MP18-01 DOES TAMSULOSIN IMPROVE THE RESULTS OF SWL FOR UPPER URINARY TRACT STONES?

Abstract

INTRODUCTION AND OBJECTIVES: Medical expulsive therapy showed promising results helping the clearance of lower ureteric stones in addition to clearance of fragments following shock wave lithotripsy (SWL) for renal or ureteric stones. We evaluated Tamsulosin as an adjuvant treatment after SWL for patients with upper urinary tract stone regarding the stone clearance and analgesic dose. METHODS: Between January 2010 and October 2012, 96 male patients with solitary, radio-opaque upper urinary tract stones, 20 mm in the maximum diameter were prospectively enrolled in the study. The patients were treated by SWL performed by the same urologist with a maximum of 3500 shocks delivered. Following SWL, the patients were instructed to drink liberal fluids and were randomly divided into 2 groups; group 1; patients received tamsulosin (0.4 mg) once daily plus analgesic on need. Group 2; patients received only analgesic on need. A maximum of 3 sessions with 2 weeks interval between the sessions were delivered to each patient. We recorded the clearance time and rate as well as the cumulative dose of analgesic used. Clearance was documented by a plain film 2 weeks after the last SWL session. RESULTS: The number of the patients was 47 for group 1 versus 49 for group 2. Themean stone size was 13 and 12.3mm for group 1 and group 2, respectively. Renal and upper ureteric stones were found in 35 (74.5%) and 12 (25.5%) patients of group 1, respectively and in 33 (67.3%) and 16 (32.7%) patients of group 2, respectively. A statistically significant difference was found between the 2 groups concerning the total stone expulsion rate (P1⁄4 0.022) as well as the expulsion of renal stones (P1⁄4 0.013). In case of upper ureteric stones, no difference in the expulsion rate between the 2 groups was found(P1⁄4 0.947). Stone clearance stratified according to time elapsed after SWL was also statistically significant at 4 (P1⁄4 0.011), 6 (P1⁄4 0.029), 8 weeks (P1⁄4 0.036) between both groups. Similarly, mean (SD) analgesic dose was 564.89 (82.04)mg in group 1 versus 1512.24 (480.83)mg in group 2 (P< 0.001). CONCLUSIONS: Using tamsulosin as a medical expulsive therapy augment the outcome of SWL by improving the overall stone clearance rate as well as the time to clearance. Also, it reduces the analgesic dose required following SWL.