Abstract
We performed a randomized, prospective study to assess the possible role of combined a1D-receptor antagonist naftopidil and nonsteroidal anti-inflammatory hormones celecoxib for the spontaneous expulsion of distal ureteral stones. Patients were randomized to one of the three treatment groups. Treatment group 1 patients received naftopidil 50 mg/day, group 2 patients received naftopidil 50 mg/day plus celecoxib 200 mg (Take two capsules (400 mg) by mouth immediately, then take one capsule (200 mg) by mouth every 12 h), and group 3 patients received celecoxib 200 mg (Take two capsules (400 mg) by mouth immediately, then take one capsule (200 mg) by mouth every 12 h). All patients were instructed to drink at least 2 L of fluids daily. Pain descriptions were recorded by the patients using the visual analog scale. All patients were followed up for 2 weeks. A total of 105 patients provided consent and 103 patients completed the study. Stone expulsion was observed in 29 patients in group 1 (29 of 35, 82.86 %), 33 patients in group 2 (33 of 35, 94.29 %) and 20 patients in group 3 (20 of 33, 60.61 %). A statistically significant difference was noted with Chi-square testing for stone expulsion rate between groups 1 and 3, and groups 2 and 3 (P = 0.04 and P = 0.000, respectively). Kaplan–Meier curves were plotted to access the expulsion rate of each group over time. A significant difference was shown for the expulsion rate between the group 3 and the other two groups. (P < 0.001 by log-rank test).Average time to expulsion for groups 1, 2 and 3 was 8.00 ± 2.07, 7.70 ± 2.34 and 10.65 ± 2.92 days, respectively (P = 0.000). Treatment with naftopidil and celecoxib appears to be beneficial in distal ureter stone clearance, shortened the expulsion time, and could be used reliably and successfully to reduce the frequency and intensity of the pain episodes particularly.
Similar content being viewed by others
References
Bensalah K, Pearle M, Lotan Y (2008) Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol 53:411–419
De Sio M, Autorino R, Di Lorenzo G, Damiano R, Giordano D, Cosentino L (2006) Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol 20:12–15
Seitz C, Liatsikos E, Porpiglia F, Tiselius HG, Zwergel U (2009) Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol 56(3):455–471
Porpiglia F, Ghignone G, Fiori C, Fontana D, Scarpa RM (2004) Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol 172:568–570
Dellabella M, Milanese G, Muzzonigro G (2005) Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol 174:167–171
Singh A, Alter HJ, Littlepage A (2007) A systematic review of medical therapy to facilitate passage of ureteral calculi. Ann Emerg Med 50(5):552–563
Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K (2007) Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol 14:749–753
Sigala S, Dellabella M, Milanese G et al (2004) Alpha-1 adrenoceptor subtypes in men juxtavesical ureters: molecular and pharmacological characterization. Eur Urol 3:119
Cervenakov I, Fillo J, Mardiak J et al (2002) Speedy elimination of ureterolithiasis in lower part of ureters with the alpha-1blocker-tamsulosin. Int Urol Nephrol 34:25–29
Canda AE, Turna B, Cinar GM, Nazli O (2007) Physiology and pharmacology of the human ureter: basis for current and future treatments. Urol Int 78:289–298
Porpiglia F, Vaccino D, Billia M et al (2006) Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol 50:339–344
Sigala S, Dellabella M, Milanese G et al (2005) Evidence for the presence of a1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn 24:142–148
Morita T, Wada I, Saeki H, Tsuchida S, Weiss RM (1987) Ureteral urine transport: changes in bolus volume, peristaltic frequency, intraluminal pressure and volume of flow resulting from autonomic drugs. J Urol 137:132–135
Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H (2005) The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol 713:2010–2012
Wolf JS Jr (2007) Treatment selection and outcomes: ureteral calculi. Urol Clin N Am 34:409–410
Wang CJ, Huang SW, Chang CH (2008) Efficacy of an a1 blocker in expulsive therapy of lower ureteral stones. J Endourol 22:41–42
