Efficacy of expulsive therapy using nifedipine or tamsulosin, both associated with ketoprofene, after shock wave lithotripsy of ureteral stones (original) (raw)
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International braz j urol : official journal of the Brazilian Society of Urology
To increase the success rate of the first treatment of ureteral stones through extracorporeal shock wave lithotripsy (ESWL), we tested the efficacy of a medical therapy with nifedipine and deflazacort administered to patients who had undergone ESWL for ureteral stones. This prospective study lasted from October 1998 to September 2000 and involved 80 patients. All the patients underwent ESWL with Sonolith 4000+. The patients were randomly divided into two groups: 40 patients (group 1) received an "adjunctive" treatment with oral medical therapy (nifedipine and deflazacort); the other 40 patients (group 2) were used as the control group. Complete fragment expulsion occurred in 30 (75%) of the 40 patients of group 1 and in 20 (50%) of the 40 patients of group 2 at the endpoint. A statistically significant difference was observed in the stone-free rate (P = 0.02). Concerning the symptomatic therapy, the average diclofenac use was 37.5 mg per patient in group 1 and 86.25 mg per patient in group 2 (P = 0.02). The results of this study have shown the role that adjunctive medical therapy with nifedipine and deflazacort given after an ESWL procedure can play in increasing the success rate of ureteral stone treatment. Furthermore, these results would suggest that adjunctive medical therapy can reduce total analgesic consumption after the ESWL procedure.
Medical Expulsive Therapy for Ureteral Stones; Beyond Alpha Blockers & Steroids
Journal of Medical Sciences, 2017
Objectives: To Know the Medical Expulsive Therapy for Ureteral Stones; Beyond Alpha Blockers & Steroids. Material and Methods: This prospective cohort study was carried out to see the effects of adding Serratiopeptidase to the already established drug therapy, 'alpha blockers' in patients with the ureteral stones size from 05mm up to 10mm, for the medical expulsion therapy. It consisted of a total of 80 patients. There were 63 male patients (78.80%) as compared to 17 female patients (21.30%). The mean age of the patients was 25.80 ± 06.43 years (Range = 15 to 41 years). Results: In our study the stones were cleared in a total of 68 patients (Total stone clearance = 85.00%). IVU was carried out in 12 patients (15%). The stones clearance was achieved in 08 patients (10%) by Extra Corporeal Shock Wave Lithotripsy (ESWL) and four patient needed surgical intervention (5%). A total of 12 (15%) patients had failed attempt at MET. Conclusion: Majority of the clinicians accept the effectiveness of the anti inflammatory and analgesic properties of serratio-peptidase & this role can be exploited in the medical expulsion therapy of the ureteral stones substituting steroids.
Videosurgery and Other Miniinvasive Techniques, 2020
Introduction: Different antagonists of αadrenergic receptors (α-blockers) have been used as medical expulsive treatment (MET) after extracorporeal shock wave lithotripsy (ESWL). Aim: To retrospectively evaluate the expulsion rate of fragments after extracorporeal shock wave lithotripsy performed for single ureteral stones followed by different medical expulsive treatments. Material and methods: We retrospectively analyzed stone expulsion rates of 190 patients treated by shock wave lithotripsy (SWL) for single, 5 to 10 mm, symptomatic and uncomplicated distal ureteric stones, treated with tamsulosin 0.4 mg, silodosin 8 mg or silodosin 4 mg as MET. Beside the stone-free rate after 4 weeks of treatment, we also investigated the pain intensity using the visual analogue scale (VAS), adverse events induced by the medication, safety of drug administration and the reasons for possible early treatment discontinuation. Results: Silodosin 8 mg and tamsulosin 0.4 mg have similar results in terms of stone-free rate. For silodosin 4 mg the stone-free rate was significantly lower than for the previous two drugs. In patients treated with silodosin 4 mg the VAS was significantly higher than in patients treated with silodosin 8 mg or tamsulosin 0.4 mg, for all the follow-up visits. Conclusions: Alpha-blocker treatment after ESWL with silodosin 8 mg offers a similar stone-free rate compared with tamsulosin 0.4 mg, being well tolerated. A lower dose of silodosin (4 mg) has significantly poor results, irrespective of ureteric stone size, with more frequent renal colic and severe pain.
Canadian Urological Association Journal, 2014
Introduction: We evaluate the efficiency of alpha-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones.Methods: A total of 356 patients with solitary lower ureteral stones who underwent single ESWL sessions were divided into 2 groups. Group 1 received our standard medical therapy, and Group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during the treatment period. A computed tomography scan was systematically performed 3 months after ESWL.Results: In total, 82 of the 170 patients in Group 1 (48.2%) and 144 of the 186 patients in Group 2 (77.4%) (p = 0.002) were stone free. Among the patients with stones 10 to 15 mm in diameter, the stone-free rate was 38.4% in Group 1 and 77.1% in Group 2 (p = 0.003). Average stone expulsion time was 10.6 days and 8.4 days in Groups 1 and 2, respectively. Ureteral coli...
Do stone size and impaction influence therapeutic approach to proximal ureteral stones?
