Alfuzosin Stone Expulsion Therapy For Distal Ureteral Calculi: A Double-Blind Placebo-Controlled Study

Main Category: Urology / Nephrology
Also Included In: Clinical Trials / Drug Trials
Article Date: 19 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - Medical expulsive therapy for the management of distal ureteral calculi has been shown in several randomized controlled trials to decrease the time to stone expulsion and to increase the stone passage rate.

In a new study with the alpha blocker alfuzosin, Pedro and colleagues from Minnesota performed a randomized controlled double blind study to evaluate the efficacy of alfuzosin for medical expulsive therapy for distal ureteral stone passage. They evaluated 76 patients with a distal ureteral calculus <8mm in largest diameter. Clinical follow up was done on a weekly basis and was continued until the patient was rendered stone free. Blood pressure, level of discomfort, stone position on imaging, medication compliance, and any adverse events were assessed in the patients. The authors found the overall rate of spontaneous stone passage to be 75%, (77.1% placebo, 73.5% alfusozin, p=0.83). The mean time (days) to pass the stone was 8.54±6.99 placebo versus 5.19±4.82 alfuzosin (p=0.003).

There was no difference in the stone size or volume passed spontaneously between the placebo and alfuzosin arms as measured at baseline CT scan (4.08±1.17 mm vs. 3.83±0.95 mm, p 0.46) and by digital caliper after stone expulsion (3.86±1.76 mm vs. 3.91±1.06 mm, p=0.57). Comparing the improvement from the baseline pain score, the alfuzosin arm experienced a greater drop in pain score in the days after the initial ER visit to date of passage of stone (p 0.0005). Four patients (12%) in the alfuzosin arm reported minor side effects including dizziness and transient orthostatic hypotension.

The authors' finding that alfuzosin improves patient discomfort, decreases the time to stone passage, but does not increase the rate of spontaneous stone passage is interesting in that other authors have shown an improvement in the rate of spontaneous stone passage with tamsulosin.

There has been one study that has evaluated several different alpha blockers for medical expulsive therapy and they concluded that although all alpha blockers improve stone passage compared to placebo, tamsulosin was better tolerated.

Presented by Renato N Pedro, MD, et al., at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Michael K. Louie, MD

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