Adjunctive tamsulosin improves stone free rate after ureteroscopic lithotripsy of large renal and ureteric calculi: a prospective randomized study.

摘要

OBJECTIVES: To prospectively evaluate the role of tamsulosin on the stone free rate and the rate of colic episodes after ureteroscopic laser lithotripsy. The presence of alpha-1A adrenoceptor in the distal ureteral smooth muscle prompted the use of tamsulosin, a selective alpha-1 blocker, to promote spontaneous passage of distal ureteral and juxtavesical calculi. Tamsulosin also improves stone clearance after shock wave lithotripsy. METHODS: Seventy-eight patients with large renal or ureteral calculi underwent ureteroscopic laser lithotripsy by a single endourologist. Stone size varied from 1 to 2 cm. After treatment, the patients were randomly divided into 2 groups. The study group (n = 40) received tamsulosin 0.4 mg and standard analgesia (tylenol with codeine). The control group (n = 38) received standard analgesia only. The primary endpoint was stone free rate, determined by helical computerized tomography at 4 weeks. The secondary endpoint was the rate of ureteric colic episodes during the 4-week period. RESULTS: Of the 73 patients available for follow up, the stone free rate was 86.5% in the study group, compared with 69.4% in the control group. 22.2% of the control group had colic episodes, whereas only 5.4% of the study group had colic. These were statistically significant with P <.01. CONCLUSIONS: Treatment with tamsulosin improves the stone free rate and reduces the occurrence of colic episodes, after ureteroscopic laser lithotripsy of large renal and ureteric calculi. To the best of our knowledge, this is the first study to show the efficacy of adjuvant tamsulosin after ureteroscopic lithotripsy.