Nishino Y, Masue T, Miwa K, Takahashi Y, Ishihara S, Deguchi T (2006) Comparison of two alpha1-adrenoceptor antagonists, naftopidil and tamsulosin hydrochloride, in the treatment of lower urinary tract symptoms with benign prostatic hyperplasia: a randomized crossover study. BJU Int 97:747–751
Sun XZ, He L, Ge WH, Lv JL (2009) Efficacy of selective alpha1D-blocker naftopidil as medical expulsive therapy for distal ureteral stones. J Urol 181:1716–1720
Zhou SG, Lu JL, Hui JH (2011) Comparing efficacy of a1Dreceptor antagonist naftopidil and a1A/D-receptor antagonist tamsulosin in management of distal ureteral stones. World J Urol 29:767–771
Lu JL, Tang QL, Liu FD et al (2012) Naftopidil and tolterodine in the medical expulsive therapy for intramural ureteral stones: a prospective randomized study. Urol Res 40:757–762
Hubner WA, Irby P, Stoller ML (1993) Natural history and current concepts for the treatment of small ureteral calculi. Eur Urol 24:172
Ueno A, Kawamura T, Ogawa A, Takayasu H (1977) Relation of spontaneous passage of ureteral calculi to size. Urology 10:544
Coll DM, Varanelli MJ, Smith RC (2002) Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol 178:101
Shokeir AA (2001) Renal colic: pathophysiology, diagnosis and treatment. Eur Urol 39:241–249
Preminger GM, Tiselius HG, Assimos DG et al (2007) Guideline for the management of ureteral calculi. J Urol 178:2418–2434
Zwergel U, Zwergel T, Ziegler M (1991) Effects of prostaglandins and prostaglandin synthetase inhibitors on acutely obstructed kidneys in the dog. Urol Int 47:64–69
Fukuda S, Hamasaki Y, Tai H (1985) Increase in enzyme activities of prostaglandin biosynthesis and catabolism by acute ureteral ligation in rat kidney. Life Sci 37:1249–1255
Kallidonis P, Liourdi D, Liatsiko E (2011) Medical treatment for renal colic and stone expulsion. Eur Urol Supp l10:415–422
Okegawa T (1983) Metabolic and cellular alterations underlying the exaggerated renal prostaglandin and thromboxane synthesis in ureter obstruction in rabbits. Inflammatory response involving fibroblasts and mononuclear cells. J Clin Invest 71:81–90
Ali M, Mohammed S (1986) Selective suppression of platelet thromboxane formation with sparing of vascular prostacyclin synthesis by aqueous extract of garlic in rabbits. Prostaglandins Leukot Med 25:139–146
Oosterlinck W, Philp NH, Charig C et al (1990) A double-blind single dose comparison of intramuscular ketorolac tromethamine and pethidine in the treatment of renal colic. J Clin Pharmacol 30:336–341
Porpiglia F, Destefanis P, Fiori C et al (2000) Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology 56:579–582
Borghi L, Meschi T, Amato F et al (1994) Nifedipine and methylprednisolone in facilitating ureteral stone passage: a randomized, double-blind, placebo-controlled study. J Urol 152:1095–1098
Cooper J, Stack G, Cooper T (2000) Intensive medical management of ureteral calculi. Urology 56:575–578
Davidson M, Lang R (2000) Effects of selective inhibitors of cyclooxygenase- 1 (COX-1) and cyclooxygenase-2 (COX-2) on the spontaneous myogenic contractions in the upper urinary tract of the guinea pig and rat. Br J Pharmacol 129:661–670
Nakada S, Jerde T, Bjorling D et al (2000) Selective cyclooxygenase-2 inhibitors reduce ureteral contraction in vitro: a better alternative for renal colic? J Urol 163:607–612
Mastrangelo D, Wisard M, Rohner S, Leisinger H et al (2000) Diclofenac and NS-398, a selective cyclooxygenase-2 inhibitor, decrease agonist induced contractions of the pig isolated ureter. Urol Res 28:376–382
LaerumE Ommundsen OE, Granseth JE, Christiansen A et al (1995) Oral diclofenac in the prophylactic treatment of recurrent renal colic: a double-blind comparison with placebo. Eur Urol 28:108–111
Phillips E, Hinck B, Pedro R (2009) Celecoxib in the management of acute renal colic: a randomized controlled clinical trial. Urology 74:994–999
Conflict of interest
There is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lv, J.L., Tang, Q.L. Comparative evaluation of efficacy of use of naftopidil and/or celecoxib for medical treatment of distal ureteral stones. Urolithiasis 42, 541–547 (2014). https://doi.org/10.1007/s00240-014-0708-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00240-014-0708-6