Efficacy and safety of α1-adrenergic blockers after extracorporeal shock wave lithotripsy in pediatric kidney stones.

Background of the study: Urolithiasis has an incidence in the world of about 5% and the probability of a recurrence within 5–7 years is 50% (Parmar, 2004). Exact data about its prevalence is not known in Bangladesh but it is quite common as seen in outpatient department. It is more common in northern part of the country, male suffer more than female (M:F: 3:1) (Salam, 2002). Symptomatic ureteral calculi represent the most common condition encountered by an urologist in an emergency setting (Pak, 1998). Intervention is recommended for individuals with larger stones, especially greater than 5 mm (Kupeli et al., 1998). The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of extracorporeal shock wave lithotripsy (ESWL), a non-invasive technology that has become one of the primary treatments for urinary stones. Its success rates vary depending on stone size and location and by the type of lithotripter employed. Medical expulsion therapy (MET) can play a key role in support of ESWL: specifically, expulsion is done by diuretics, calcium antagonists, anti-edema agents, and alpha-blockers. A few studies have reported their effectiveness (Borghi et al., 1994, Cervenakov et al., 2002, Porpiglia et al., 2002,Dellabella et al., 2003). Objective: This study is carried out to find out the role of Tamsulos in stone clearance in patientswith upper ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods & Material: This randomized control clinical trialwas performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBangla Nagar, Dhaka during the period from July 2015 to June 2017. A total of 70 cases with upper ureteric stone were included during the study period. Patients were selected randomly in every alternate sequence, odd numbers for experimental group, Tamsulosin+ ESWL, group A & even numbers for control group, only ESWL, group B. Stone clearance rate, number of ESWL session and stone expulsion time were evaluated. Results: In this study showed complete stone clearance one month after ESWL in Group A was 16(89%) and Group B was 16(84.21%) for stone size 6 to 10 mm. Comparison of clearance rate between two groups in stone size 6 to 10 mm was not statistically significant (p value >.05). Complete stone clearance one month after ESWL in Group A was 13(76%) and Group B was 07(43.75%) for stone size 11 to 15 mm. Comparison of clearance rate between two groups in stone size 11 to 15 mm was statistically significant (p value <.05). In this study requirement of number of ESWL sessions according to the stone size showed, in case of 6 to 10 mm stone size, average ESWL sessions 1.28±0.5 in Group A and 1.53±0.7 in Group B and in case of 11to 15 mm stone size, average ESWL sessions 1.29±0.5 in Group A and 1.62±0.7 in Group B. Comparison of ESWL sessions between two groups were statistically significant (p value <.05). In this study mean expulsion time of stone in Group A was 22.34±12.23 days and in Group B was 32.34±21.96 days. Comparison of stone expulsion time between two groups were statistically significant (p value <.05). Conclusion: Tamsulosin results in increased stone-free rates and in lower percentages of patients requiring re-treatment. Tamsulosin can be self-administered and can play a key role in the choice between tamsulosin after ESWL and only ESWL for upper ureteric stone disease treatment. Use of tamsulosin makes the expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for upper ureteral stones. Tamsulosin helps in clearance of upper ureteral stones after ESWL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.36-42

The Efficacy of Medical Expulsive Therapy (MET) in Improving Stone-free Rate and Stone Expulsion Time, After Extracorporeal Shock Wave Lithotripsy (SWL) for Upper Urinary Stones: A Systematic Review and Meta-analysis

BACKGROUND: The efficacy of tamsulosin as an adjunctive treatment after extracorporeal shock wave lithotripsy (ESWL) for urolithiasis has increasingly become the subject of interest in the field of Urology. Although tamsulosin is thought to enhance stone passage by relaxing the smooth muscle of the urinary tract, previous studies have generated conflicting evidence regarding its effectiveness in enhancing stone-free rates after ESWL. This inconsistency necessitates further investigation to clarify the role of tamsulosin in optimizing clinical outcomes following ESWL. OBJECTIVE: To determine the efficacy of tamsulosin as a medical adjunctive after extracorporeal shock wave lithotripsy in proximal ureteric stones. METHODOLOGY: This descriptive study was carried out on patients presenting to the Department of Urology, Institute of Kidney Diseases, Peshawar, with proximal ureteric stones from April 1, 2024, to October 31, 2024. A total of 195 patients were selected based on inclusion criteria by consecutive non-probability sampling. Data on demographics, stone characteristics, Stone clearance, and stone expulsion time are recorded. Statistical analysis is performed using IBM SPSS 25. RESULTS: Among 195 subjects with proximal ureteric stones who underwent ESWL along with adjunctive therapy of tamsulosin showed an efficacy of 85.1%. The stones <10mm and ≥ 10mm were compared revealing efficacy of 93% and 75%, respectively (p-value 0.001). 84% of smaller stones had expulsion time within 2 weeks and 75% of larger stones had expulsion time within 4 weeks. CONCLUSION: These data support the effectiveness of adjuvant therapy with tamsulosin after extracorporeal shockwave lithotripsy in proximal ureteric stones, especially small stones. The increase in the passage of residual fragments of stone improves the clearance rate. The limitation of this study is that the complication of this therapy is not considered; otherwise, it is the non-invasive management of post-ESWL therapy that resolves the misery of the patients. KEYWORDS: Extracorporeal Shockwave Lithotripsy (ESWL), Tamsulosin, Proximal Ureteric Stone, Adjuvant therapy, Expulsion time

