Abstract
It has been suggested that nitrates are potent smooth muscle relaxants that may reduce pain and facilitate ureteral stone passage; therefore it may be an option for medical expulsive therapy in ureteral stones. In a prospective randomized controlled clinical trial, we evaluated the efficacy of medical expulsive therapy with isosorbide-SR 40 mg in patients with ureteral stones (≤10 mm). The patients with ureteral stones in KUB or urinary tract ultrasonography were randomized to receive methylprednisolone plus celecoxib without (control group), and with isosorbide-SR 40 mg (treatment group) for 21 days. 66 patients [33(50%) in control, 33(50%) in treatment group] were entered randomly to our study. The stone expulsion rate was not significantly different between two groups (54.5 vs. 45.5%) (P = 0.497). The need for surgical procedures were more common in control group within 21 days (9.4 vs. 6.1%) and more common in treatment group after 21 days (33.3 vs. 21.9%) (P = 0.756).Patients in the treatment group experienced more intractable pain (27.3 vs. 6.1%), intractable vomiting (3 vs. 0%) (P = 0.046) and hospitalization (3 vs. 0%) (P = 0.314). Drug side effects including headache and dizziness were more common in treatment group (39.4 vs. 9.1%) (P = 0.004). In our study, the use of isosorbide-SR in treatment group did not improve the stone expulsion rate in patients with ureteral stones (≤10 mm) but developed more side effects. Then it may not an appropriate alternative for medical expulsive therapy. Of course, further trials are recommended.
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References
Sun X, He L, Ge W, Lv J (2009) Efficacy of selective 1D-blocker naftopidil as medical expulsive therapy for distal ureteral stones. J Urol 181(4):1716–1720
Pearle MS, Lotan Y (2007) Urinary lithiasis: etiology, epidemiology, and pathogenesis. In: Wein AJ, Kavousi LR, Novick AC, Partin AW, Peters CA Campbell-Walsh Urology 9th edn. Saunders, Philadelphia, p 1363
Strohmaier WL, Schubert G, Rosenkranz T, Weigl A (1999) Comparison of extracorporeal shock wave lithotripsy and ureteroscopy in the treatment of ureteral calculi: a prospective study. Eur Urol 36(5):376–379
Osorio L, Lima E, Soares J, Autorino R, Versos R et al (2007) Emergency ureteroscopic management of ureteral stones: why not? Urology 69(1):27–33
Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C et al (2007) Guideline for the management of ureteral calculi. EAU/AUA Nephrolithiasis Guideline Panel. J Urol 178(6):2418–2434
Wolf JS Jr (2007) Treatment selection and outcomes: ureteral calculi. Urol Clin North Am 34(3):421–430
Hermanns T, Sauermann P, Rufibach K, Frauenfelder T, Sulser T, Strebel RT (2009) Is there a role for tamsulosin in the treatment of distal ureteral stones of 7 mm or less? Results of a randomised, double-blind, placebo-controlled trial. Eur Urol 56(3):407–412
Hussain Z, Inman RD, Elves AW, Shipstone DP, Ghiblawi S, Coppinger SW (2001) Use of glycerin trinitrate in patients with ureteral stones: a randomized, double-blind, placebo-controlled study. Urology 58(4):521–525
Pedro RN, Hinck B, Hendlin K, Feia K, Canales BK, Monga M (2008) Alfuzosin stone expulsion therapy for distal ureteral calculi :a double-blind, placebo controlled study. J Urol 179(6):2244–2247
Miller OF, Kane CJ (1999) Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 162:688–691
Cervenàkov I, Fillo J, Mardiak J, Kopecný M, Smirala J, Lepies P (2002) Speedy elimination of ureterolithiasis in lower part of ureters with the α1-blocker-tamsulosin. Int Urol Nephrol 34(1):25–29
Borghi L, Meschi T, Amato F, Novarini A, Giannini A et al (1994) Nifedipine and methylprednisolone in facilitating ureteral stone passage: a randomized, double-blind, placebo-controlled study. J Urol 152(4):1095–1098
Resim S, Ekerbicer HC, Ciftci A (2005) Role of tamsulosin in treatment of patients with stienstrasse developing after extracorporeal shock wave lithotripsy. Urology 66(5):945–948
Park JK, Cui Y, Kim MKI, Kim YG, Kim SH, Kim SZ, Cho KW (2002) Effects of extracorporeal shock wave lithotripsy on plasma levels of nitric oxide and cyclic nucleotides in human subjects. J Urol 168(1):38–42
Papadoukakis S, Stolzenburg JU, Truss MC (2006) Treatment strategies of ureteral stones. Eur Urol Updat Ser 4(5):184–190
Lingeman JE, Matlaga BR, Evan AP (2007) Surgical management of upper urinary tract calculi. In: Wein AJ, Kavousi LR, Novick AC, Partin WA, Peters CA Campbell-Walsh Urology, 9th edn, vol 2. WB Saunders, Philadelphia, pp 1363–1365
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Hamidi Madani, A., Kazemzadeh, M., Pourreza, F. et al. Randomized controlled trial of the efficacy of isosorbide-SR addition to current treatment in medical expulsive therapy for ureteral calculi. Urol Res 39, 361–365 (2011). https://doi.org/10.1007/s00240-010-0357-3
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DOI: https://doi.org/10.1007/s00240-010-0357-3