Tamsulosin Facilitates Earlier Clearance Of Stone Fragments And Reduces Pain After Shockwave Lithotripsy For Renal Calculi

Main Category: Urology / Nephrology
Article Date: 26 Jan 2009 - 3:00 PDT

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UroToday.com - In this non-placebo controlled study, the authors reviewed their results with 139 shockwave lithotripsy (SWL) patients with single stones of 5-20 mm receiving SWL at a rate of 120/min. with a Lithostar-Multiline (Siemens, Germany). After SWL patients were randomized to receive either 0.4 mg tamsulosin daily or nothing. Follow-up was done with "radiographic assessment" and analog pain scores; success was defined as a pain free patient with < 3 mm fragments. The findings are best summarized below:

Stone size: Tamsulosin - 12 mm, No Tamsulosin - 13 mm
BMI: Tamsulosin - 24, No Tamsulosin - 24
Success (3 wks): Tamsulosin - 53%, No Tamsulosin - 31%*
Success after 2 SWL treatments: Tamsulosin - 78%, No Tamsulosin - 52%*
Success after 3 SWL treatments: Tamsulosin - 94%, No Tamsulosin - 75%*
Pain by analog scale: Tamsulosin - 29, No Tamsulosin - 47*
Steinstrasse: Tamsulosin - 1, No Tamsulosin - 9
*(p < .05)

Of note, only 1 patient in the tamsulosin group was withdrawn due to postural hypotension. Apparently tamsulosin acts on the α1A and α 1D receptors in the lower ureter to: decrease ureteral spasm, reduce the force as well as the frequency of ureteral contractions, and block pain transmission via C-fibers.

While it is certainly clear that an alpha blocker benefits passage of stone fragments, be they natural or surgeon-made, the overriding question is why does SWL in 2008 provide such poor results? In this series, part of the reason could be the high treatment rate of 120 shocks/minute, but even given this factor, how many patients are accepting of a therapy with only a 78% success rate after two sessions with the adjunct of tamsulosin? To my mind, this is similar to what we have seen with UPJ obstruction - a less invasive but less successful therapy such as endopyelotomy has largely given way to a more invasive but more successful therapy, specifically, laparoscopic or robotic pyeloplasty. So it goes, with SWL being largely superseded by ureteroscopy at many centers across the United States.

Naja V, Agarwal MM, Mandal AK, Singh SK, Mavuduru R, Kumar S, Acharya NC, Gupta N
Urology. 2008 Nov;72(5):1006-11.
doi:10.1016/j.urology.2008.05.035

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

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