Objective: To determine whether the administration of tamsulosin, as adjunctive medical therapy, increases the efficacy of one session of extracorporeal shock wave lithotripsy (ESWL) to treat renal stones. Material & Method: A prospective randomized placebo controlled study enrolled 21 patients. They underwent a single ESWL session to treat solitary radiopaque renal stones 4 to 20 mm in diameter. After ESWL, the study group (11) received 0,4 mg tamsulosin daily and the control group (10) received placebo until stone clearance or a maximum period of 8 weeks. The primary endpoint was stone-free rate and parameters were stone size and clearance time. Results: The overall stone-free rate was better in the study group than in the control group (90,9% vs. 60,0%). The clearance time after 2, 4, 6 and 8 weeks was greater in the study group than in the control group (36,4%; 63,6%; 72,7% and 90,9% vs 30,0%; 50,0%; and 60,0% respectively) but statistically insignificant. Conclusion: Clinically, the results of our study have demonstrated that tamsulosin therapy, as an adjunctive medical therapy after ESWL, is more effective than lithotripsy alone for the treatment of patients with renal stones.
 Keywords: ESWL, tamsulosin, medical expulsive therapy, renal stones.

Treatment of Proximal Ureteral Calculi: Holmium:Yag Laser Ureterolithotripsy Versus Extracorporeal Shock Wave Lithotripsy

Complications and Associated Factors of Pediatric Extracorporeal Shock Wave Lithotripsy

Purpose: The use of various alpha-receptor antagonists (α-blocker) drugs as medical expulsive therapy (MET) for spontaneous clearance of ureteral calculi of various sizes has been extensive in the last decade by urologists across the world. Among all, α-blocker tamsulosin has been used widely. In contrast silodosin which is recently introduced in the market and more selective alpha-receptor antagonist and cardioselective drug but it has not been used widely as MET. In this study, silodosin (8 mg), tamsulosin (0.4 mg), and oral hydration therapy were compared in terms of efficacy and safety as MET in the management of ureteric stone along with rate of stone clearance, expulsion time, analgesic requirements, and adverse effects for treating ureteral stones size between ≥4 mm and ≤10 mm in diameter. Materials and Methods: Prospective randomized study was conducted between September 2018 and August 2020 with a total of 240 patients (80 patients in each arm) in tertiary care center of eastern India. First group received a single dose of silodosin (8 mg) daily, second group received a single dose of tamsulosin (0.4 mg) daily and third group received oral hydration therapy for 4 weeks. Results: There is no difference in the stone expulsion rate (SER), stone expulsion time (SET), and surgical intervention between tamsulosin, silodosin and oral hydration therapy group for ureteric stones ≤5 mm size. For ureteric stones of size 6 mm–10 mm, silodosin has better SER than tamsulosin with no difference in terms of SET. Analgesic requirement and pain episodes were more in the oral hydration group with no adverse effects (statistically significant). Conclusion: The proportion of passed-out stone was significantly higher among the patients treated with silodosin (65.0%) in comparison to other two groups (P < 0.05) with no difference in SET.

