Urological Research

, Volume 40, Issue 4, pp 327–332 | Cite as

Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial

  • Osama M. Zaytoun
  • Rachid Yakoubi
  • Abdel Rahman M. Zahran
  • Khaled Fouda
  • Essam Marzouk
  • Salah Gaafar
  • Khaled Fareed
Original Paper


Alpha-blockers have been established as medical expulsive therapy for urolithiasis. We aimed to assess the effect of tamsulosin and doxazosin as adjunctive therapy following SWL for renal calculi. We prospectively included 150 patients who underwent up to four SWL sessions for renal stones from June 2008 to 2009. Patients were randomized into three groups of 50 patients each, group A (phloroglucinol 240 mg daily), group B (tamsulosin 0.4 mg once daily plus phloroglucinol), and group C (doxazosin 4 mg plus phloroglucinol). The treatment continued up to maximum 12 weeks. Patients were evaluated for stone expulsion, colic attacks, amount of analgesics and side-effects of alpha-blockers. There were no significant differences between the groups regarding stone expulsion rates (84; 92 and 90%, respectively). The mean expulsion time of tamsulosin was significantly shorter than both control group (p = 0.002) and doxazosin (p = 0.026). Both number of colic episodes and analgesic dosage were significantly lower with tamsulosin as compared to control and doxazosin. Steinstrasse was encountered in 10 (6.7%) patients with no significant difference between the groups. 16 patients on tamsulosin and 21 on doxazosin experienced adverse effects related to postural hypotension. Moreover, 2 (4%) patients in the tamsulosin group reported ejaculatory complaints. In conclusion, adjunction of tamsulosin or doxazosin after SWL for renal calculi decreases the time for stone expulsion, amount of the analgesics and number colic episodes. There was no benefit regarding the overall stone expulsion rate. The side-effects of these agents are common and should be weighted against the benefits of their usage.


