title: The effect of tamsulosin on pain and clearance according to ureteral stone location after shock wave lithotripsy.
abstract: BACKGROUND
  Medical expulsion therapy has shown encouraging results in facilitating spontaneous clearance of ureteral stones after extracorporeal shock wave lithotripsy. However, no other study has yet determined the benefit of medical expulsion therapy for stones in different ureteral locations.
  
  
  OBJECTIVE
  The aim of the study was to evaluate tamsulosin as adjunctive therapy to extracorporeal shock wave lithotripsy (SWL) in terms of pain clearance of stones in the upper, middle, and lower ureter.
  
  
  METHODS
  Between June 2008 and July 2011, patients with a solitary ureteral stone that was ≥6 mm up to 15 mm and located in the upper, middle, or lower ureter undergoing SWL were evaluated. The patients were randomly allocated to a conservative treatment (group 1) and a tamsulosin treatment group (group 2). Administration of the drug was started immediately after SWL and was continued for a maximum of 28 days. Patients were evaluated for stone clearance, time to stone clearance, and number of SWL sessions. The pain intensity was evaluated by visual analog scale.
  
  
  RESULTS
  There were 64 patients in the control group and 59 in the tamsulosin group. The average stone sizes were 10.70 (3.20) mm and 11.40 (3.01) mm (P = 0.24). Group 1 and group 2 received 2507 (984) and 2759 (775) shock waves (P = 0.86), 1.53 (0.8) and 1.49 (0.75) sessions (P = 0.85), respectively. Mean visual analog scale scores and times to clearance were 3.81 (2.74) and 2.73 (2.28) (P = 0.00) and 12.59 (8.63) days and 8.34 (7.60) days (P = 0.00), respectively, for all stones in groups 1 and 2. Only the clearance time of upper ureteral stones between groups showed statistical significance (13.54 [8.32] days vs 7.10 [6.40] days; P = 0.00).
  
  
  CONCLUSIONS
  Tamsulosin may help in the treatment of all ureteral stones after SWL, particularly stones in the upper ureter, with a shorter time to clearance and less need for analgesic drugs.
authors.affiliation: Urology Clinic, Hisar Intercontinental Hospital, Umraniye/Istanbul, Turkey.
authors.lastname: Basri Cakıroglu
authors.affiliation: Department of Urology, Maltepe University School of Medicine, Maltepe/Istanbul, Turkey.
authors.forename: Orhun
authors.initials: O
authors.lastname: Sinanoglu
authors.affiliation: Department of Emergency Medicine, Maltepe University School of Medicine, Maltepe/Istanbul, Turkey.
authors.lastname: Mahmure Uraz
keywords: shock wave lithotripsy; stones; tamsulosin; ureteral