Introduction. The development of medical expulsive therapy options following extracorporeal shock wave lithotripsy (ESWL) in pediatric urolithiasis plays a crucial role in accelerating stone fragment clearance. The aim: evaluation of the efficacy and safety of α1-adrenergic blockers (tamsulosin and silodosin) in pediatric patients with urinary stone disease after ESWL. Materials and Methods. We conducted a prospective comparative study of 200 patients (aged 2-18 years) divided into a study group (n=50, received α1-adrenergic blockers after ESWL) and a control group (n=150, standard therapy). Efficacy endpoints included: stone-free rate, stone fragment expulsion time, pain dynamics, analgesic requirements and α1-blocker adverse effects. Statistical analysis was performed using StatTech v.4.8.3. Results. The use of α1-adrenergic blockers increased the stone-free rate after ESWL by 1.23-fold compared to standard therapy (OR = 0.474; 95% CI: 0.229-0.980). The median stone fragment expulsion time decreased from 7 to 5 days (p=0.010). Pain intensity decreased by the second day of treatment (p<0.001), with reduced analgesic requirements (p=0.003). Adverse effects of α1-blockers were rare (5 cases of nasal congestion, 2 of nausea). Conclusion. The use of α1-blockers in children with urolithiasis after ESWL improves treatment efficacy, reduces expulsion time, and alleviates pain with a favorable safety profile.

Treatment of urolithiasis remains an urgent problem related to medical, social and work rehabilitation. To evaluate the efficiency of the biologically active additive "Oxaphorin" in the treatment of urolithiasis after extracorporeal shock-wave lithotripsy (ESWL). The study included 60 male and female patients from 18 to 75 years old (average age of 45.56+/-12.49 years) with renal stones of up to 10 mm in size, which were disintegrated by the ESWL. All patients were randomized into 3 groups (20 people each). In the first group, patients received standard treatment in the postoperative period (antispasmodics, NSAIDs, uroseptics). In the second group, along with standard therapy, Oxaphorin (1 capsule 2 times a day) was administered, while in the third group Oxaphorin as monotherapy (1 capsule 2 times a day) was given. Treatment and follow-up were carried out in accordance with the study protocol for 30 days. The efficiency of treatment was assessed by the stone-free rate and time to complete evacuation of fragments. Study design included history taking, physical examination, assessment of the tolerability of therapy and adverse events, complete blood count, urinalysis, biochemical panel, ultrasound of the genitourinary system and kidney X-ray. As the study showed, the rate of stone expulsion was higher in groups of patients receiving Oxaforin. Stone-free rate after 10 days was confirmed using imaging studies and laboratory analyses in 8 (40%) patients of the first group, in 11 (55%) in the second group and in 6 (30%) in the third group. After 1 month of follow-up, stone-free status was confirmed in 16 (80%), 18 (90%) and 15 (75%) patients, respectively. In those taking Oxaforin as part of combined therapy, stone-free rate after ESWL was higher (90% vs. 75% in third group, where Oxaforin was used as monotherapy). The frequency of renal colic and its severity based on a visual analogue scale was significantly lower and less pronounced in patients receiving Oxaforin. Our results showed that the biologically active additive "Oxaphorin" has a pronounced effect as medical expulsive therapy without any adverse events and is effective in patients with urinary stone disease after ESWL for kidney stones.

Introduction. Effective evacuation of stone fragments is a critical stage determining the success of extracorporeal shock wave lithotripsy (ESWL) in children with urolithiasis. However, optimal approaches to postoperative lithokinetic therapy in pediatric practice remain a subject of debate. Objective:comparative analysis of the efficacy and safety profile of combined lithokinetic therapy, including alpha-1-adrenergic blockers and polychromatic polarized light, for improving the elimination of stone fragments after extracorporeal shock wave lithotripsy (ESWL) in children with urolithiasis. Methods.This prospective randomized study included 250 children aged 2 to 18 years who underwent ESWL. All patients were randomized into three groups: a control group (n=150) receiving standard postoperative therapy, Group 2 (n=50) receiving a course of PPL exposure, and Group 3 (n=50) receiving a combination of alpha-1-adrenergic blockers (tamsulosin/silodosin) and a course of PPL exposure. To assess efficacy, the following parameters were analyzed: stone-free rate (SFR), time to stone expulsion, level of pain, and frequency of postoperative complications. Results.Combined lithokinetic therapy resulted in the highest stone-free rate (88.0%), which was significantly higher than in the control group (60.0%; p0.001). The SFR in the PPL group was 76.0%. The dynamics of SFR achievement differed, occurring earlier in Groups 2 and 3. The lowest need for analgesia was noted in the combination therapy group (82.0% of patients required no pain relief). Dynamic ultrasound showed a significantly faster reduction in the size of residual fragments in the study groups. Postoperative complications were less frequent in Groups 2 and 3. No adverse effects from the use of alpha-1-adrenergic blockers were noted. Conclusion.Combined lithokinetic therapy with alpha-1-adrenergic blockers and PPL may be associated with a higher rate of complete stone fragment passage after ESWL in children compared with standard therapy, as well as with a reduced need for analgesics.

