title: Adjuvant tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for renal stones: a double blind, randomized, placebo-controlled trial.
abstract: OBJECTIVE
  To evaluate the effects of the adjuvant use of tamsulosin or nifedipine after extracorporeal shock wave lithotripsy for nonlower pole kidney stones 5-20 mm in size.
  
  
  METHODS
  We conducted a randomized double-blind trial involving 136 patients with radiopaque kidney stones. The patients received daily treatment with 0.4 mg tamsulosin, 20 mg nifedipine retard, or placebo for ≤30 days after 1 session of extracorporeal shock wave lithotripsy. Success was defined as plain film radiography showing the patient was completely stone free or with asymptomatic stone fragments ≤4 mm in size at any time during the weekly follow-up.
  
  
  RESULTS
  The success rate was 60.5% (23 of 38) in the tamsulosin group, 48.6% (17 of 35) in the nifedipine group, and 36.8% (14 of 38) in the placebo group (P = .118). In the subgroup analysis, stones 10-20 mm had significantly greater success rates in the tamsulosin (13 of 21, 61.9%) and nifedipine (15 of 25, 60%) groups compared with the placebo group (6 of 23, 26.1%; P = .024), but not for stones 5-9 mm (P = .128). The number needed to treat was 2.9 for tamsulosin and 3 for nifedipine. Adverse events were more frequent in the nifedipine than in the placebo group (28.5% vs 2.6%, respectively, P = .009), but without a significant difference between the nifedipine and tamsulosin (28.5% vs 15.8%, P = .15) or the tamsulosin and placebo (P = .54) groups. No difference was found among the groups with regard to pain intensity, interval to clearance, or steinstrasse.
  
  
  CONCLUSIONS
  The stone-free rates after extracorporeal shock wave lithotripsy with adjuvant tamsulosin or nifedipine were significantly increased only for nonlower pole renal stones 10-20 mm in size compared with placebo. Nifedipine was associated with more adverse effects than placebo.
authors.affiliation: Section of Endourology and Lithiasis, Department of Urology, University of São Paulo Medical School, São Paulo, São Paulo, Brazil. fabiovicentini@usp.br
authors.forename: Fabio C
authors.initials: FC
authors.lastname: Vicentini
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mazzucchi
authors.forename: Artur H
authors.initials: AH
authors.lastname: Brito
authors.forename: Elias A
authors.initials: EA
authors.lastname: Chedid Neto
authors.forename: Alexandre
authors.initials: A
authors.lastname: Danilovic
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000188:drug therapy / Q000628:therapy*; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*; D011446:Prospective Studies; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D002121:Calcium Channel Blockers; D013449:Sulfonamides; D000077409:Tamsulosin; D009543:Nifedipine