Stone Disease: ESWL And Invasive Therapy, Including Ureteroscopy

Main Category: Urology / Nephrology
Article Date: 23 Jun 2008 - 1:00 PDT

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ORLANDO, FL (UroToday.com) - Taken together, the three following abstracts support the use of an alpha blocker for myriad ureteral conditions: indwelling stents, ureteroscopic lithotripsy, and shock wave lithotripsy.

In each situation in these level I, randomized studies, the alpha blocker was of benefit. Specifically among patients with an indwelling stent, 10 days worth of alfuzosin resulted in a statistically significant decrease of >50% in flank pain, pain interfering with one's life, sleep interrupted by pain, and frequency of analgesic use.

Not surprisingly there was no change in irritative voiding symptoms. Similarly, among patients undergoing ureteroscopic laser lithotripsy for larger ureteral stones (1-2cm), the stone free rate (i.e. < 2 mm fragments on follow-up CT scans, the new gold standard) at 4 weeks, increased from 82% for placebo to 92% for the four week tamsulosin group; of note, episodes of ureteral colic were also markedly less (5% vs. 24% in the placebo group).

Lastly, for patients undergoing shock wave lithotripsy for calculi in the 0.5 -2cm. range, doxazosin at 1 mg per day, improved stone free rates as determined by standard radiographs and/or ultrasonography, from 75% to 92%; additional side benefits of the alpha blocker included quicker time to stone passage (7 vs. 14 days), fewer episodes of flank pain (26% vs. 75%), and a small decrease in steinstrasse (6% vs. 9%).

Interestingly, both ureteral and renal stones responded similarly to the use of an alpha blocker with respective stone free rates of 93% vs. 76%, and 92% vs. 75% for ureteral and renal stones, respectively. The only caveat among these 3 studies is that patients had fewer side effects with either tamsulosin or alfuzosin vs. doxazosin.

While use of alpha blockers for the treatment of a wide variety of ureteral conditions (e.g. stent discomfort, post shock wave lithotripsy, post ureteroscopic lithotripsy, and in the patient presenting with a new onset ureteral stone), remains "off label", it is clear from these randomized studies, as well as many preceding evaluations, that its use for these purposes is truly effective, efficient, pain limiting, and safe. Hopefully, these types of level I, scientific works will bring more widespread acceptance of alpha blocker usage for dealing with obstructive ureteral pathology, be it natural or physician-induced.

ABST# 1459
Is There A Role for Alpha Blockers After SWL for Renal and Upper Ureteral Stones? Alaa M. Shaaban, Nady M. Barsoum, Gamal A. Sagheer, Ahmed Z. Anwar . El Minia, EGYPT

ABST# 1460
Adjunctive Tamsulosin Improves Stone Free Rate After Ureteroscopic Lithotripsy of Large Renal and Ureteric Calculi: A Prospective Randomized Study. Tony T. John and Sanjay Razdan. Miami, Florida

ABST# 1461
Alfuzosin to Relieve Ureteral Stent Discomfort: A Randomized Placebo-Controlled Study. Richard Beddington, Renato N. Pedro, Bryan Hinck, and Manoj Monga. Edina, MN

Presented 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 Medical Editor Ralph V. Clayman, MD

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