The choice of treatment for the stones of the lower renal calyx is one of the challenging issues of modern urology. The aim of this retrospective and prospective study was to investigate the clinical effectiveness and safety of 3 modern minimally invasive techniques for treating renal stones: percutaneous (PNL) and transurethral (TNL) nephrolithotripsy and extracorporeal shock wave lithotripsy (ESWL) in patients with solitary lower calyx stones sized from 10 to 15 mm. The study included 136 patients with symptomatic stones of the lower calyces, who underwent ESWL, PNL and TNL from November 2010 to the present day. The criteria for inclusion in the study were: the presence of a solitary stone of the lower calyx, the stone size of 10 mm to 15 mm, the performance of the classical (standard) PNL in the prone position (puncture access 28-30 Fr) and the follow-up examination at 3 months after the operation. Forty-six patients underwent ESWL, 49 - PNL, and 41 - TNL. Postoperative follow-up was done at 3 months and included a plain radiography, ultrasound and non-contrast-enhanced computed tomography. The stone free rate (SFR) was used as a criterion for the effectiveness of the intervention, where the stone size of 3 mm was taken as the upper limit for the possible presence of fragments. Besides, the rate of repeat interventions, complications and subjective assessment of patients treatment satisfaction (0 to 10) by using visual analogue scale (VAS) were investigated. The effectiveness analysis of the three methods for treating the lower calyx stones sized 10-15 mm showed that PNL was no more effective than TNL (SFR 95.9% and 85.4%, respectively), but both methods were significantly more effective than ESWL (SFR 69.5%). 29.3% of patients who underwent TNL required repeat interventions (TNL or ESWL), while among those treated with ESWL, 45.6% required repeat ESWL sessions. PNL resulted in stone clearance in one stage. Postoperative inflammatory complications were most prevalent among patients who underwent TNL (26.8%). Bleeding requiring hemotransfusion was observed only after PNL (14.3%). Obstructive complications were observed in all study groups. For them, internal stenting was most often performed after ESWL (10.9%), puncture nephrostomy - after TNL (7.3%). Statistically significantly higher VAS measured quality of life was found after ESWL (7.9) and PNL (7.0) compared with THL (4.8). All three methods (PNL, TNL and ESWL) for treating lower calyceal stones sized from 10 to 15 mm are quite effective. Using them separately or in combination allows most patients to safely achieve a stone-free state.

PurposeThe objective of this study was to evaluate the efficacy of tamsulosin on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with a single proximal ureteral stone.Materials and MethodsThis prospective randomized controlled trial was performed on 88 patients with a single proximal ureteral stone. After consenting with a doctor, the patients were allocated to the treatment (tamsulosin 0.2 mg once a day) or control (no medication) group, and the efficacy of tamsulosin was evaluated. The primary outcome of this study was the stone-free rate, and the secondary outcomes were the period until clearance, pain intensity, analgesic requirement, and incidence of complications.ResultsA stone-free state was reported in 37 patients (84.1%) in the treatment group and 29 (65.9%) in the control group (p=0.049). The mean expulsion period of the stone fragments was 10.0 days in the treatment group and 13.2 days in the control group (p=0.012). There were no statistically significant differences in aceclofenac requirement or pain score between the two groups. Only one patient in the treatment group experienced transient dizziness associated with medical expulsive therapy, and this adverse event disappeared spontaneously.ConclusionsThe results of this prospective randomized controlled trial of the efficacy of tamsulosin after ESWL for a single proximal ureteral stone suggest that tamsulosin helps in the earlier clearance of stone fragments and reduces the expulsion period of stone fragments after ESWL.

Modified Mechanical Percussion for Upper Urinary Tract Stone Fragments After Extracorporeal Shock Wave Lithotripsy: A Prospective Multicenter Randomized Controlled Trial

Use of Ureteral Stent in Extracorporeal Shock Wave Lithotripsy for Upper Urinary Calculi: A Systematic Review and Meta-Analysis

MECHANICAL PERCUSSION, INVERSION AND DIURESIS FOR RESIDUAL LOWER POLE FRAGMENTS AFTER SHOCK WAVE LITHOTRIPSY: A PROSPECTIVE, SINGLE BLIND, RANDOMIZED CONTROLLED TRIAL