title: Long-term prescription of α-blockers decrease the risk of recurrent urolithiasis needed for surgical intervention-a nationwide population-based study.
abstract: OBJECTIVE
  α1 receptors and subtypes have been confirmed to distribute in human pelvis and calyces recently. As used in ureteral stones, α-blocker treatment may facilitate kidney stone passage and long-term prescription of α-blocker may decrease the risk of recurrent urolithiasis. The aim of this study is to determine if use of α-blockers 180 days or more can decrease the risk of recurrent urolithiasis needed for surgical intervention.
  
  
  METHODS
  A representative database of 1,000,000 patients from Taiwan's National Health Insurance was analyzed. Eligible patients were those who had received the first-time procedure for upper urinary stone removal, including extracorporeal shock-wave lithotripsy, ureterorenoscopic lithotripsy, or both, between 2000 and 2010. After completing a 180-day treatment for first event, patients were prospectively followed-up until a second set of stone procedures was performed (proxy of stone recurrence), loss to follow-up, or end of study. The effect of percentage of total number of days of α-blocker use on need for second set of stone procedures within a post treatment 180-day follow-up period was analyzed by quartile. A nested case-control study was also performed.
  
  
  RESULTS
  1,259 patients were eligible for final analyses. During 3,980 person-years follow-up, 167 patients had recurrent urolithiasis needed for surgical intervention. From first to fourth quartile of drug exposure, recurrence rates were 45.64, 47.19, 43.11, and 18.52 per 1,000 person-years. The adjusted hazard ratio was 0.46 (95% CI = 0.24 to 0.89) for the fourth quartile (vs. quartile 1). In the nested case-control study, adjusted ORs was 0.23 (95% CI = 0.10 to 0.53) in the fourth quartile (vs. quartile 1). The results remained similar even in patients categorized by cumulative defined daily dose (cDDD) quartiles and average cDDD per day quartiles.
  
  
  CONCLUSIONS
  Use of α-blockers for 180 days or more decrease the risk of recurrent urolithiasis needed for surgical intervention. In patients at higher risk of recurrent urolithiasis, long term prescription of α-blockers might help them prevent further surgical intervention.
authors: Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Urology, Pingtung Hospital, Ministry of Health and Welfare, Executive Yuan, Pingtung, Taiwan.
authors: Chia-Chu
authors: CC
authors: Liu
authors: Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Hui-Min
authors: HM
authors: Hsieh
authors: Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Chia-Fang
authors: CF
authors: Wu
authors: Department of Medical Genetics, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Tusty-Jiuan
authors: TJ
authors: Hsieh
authors: Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Shu-Pin
authors: SP
authors: Huang
authors: Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Yii-Her
authors: YH
authors: Chou
authors: Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Chun-Nung
authors: CN
authors: Huang
authors: Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Wen-Jeng
authors: WJ
authors: Wu
authors: Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Center of Environmental and Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
authors: Ming-Tsang
authors: MT
authors: Wu
mesh_terms: D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013624:Taiwan; D052878:Urolithiasis / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
chemical_list: D000317:Adrenergic alpha-Antagonists