2238 ADJUVANT USE OF TAMSULOSIN AND NIFEDIPINE AFTER EXTRACORPOREAL SHOCK WAVES LITHOTRIPSY IN PATIENTS WITH KIDNEY STONES - A PROSPECTIVE, DOUBLE-BLIND AND RANDOMIZED STUDY

Abstract

INTRODUCTION AND OBJECTIVES: Extracorporeal shock wave lithotripsy (SWL) is the most employed treatment for renal stones up to 20 mm. Adjuvant use of some drugs may increase the rates of success of the procedure and reduce its morbidity. This is the first trial that evaluate the effects of Tamsulosin and Nifedipine, compared to placebo, in the success rates, episodes of pain and velocity of clearance of fragments after treatment of radiopaque renal stones between 5–20 mm with only one session of SWL. METHODS: We conducted a prospective, randomized and double-blind trial involving 136 patients with radiopaque renal stones between 2006 and 2009. Patients were divided in three groups to receive daily Tamsulosin 0.4 mg, Nifedipine Retard 20mg or placebo for up to 30 days after one session of SWL. The parameters assessed were success rate, analgesic requirements, pain intensity, velocity of elimination of fragments, adverse effects and occurrence of Steinstrasse. RESULTS: The rate of success was 60.5% (23 of 38) in Tamsulosin Group, 48.6% (17 of 35) in Nifedipine Group and 36.8% (14 of 38) in the Placebo Group. (p 0.118) Between the stones of 10 and 20 mm, the success rates were significantly higher in Tamsulosin (61.9%) and Nifedipine Groups (60.0%) than in the Placebo Group (26.1%) (p 0.024) but not so between the stones of 5–9 mm (p 0.128). The Number Needed to Treat (NNT) was 2.9 for Tamsulosin and 3 for Nifedipine. Occurrence of adverse effects was higher in Nifedipine Group than the Placebo Group (28.5% vs. 2.6% respectively, p 0.009). There was no difference among groups with respect to stone and demographic data, pain intensity (p 0.28), velocity of elimination of fragments (p 0.6) and occurrence of Steinstrasse (p 0.48). CONCLUSIONS: Adjuvant use of Tamsulosin or Nifedipine after SWL for renal stone 10 to 20 mm increases the success rates, but without reducing the intensity of pain or the need for analgesia neither the velocity of eliminations of fragments.