
Stone expulsion rate (%)∗      
Overall 18/42 (42.9) 26/34 (76.5) 0.005
Proximal 6/22 (27.3) 7/13 (53.8) 0.157
Distal 12/20 (60.0) 19/21 (90.5) 0.032
Mean days of stone expulsion      
Overall 18.5±6.9 12.7±6.6 0.008
Proximal 20.2±6.5 17.2±6.0 0.383
Distal 17.3±6.7 12.2±6.1 0.025
ER visit for pain control (times)      
Overall 0.9±0.6 0.9±0.5 0.893
Proximal 0.9±2.7 1.1±0.5 0.406
Distal 1.0±0.5 0.8±0.5 0.384

ER: emergency room. ∗Fisher's exact test

Table 3.
Comparison of results between the control and tamsulosin groups for proximal ureter stones
  Group p-value
Control (n=22) Tamsulosin (n=13)
Stone expulsion rate (%)∗      
Male 4/13 (30.8) 5/11 (45.5) 0.675
Female 2/9 (22.2) 2/2 (100) 0.109
Right 5/12 (41.7) 2/4 (50.0) 1.000
Left 1/10 (10.0) 5/9 (55.6) 0.057
Age＞50 2/6 (33.3) 0/1 (0.0) 1.000
Age≤50 4/16 (25.0) 7/12 (58.3) 0.121
Size＞5mm 0/7 (0.0) 1/4 (25.0) 0.364
Size≤5mm 6/15 (40.0) 6/9 (66.7) 0.400
Mean days to stone expulsion      
Male 22.0±7.0 19.0±6.7 0.515
Female 16.5±5.0 13.7±1.5 0.564
Right 17.5±3.5 16.0±5.5 0.738
Left 21.5±7.7 19.7±7.4 0.764
Age＞50 17.3±9.7 N/A N/A
Age≤50 20.2±6.5 17.2±4.4 0.372
Size＞5mm 28.0±2.1 15.5±0.0 0.130
Size≤5mm 18.6±5.9 17.7±6.8 0.819
ER visit for pain control (times)      
Male 0.9±0.6 1.1±0.5 0.406
Female 0.9±0.6 1.0±0.0 0.808
Right 0.9±0.7 1.3±0.5 0.380
Left 0.9±0.6 1.0±0.5 0.690
Age＞50 0.8±0.8 2.0±0.0 0.211
Age≤50 0.9±0.6 1.0±0.4 0.754
Size＞5mm 1.0±0.0 1.0±0.8 1.000
Size≤5mm 0.9±0.7 1.1±0.3 0.283

ER: emergency room. ∗Fisher's exact test

Table 4.
Comparison of results between the control and tamsulosin groups for distal ureter stones
  Group p-value
Control (n=20) Tamsulosin (n=21)
Stone expulsion rate (%)∗      
Male 6/11 (54.5) 12/13 (92.3) 0.061
Female 6/9 (66.7) 7/8 (87.5) 0.576
Right 6/11 (54.5) 10/11 (90.9) 0.149
Left 6/9 (66.7) 9/10 (90.0) 0.303
Age＞50 2/5 (40.0) 4/5 (80.0) 0.524
Age≤50 10/15 (66.7) 15/16 (93.8) 0.083
Size＞5mm 6/11 (54.5) 5/7 (71.4) 0.637
Size≤5mm 6/9 (66.7) 14/14 (100.0) 0.047
Mean days to stone expulsion      
Male 16.3±6.3 11.3±5.5 0.074
Female 19.0±7.6 13.3±7.2 0.172
Right 19.2±7.6 12.1±6.2 0.049
Left 15.2±5.3 12.3±6.5 0.316
Age＞50 12.0±4.8 11.3±5.5 0.844
Age≤50 18.7±6.6 12.5±6.5 0.021
Size＞5mm 13.0±7.6 12.2±7.1 0.856
Size≤5mm 18.9±6.0 12.1±5.1 0.018
ER visit for pain control (times)      
Male 0.8±0.4 1.0±0.4 0.287
Female 1.1±0.6 0.5±0.5 0.044
Right 1.1±0.5 0.8±0.6 0.277
Left 0.8±0.4 0.8±0.4 0.912
Age＞50 1.0±0.0 0.8±0.4 0.347
Age≤50 0.9±0.6 0.8±0.5 0.559
Size＞5mm 0.9±0.3 0.4±0.5 0.060
Size≤5mm 1.0±0.7 1.0±0.4 1.000

ER: emergency room. ∗Fisher's exact test

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