Alpha-adrenergic antagonists Tamsulosin Doxazosin Calculi Lithotripsy 


  1. 1.
    Curhan GC (2007) Epidemiology of stone disease. Urol Clin North Am 34:287–293PubMedCrossRefGoogle Scholar
  2. 2.
    Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C (2010) Guidelines on urolithiasis. European Association of Urology, UKGoogle Scholar
  3. 3.
    Kim TH, Oh SY, Moon YT (2008) The effect of tamsulosin on expulsion of ureteral stones after extracorporeal shock wave lithotripsy. Korean J Urol 49:1100–1104CrossRefGoogle Scholar
  4. 4.
    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):455–471PubMedCrossRefGoogle Scholar
  5. 5.
    Zheng S, Liu LR, Yuan HC, Wei Q (2010) Tamsulosin as adjunctive treatment after shockwave lithotripsy in patients with upper urinary tract stones: a systematic review and meta-analysis. Scand J Urol Nephrol 44(6):425–432PubMedCrossRefGoogle Scholar
  6. 6.
    Wang CJ, Huang SW, Chang CH (2009) Adjunctive medical therapy with an alpha-1A-specific blocker after shock wave lithotripsy of lower ureteral stones. Urol Int 82(2):166–169PubMedCrossRefGoogle Scholar
  7. 7.
    Zehri AA, Ather MH, Abbas F, Biyabani SR (2010) Preliminary study of efficacy of doxazosin as a medical expulsive therapy of distal ureteric stones in a randomized clinical trial. Urology 75(6):1285–1288PubMedCrossRefGoogle Scholar
  8. 8.
    Schuler TD, Shahani R, Honey RJ, Pace KT (2009) Medical expulsive therapy as an adjunct to improve shockwave lithotripsy outcomes: a systematic review and meta-analysis. J Endourol 23(3):387–393PubMedCrossRefGoogle Scholar
  9. 9.
    Madaan S, Joyce AD (2007) Limitations of extracorporeal shock wave lithotripsy. Curr Opin Urol 17(2):109–113PubMedCrossRefGoogle Scholar
  10. 10.
    Bhagat SK, Chacko NK, Kekre NS, Gopalakrishnan G, Antonisamy B, Devasia A (2007) Is there a role for tamsulosin in shock wave lithotripsy for renal and ureteral calculi? J Urol 177(6):2185–2188PubMedCrossRefGoogle Scholar
  11. 11.
    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(1):167–172PubMedCrossRefGoogle Scholar
  12. 12.
    Rajpathy J, Aswathaman K, Sinha M, Subramani S, Gopalakrishnan G, Kekre NS (2008) An in vitro study on human ureteric smooth muscle with the alpha1-adrenoceptor subtype blocker, tamsulosin. BJU Int 102(11):1743–1745PubMedCrossRefGoogle Scholar
  13. 13.
    Naja V, Agarwal MM, Mandal AK, Singh SK, Mavuduru R, Kumar S, Acharya NC, Gupta N (2008) Tamsulosin facilitates earlier clearance of stone fragments and reduces pain after shockwave lithotripsy for renal calculi: results from an open-label randomized study. Urology 72(5):1006–1011PubMedCrossRefGoogle Scholar
  14. 14.
    Gravina GL, Costa AM, Ronchi P, Galatioto GP, Angelucci A, Castellani D, Narcisi F, Vicentini C (2005) Tamsulosin treatment increases clinical success rate of single extracorporeal shock wave lithotripsy of renal stones. Urology 66(1):24–28PubMedCrossRefGoogle Scholar
  15. 15.
    Hussein MM (2010) Does tamsulosin increase stone clearance after shockwave lithotripsy of renal stones? A prospective, randomized controlled study. Scand J Urol Nephrol 44(1):27–31PubMedCrossRefGoogle Scholar
  16. 16.
    Zhu Y, Duijvesz D, Rovers MM, Lock TM (2010) alpha-Blockers to assist stone clearance after extracorporeal shock wave lithotripsy: a meta-analysis. BJU Int 106(2):256–261PubMedCrossRefGoogle Scholar
  17. 17.
    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 173(6):2010–2012PubMedCrossRefGoogle Scholar
  18. 18.
    Tajari H, Pedram P, Keshtkar A et al (2009) The comparison between efficacy of tamsulosin and terazosin in alpha-adrenergic blockers after ESWL. Urology 74(Suppl 4A):S340CrossRefGoogle Scholar
  19. 19.
    Micali S, Grande M, Sighinolfi MC, De Stefani S, Bianchi G (2007) Efficacy of expulsive therapy using nifedipine or tamsulosin, both associated with ketoprofene, after shock wave lithotripsy of ureteral stones. Urol Res 35(3):133–137PubMedCrossRefGoogle Scholar
  20. 20.
    Gravas S, Tzortzis V, Karatzas A, Oeconomou A, Melekos MD (2007) The use of tamsulosin as adjunctive treatment after ESWL in patients with distal ureteral stone: do we really need it? Results from a randomised study. Urol Res 35(5):231–235PubMedCrossRefGoogle Scholar
  21. 21.
    Agarwal MM, Naja V, Singh SK, Mavuduru R, Mete UK, Kumar S, Mandal AK (2009) Is there an adjunctive role of tamsulosin to extracorporeal shockwave lithotripsy for upper ureteric stones: results of an open label randomized nonplacebo controlled study. Urology 74(5):989–992PubMedCrossRefGoogle Scholar
  22. 22.
    Falahatkar S, Khosropanah I, Vajary AD, Bateni ZH, Khosropanah D, Allahkhah A (2011) Is there a role for tamsulosin after shock wave lithotripsy in the treatment of renal and ureteral calculi? J Endourol 25(3):495–498PubMedCrossRefGoogle Scholar
  23. 23.
    Sigala S, Dellabella M, Milanese G, Fornari S, Faccoli S, Palazzolo F, Peroni A, Mirabella G, Cunico SC, Spano P, Muzzonigro G (2005) Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn 24(2):142–148PubMedCrossRefGoogle Scholar
  24. 24.
    Cervenàkov I, Fillo J, Mardiak J, Kopecný M, Smirala J, Lepies P (2002) Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker—tamsulosin. Int Urol Nephrol 34(1):25–29PubMedCrossRefGoogle Scholar
  25. 25.
    Ukhal MI, Malomuzh OI, Strashny V (1999) Administration of doxazosin for speedy elimination of stones from lower section of ureter. Eur Urol 35(Suppl 2):4–6Google Scholar
  26. 26.
    Liatsikos EN, Katsakiori PF, Assimakopoulos K, Voudoukis T, Kallidonis P, Constantinides C, Athanasopoulos A, Stolzenburg JU, Perimenis P (2007) Doxazosin for the management of distal-ureteral stones. J Endourol 21(5):538–541PubMedCrossRefGoogle Scholar
  27. 27.
    Madbouly K, Sheir KZ, Elsobky E, Eraky I, Kenawy M (2002) Risk factors for the formation of a steinstrasse after extracorporeal shock wave lithotripsy: a statistical model. J Urol 167(3):1239–1242PubMedCrossRefGoogle Scholar
  28. 28.
    Soyupek S, Armağan A, Koşar A, Serel TA, Hoşcan MB, Perk H, Oksay T (2005) Risk factors for the formation of a steinstrasse after shock wave lithotripsy. Urol Int 74(4):323–325PubMedCrossRefGoogle Scholar
  29. 29.
    Resim S, Ekerbicer HC, Ciftci A (2005) Role of tamsulosin in treatment of patients with steinstrasse developing after extracorporeal shock wave lithotripsy. Urology 66(5):945–948PubMedCrossRefGoogle Scholar
  30. 30.
    Moursy E, Gamal WM, Abuzeid A (2010) Tamsulosin as an expulsive therapy for steinstrasse after extracorporeal shock wave lithotripsy: a randomized controlled study. Scand J Urol Nephrol 44(5):315–319PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Osama M. Zaytoun
    • 1
    • 2
  • Rachid Yakoubi
    • 3
  • Abdel Rahman M. Zahran
    • 2
  • Khaled Fouda
    • 2
  • Essam Marzouk
    • 2
  • Salah Gaafar
    • 2
  • Khaled Fareed
    • 1
  1. 1.Glickman Urological and Kidney InstituteCleveland ClinicClevelandUSA
  2. 2.Department of Urology, Faculty of MedicineUniversity of AlexandriaAlexandriaEgypt
  3. 3.Department of UrologyHôpital Huriez, CHRU, University of Lille 2LilleFrance

Personalised recommendations