Abstract
Extracorporeal shock wave lithotripsy (ESWL) is currently considered one of the main treatments for ureteral stones. Some studies have reported the effectiveness of pharmacologic therapies (calcium antagonists or alpha-blockers) in facilitating ureteral stone expulsion after ESWL. We prospectively evaluated the efficacy, after ESWL, of nifedipine on upper-middle ureteral stones, and tamsulosin on lower ureteral stones, both associated to ketoprofene as anti-edema agent. From January 2003 to March 2005 we prospectively evaluated 113 patients affected by radiopaque or radiolucent ureteral stones. Average stone size was 10.16 ± 2.00 mm (range 6–14 mm). Thirty-seven stones were located in the upper ureter, 27 in the middle ureter, and 49 in the lower ureter. All patients received a single session of ESWL (mean number of shock waves: 3,500) by means of a Dornier Lithotripter S (mean energy power for each treatment: 84%). Both ultrasound and X-ray were used for stone scanning. After treatment, 63 of 113 patients were submitted to medical therapy to aid stone expulsion: nifedipine 30 mg/day for 14 days administered to 35 patients with upper-middle ureteral stones (group A1) and tamsulosin 0.4 mg/day for 14 days administered to 28 patients with stones located in the distal ureter (group A2). The remaining 50 patients were used as a control group (29 upper–middle ureteral stones—B1—and 21 lower ureteral stones—B2—), receiving only pain-relieving therapy. No significant difference in stone size between the groups defined was observed. Stone clearance was assessed 1 and 2 months after ESWL by means of KUB, ultrasound scan and/or excretory urography. A stone-free condition was defined as complete stone clearance or the presence of residual fragments smaller than 3 mm in diameter. The stone-free rates in the expulsive medical therapy group were 85.7 and 82.1% for the nifedipine (A1) and tamsulosin (A2) groups respectively; stone-free rates in the control groups were 51.7 and 57.1% (B1 and B2, respectively). Five patients (14.3%) in group A1, 5 (17.8%) in group A2, 14 (48.3%) in group B1 and 9 (42.8%) in group B2 were not stone-free after a single ESWL session and required ESWL re-treatment or an endoscopic treatment. Medical therapy following ESWL to facilitate ureteral stone expulsion results in increased 1- and 2-month stone-free rates and in a lower percentage of those needing re-treatment. The efficacy of nifedipine for the upper-mid ureteral tract associated with ketoprofene makes expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for ureteral stones.
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References
Parmar MS (2004) Kidney stones. Br J Urol 328:1420
Muslumanoglu AY, Tefekli A, Sarilar O, Binbay M, Altunrende F, Ozkuvanci U (2003) Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract stones in children: a large scale retrospective analysis. J Urol 170:2408
Lingeman JE, Kim SC, Ramsay LK, Mcateer JA, Evan AP (2003) Shockwave lithotripsy: anecdotes and insights. J Endourol 17:690
Lotan Y, Gettman MT, Roehrborn CG, Cadeddu JA, Pearle MS (2002) Management of ureteral calculi: a cost comparison and decision making analysis. J Urol 167:1623
Pace K, Weir M, Tariq N, Honey RJD’A (2000) Low success rate of repeat shock wave lithotripsy for ureteral stones after failed initial treatment. J Urol 164:1905–1907
Peschel R, Janetschek G, Bartsch G (1999) Extracorporeal shock wave lithotripsy vs ureteroscopy for distal ureteral calculi: a prospective randomized study. J Urol 162:1911
Borghi L, Meschi T, Amato F, Novarini A, Giannini A, Quarantelli C et al (1994) Nifedipine and methylprednisolone in facilitatine ureteral stone passage: a randomized, double blind, placebo controlled study. J Urol 152:1095–1098
Cervenakov I, Fillo J, Mardiak J, Kopecny M, Smirala J, Lepies P (2002) Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1 blockers-tamsulosin. Int J Urol Nephrol 34:25
Porpiglia F, Destefanis C, Fiori R, Scarpa RM, Fontana D (2002) Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology 59:835–838
DellaBella M, Milanese G, Muzzonigro G (2003) Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol 170:2202–2205
Lingeman JE (2004) Stone treatments: currents trends and future possibilities. J Urol 172:1774
Sakhaee K, Nicar M, Hill K et al (1983) Contrasting effects of potassium citrate and sodium citrate therapies on urinary chemistries and crystallization of stone-forming salts. Kidney Int 24:348–352
Rodman JS (2002) Intermittent versus continuous alkaline therapy for uric acid stones and ureteral stones of uncertain composition. Urology 60(3):378–82
Micali S, Sighinolfi MC, Celia A, De Stefani S, Grande M, Bianchi GP (2006) Can Phyllanthus niruri affect the efficacy of extracorporeal shock wave lithotripsy for renal stones? A randomized, prospective, long-term study. J Urol 176:1020–1022
Kupeli B, Irkilata L, Gurocak S, Tunc L, Kirac M, Karaoglan U, Bozkirli I (2004) Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology 64:1111–1115
Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn R, Lingeman JE, Macaluso JN Jr (1997) Ureteral stones guidelines panel summary report on the management of ureteral calculi. J Urol 158:1919
Wu C, Shee J, Lin W, Lin Cand Chen C (2004) Comparison between extracorporeal shockwave lithotripsy and semirigid ureteroscope with holmium:yag laser for treating large proximal ureteral stones. J Urol 172:1902
Lam JS, Greene TD, Gupta M (2002) Treatment of proximal ureteral calculi: holmium:YAG laser lithotripsy versus extracorporeal shockwave lithotripsy. J Urol 167:1972–1976
Anagnostou T, Tolley D (2004) Management of ureteric stones. Eur Urol 45:714–721
Turk TM, Jenkins AD (1999) A comparison of ureteroscopy to in situ extracorporeal shock wave lithotripsy for the treatment of distal ureteral calculi. J Urol 161:45–46
Pearle MS, Nadler R, Bercowsky E et al (2001) Prospective randomised trial comparing shock wave lithotripsy and ureteroscopy for management of distal ureteral calculi. J Urol 166:1255–1260
Hendrikx AJM, Strijbos WEM, De Knijff DW, Kums JJM, Doesburg WH, Lemmens WAJG (1999) Treatment for extended-mid and distal ureteral stones: SWL or ureteroscopy? Results of a multicenter study. J Endourol 13:727–733
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Micali, S., Grande, M., Sighinolfi, M.C. et al. Efficacy of expulsive therapy using nifedipine or tamsulosin, both associated with ketoprofene, after shock wave lithotripsy of ureteral stones. Urol Res 35, 133–137 (2007). https://doi.org/10.1007/s00240-007-0085-5
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DOI: https://doi.org/10.1007/s00240-007-0085-5