Effect of Tamsulosin on Ureteral Stones Expulsion before Performing Transureteral Lithotripsy: A Randomized Clinical Trial
Mostafa Heidari
1
(
Assistant Professor of Ophthalmology Department of Ophthalmology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
)
Faramarz Beigi
2
(
Department of Urology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
)
Soleiman Kheiri
3
(
Department of Epidemiology and Biostatistics, School of Health Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran
)
الکلمات المفتاحية: Tamsulosin, Flomax, Lithotripsy, Kidney calculi, Kidney stones,
ملخص المقالة :
Prevalence of ureteral stones has been increasing, and has direct effect on patients' quality of life and the number of phases of renal colic which patients destined to suffer from it. This study aims to investigate the effect of Tamsulosin administration before transureteral lithotripsy (TUL) on the expulsion rate of ureteral stones. In this single-blind clinical trial, 80 patients who were diagnosed with ureteric stones and referred to Ayatollah Kashani Shahrekord Hospital in Southwest Iran were randomly divided into two groups. The first group was given the drug Tamsulosin (0.4 mg day-1) one week before undergoing TUL, along with an oral painkiller (Naproxen 250 mg every 12 hours). The second group only received the painkiller. We evaluated the two groups based on the rate of stone elimination, number of phases of renal colic, painkiller intake, ease of access to the stone at the start of TUL, the need for Stent ventilation during TUL, and additional TUL. The intervention group showed a significantly higher rate of stone expulsion compared to the control group (p=0.046). The number of renal colic phases before TUL (p<0.001) and the use of painkillers were significantly lower in the intervention group compared to the control group (p<0.01). Additionally, the stone expulsion in the first week was significant for the intervention group (p=0.034). Based on the study results, it is recommended that the drug Tamsulosin be administered before performing TUL for patients with stones larger than 6 mm in diameter. This is because it not only helps the stone pass in many patients before TUL but also reduces post-TUL pain, shortens the procedure duration, and speeds up the stone passage.
1. Glazer K., Brea I.J., Leslie S.W, Vaitla P., Ureterolithiasis. [Updated 2024 Apr 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www. ncbi.nlm. nih.gov/books/NBK560674/.
2. Küpeli B., Irkilata L., Gürocak S., Tunç L., Kiraç M., Karaoğlan U., Bozkirli I., 2004. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology. 64(6), 1111-1115.
3. Stamatelou K., Goldfarb D. S., 2023. Epidemiology of Kidney Stones. Healthcare (Basel). 11(3), 424.
4. Peerapen P., Thongboonkerd V., 2023. Kidney Stone Prevention. Adv Nutr. 14(3), 555-569.
5. Emami E., Heidari-Soureshjani S., Oroojeni Mohammadjavad A., Sherwin C.M., 2023. Obesity and the Risk of Developing Kidney Stones: A Systematic Review and Meta-analysis. Iran J Kidney Dis. 1(2), 63-72.
6. Almaghlouth A.K., Alqutayfi H.M., Bohamad A.H., Almarzooq A.J., Alamer M.A., Alqattan D.J., 2023. Urolithiasis Symptoms and Risk Factors Among the General Population of Alahsa, Saudi Arabia. Cureus. 15(5), e39645.
7. Talamini S., Wong D., Phillips T., Palka J., Vetter J., Chow A., Paradis A., Desai A., Sands K., Nottingham C., Venkatesh R., 2024. Improved stone quality of life in patients with an obstructing ureteral stone on alpha-blocker medical expulsive therapy. Int Urol Nephrol. 56(4), 1289-1295.
8. Wade C.A., Goodwin J., Preston D., Kyprianou N., 2019. Impact of α-adrenoceptor antagonists on prostate cancer development, progression and prevention. Am J Clin Exp Urol. 7(1), 46-60.
9. Chavez-Tapia N.C., Kinney-Novelo I.M., Sifuentes-Rentería S.E., Torres-Zavala M., Castro-Gastelum G., Sánchez-Lara K., Paulin-Saucedo C., Uribe M., Méndez-Sánchez N., 2012. Association between cholecystectomy for gallstone disease and risk factors for cardiovascular disease. Ann Hepatol. 11(1), 85-89.
10. Yoosuf B.T., Panda A.K., Kt M.F., Bharti S. K., Devana S.K., Bansal D., 2024. Comparative efficacy and safety of alpha-blockers as monotherapy for benign prostatic hyperplasia: a systematic review and network meta-analysis. Sci Rep. 14(1), 11116.
11. Li H., Zhang W., Xu G., Wang D., Xu C., Zhang H., Zhang L., Li J., Tang P., 2022. Prophylactic tamsulosin can reduce the risk of urinary retention after surgery in male patients: A systematic review and meta-analysis. Front Surg. 9, 930707.
12. Choi C.I, Kim J.K., Choo M.S., Lee S.H., Chang J.D., Han J.H., 2021. Preventive effects of tamsulosin for postoperative urinary retention after lower limb arthroplasty: A randomized controlled study. Investig Clin Urol. 62(5), 569-576.
13. Basri C., Sinanoglu O., Mahmure U., 2013. The effect of tamsulosin on pain and clearance according to ureteral stone location after shock wave lithotripsy. Curr Ther Res Clin Exp. 74, 33-35.
14. Nuraj P., Hyseni N., 2017. The Role of the Tamsulosin in the Medical Expulsion Therapy for Distal Ureteral Stones. Med Arch. 71(2), 137-140.
15. Hughes P., Lyon C., 2018. PURLs: Tamsulosin for patients with ureteral stones? J Fam Pract. 67(1), 37-38.
16. Yilmaz E., Batislam E., Basar M. M., 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), 2010-2012.
17. Sauermann P., Hermanns T., Frauenfelder T., Rufibach K., Sulser T., Strebel R., 2009. Expulsive effect of tamsulosin on distal ureteral stones? Results of a double-blind randomised, placebo-controled single-centre trial. Eur Urol Suppl. 4(8), 206.
18. Ohki K., Ohno Y., Suzuki K., 2010. The investigation of ureteral sympathetic innervation, using semi-serial sections: why does the alpha1-adrenergic receptor antagonist work well for ureteral stones? Int Urol Nephrol. 42(1), 113-117.
19. Erdoğan E., Şimşek G., Aşık A., Yaşar H., Şahin C., Sarıca K., 2024. Optimal duration of medical expulsive therapy for lower ureteral stones: a critical evaluation. Urolithiasis. 52(1), 48.
20. John T. T., Razdan S., 2010. Adjunctive tamsulosin improves stone free rate after ureteroscopic lithotripsy of large renal and ureteric calculi: a prospective randomized study. Urology. 75(5), 1040-1042.
21. Griwan M. S., Singh S. K., Paul H., Pawar D. S., Verma M., 2010. The efficacy of tamsulosin in lower ureteral calculi. Urol Ann. 2(2), 63-66.
22. Sun Y., Lei G. L., Yang L., Wei Q., Wei X., 2019. Is tamsulosin effective for the passage of symptomatic ureteral stones: A systematic review and meta-analysis. Medicine (Baltimore). 98(10), e14796.
23. Campschroer T., Zhu X., Vernooij R. W., Lock M. T., 2018. Alpha-blockers as medical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 4(4), Cd008509.
