Comparison of tamsulosin with extracorporeal shock wave lithotripsy in treating distal ureteral stones.
BACKGROUND
Tamsulosin, an alpha-1 receptor antagonist, has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion. This study aimed to evaluate the effect of tamsulosin in comparison with nifedipine and extracorporeal shock wave lithotripsy (ESWL) on the expulsion rate of distal ureteral stones at different sizes.


METHODS
We assigned 314 patients to three categories: I, the stone with maximal diameter of 4.0 - 5.9 mm; II, 6.0 - 7.9 mm, and III, 8.0 - 9.9 mm. Patients in each category were randomly subdivided into three treatment subgroups: group A (nifedipine group), group B (tamsulosin group), and group C (ESWL group). Stone-free rate and the dose of analgesics were recorded weekly during the 4-week follow-up period.


RESULTS
Three hundred and three patients completed the study. The results showed that nifedipine and tamsulosin treatments promoted a small (4 - 8 mm, categories I and II) stone expulsive rate that was comparable with ESWL treatment. Nonetheless, when the stone diameter was 8.0 - 9.9 mm, ESWL showed a greater stone free rate than nifedipine and tamsulosin treatments; no significant difference existed between the latter two therapies. Although the ESWL treatment group required the least analgesics, tamsulosin treatments required less pain medication than nifedipine (P < 0.05).


CONCLUSIONS
Tamsulosin treatment is recommended for patients with the stone diameter smaller than 8 mm because of its feasibility, effectiveness and safety. ESWL is more appropriate than tamsulosin therapy for the patients whose stones are larger than 8 mm.
Zhang
Meng-Yuan
MY
Department of Urology, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China.
Ding
Sen-Tai
ST
Lü
Jia-Ju
JJ
Lue
Yan-He
YH
Zhang
Hui
H
Xia
Qing-Hua
QH
D000317:Adrenergic alpha-Antagonists / Q000494:pharmacology*; D000328:Adult; D002121:Calcium Channel Blockers / Q000494:pharmacology; D005260:Female; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000188:drug therapy / Q000628:therapy*
D000317:Adrenergic alpha-Antagonists; D002121:Calcium Channel Blockers; D013449:Sulfonamides; D000077409:Tamsulosin; D009543:Nifedipine