2057 EFFICACY OF SELECTIVE α1D-BLOCKER NAFTOPIDIL AS MEDICAL EXPULSIVE THERAPY FOR DISTAL URETERAL STONES: A MULTICENTER, DOUBLE-BLIND, RANDOMIZED CONTROLLED TRIAL

Abstract

You have accessJournal of UrologyStone Disease: Basic Research1 Apr 20112057 EFFICACY OF SELECTIVE α1D-BLOCKER NAFTOPIDIL AS MEDICAL EXPULSIVE THERAPY FOR DISTAL URETERAL STONES: A MULTICENTER, DOUBLE-BLIND, RANDOMIZED CONTROLLED TRIAL Yasuo Kohjimoto, Takatoshi Ogawa, Keizo Hagino, Yumiko Sasaki, Nagahide Matsumura, Takeshi Inagaki, and Isao Hara Yasuo KohjimotoYasuo Kohjimoto Wakayama, Japan More articles by this author , Takatoshi OgawaTakatoshi Ogawa Wakayama, Japan More articles by this author , Keizo HaginoKeizo Hagino Wakayama, Japan More articles by this author , Yumiko SasakiYumiko Sasaki Wakayama, Japan More articles by this author , Nagahide MatsumuraNagahide Matsumura Wakayama, Japan More articles by this author , Takeshi InagakiTakeshi Inagaki Wakayama, Japan More articles by this author , and Isao HaraIsao Hara Wakayama, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2288AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several studies have demonstrated that tamsulosin, a combined α1A and α1D selective antagonist increases spontaneous stone passage and decreases colic pain in patients with distal ureteral stones. However, there has been only one report on the efficacy of naftopidil, a specific α1D-antagonisit, as medical expulsive therapy (MET). Thus, we performed the multicenter, double-blind, randomized controlled trial to compare the expulsive role of naftopidil and flopropione, an antispasmodic agent widely used in Japan, for distal ureteral stones. METHODS From March 2006 to July 2010, a total of 99 patients diagnosed in 7 urology department as distal ureteral stones not larger than 10 mm were randomized to receive either 75mg naftopidil daily or flopropione 240mg daily for a maximum of 28 days. Investigators and patients were blinded to the randomization scheme. The primary end point was the stone expulsion rate. The secondary end points included time to stone passage, use of analgesics, number of hospitalization, surgical intervention, and drug side effects. RESULTS Eleven of 99 randomized patients were excluded from the analysis. Female patient were more frequent in the flopropione arm (p = 0.04). No statistically significant differences in patient age and stone size (mean: 5.1 mm [naftopidil arm] vs 5.2 mm [flopropione arm], p = 0.80). The stone expulsion rate was higher in the naftopidil arm (80.0%) compared to the flopropione arm (63.2%), although the difference was marginally significant (p = 0.08). Median time to stone passage was significantly shorter in naftopidil arm (8 days) compared to the flopropione arm (18 days, log-rank test, p = 0.04, Figure). A multivariable Cox regression model revealed that the probability of expulsion was 1.77-fold higher (95% confidence interval 1.01–3.16) in the naftopidil arm compared with the flopropione arm. No significant differences in other secondary end points were noted between the arms. CONCLUSIONS The results indicate that the selective α1D-blocker naftopidil was more effective than conventionally used antispasmodic agent in facilitating spontaneous passage of the distal ureteral stones, providing a new option for MET. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e823-e824 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasuo Kohjimoto Wakayama, Japan More articles by this author Takatoshi Ogawa Wakayama, Japan More articles by this author Keizo Hagino Wakayama, Japan More articles by this author Yumiko Sasaki Wakayama, Japan More articles by this author Nagahide Matsumura Wakayama, Japan More articles by this author Takeshi Inagaki Wakayama, Japan More articles by this author Isao Hara Wakayama, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...