Vojnosanitetski Pregled, 2009
Background/Aim. Primary therapeutic approach to lumbar ureteral stones is still contraversial. The aim of the study was to investigate the influence of stone impaction and size on the effectiveness of proximal ureteral stone lithotripsy. Methods. A total of 123 patients with proximal ureteral stones were investigated in this prospective study performed in a 10-month period. The patients were divided into the group I-86 patients treated with extracorporeal shock wave lithotripsy (ESWL) and the group II-37 patients treated with "Swiss" Lithoclast. In the group I, 49 stones (57%) were classified as impacted, while 20 stones (23.3%) were larger than 100 mm 2. In the group II, 26 stones (70.3%) were impacted, and 11 stones (29.7%) were larger than 100 mm 2. Stones were defined as impacted by the radiographic, echosonographic as well as endoscopic findings in the group II of patients. Stone size was presented in mm 2. Chemical composition of stones were almost the same in both groups of the patients. Results. Generally, there was no statistically significant difference in the treatment success between the groups. However, stones larger than 100 mm 2 were statistically more successfully treated endoscopically, while there was no statistical difference in the treatment success of impacted stones between these two groups. Conclusion. ESWL can by considered as primary first therapeutic approach in treatment of all proximal ureteral stones except for stones larger than 100 mm 2 that should primarily be treated endoscopically.
Arab Journal of Urology, 2013
Objectives: To assess and compare, in a randomised clinical trial, the efficacy of tamsulosin and nifedipine as medical expulsive therapy for distal ureterolithiasis. Patients and methods: In all, 128 symptomatic patients with stones in the juxtavesical tract of the ureter were randomly divided into group 1 (64 patients) receiving oral nifedipine sustained-release 30 mg/day, and group 2 (64 patients) receiving tamsulosin 0.4 mg/day. Both groups received oral prednisolone 30 mg/day for 10 days and diclofenac 75 mg intramuscularly on demand. Patients were assessed by weekly ultrasonography with or with no abdominal computed tomography, during a followup of 4 weeks. The stone passage rate and time, analgesic use, hospitalisation and endoscopic interventions were evaluated. The results were analysed statistically using appropriate tests. Results: The stone expulsion rate was 55% for group 1 and 80% for group 2 (P = 0.004). The mean stone size was 8.59 and 8.85 mm in groups 1 and 2, respectively. The mean expulsion time was 23 days for group 1 and 9 days for group 2 (P < 0.001). The mean number of diclofenac injections was 1.19 for group 1 and 0.42 for group 2 (P < 0.001). Eleven patients in group 1 vs. two in group 2 were
The Egyptian Journal of Hospital Medicine, 2018
To compare the efficacy, cost effect and safety of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) for distal ureteric calculi by evaluating stone-free rates, retreatment rates, need for auxiliary procedures, associated complications and technical consideration with respect to patient satisfaction. Patient and method: 70 patients with single unilateral radiopaque distal ureteric stone ranges from 0.8 cm to 1.2 cm in diameter and ≥1.5 cm in length were enrolled in a prospective randomized trial. Patients were randomized to undergo URS (35) or ESWL (35). The electromagnetic Dornier lithotripter S was used for ESWL and a semi-rigid Olympus ureteroscope, 7° direction of view, angled ocular,8.6/9.8 Fr. x 43 cm, 6.4 Fr. channel was used for URS. Patient and stone characteristics, treatment parameters, clinical outcomes, and patient satisfaction were assessed for each group. Results: Patients in the ESWL group achieved a 77.1% overall stone-free rate (SFR) with a 74.3% retreatment rate and no auxiliary procedure was done. Complications occurred in 11.4% of patients treated with ESWL. Patients in the URS group achieved a 97.1% overall SFR with a retreatment rate of 8.6% and an auxiliary procedure rate of 100%. Complications occurred in 31.4% of patients treated with URS. Patient satisfaction was high for both groups, including 94.3% for URS and 77.1% for ESWL. ESWL were already at outpatient clinic so there were no admission or hospital stay. While in URS group patients admitted with mean hospital stay 1.6±0.5 day. Conclusions: In the treatment of large distal ureteral calculi ≥ 1.5 cm, both URS and ESWL modalities are comparable but URS is recommended as a first option as it is more effective than ESWL regarding stone-free rate and it provides immediate stone clearance with lower retreatment rates and higher patient satisfaction.
Prediction of success of extracorporeal shock wave lithotripsy in the treatment of ureteric stones
International Urology and Nephrology, 2007
Objectives To define the factors that affect the success rate of extracorporeal shock wave lithotripsy (ESWL) for the treatment of ureteric stones. Patients and methods Between January 2000 and December 2003, 468 patients with ureteric stones underwent in situ ESWL using Storz SL 20 lithotriptor. The results of treatment were evaluated after 3 months of follow-up. Treatment success was defined as complete clearance of the stones. Characteristics of the patients, condition of the urinary tract and stone features were correlated to the success rate to define the significant predictors of success. Results At 3-month follow-up, the overall success rate was 394/468 (84.2%). Repeat treatment was required in 239 patients (51.1%). Post-ESWL auxiliary procedures were necessary in 58 patients (12.4%). Post-ESWL complications were observed in 11 patients (2.4%). Only three factors had a significant impact on the stone-free rate, namely stone site, stone width and the presence of a ureteral stent. The stone-free rate was highest for stones located in the lumbar ureter (159/183; 86.9%) and lowest for those in iliac ureter (28/40; 70%) (P < 0.05). Stones with a transverse diameter < 8 mm were associated with a stonefree rate of 89.9% (248/276), compared to 66.7% (128/192) for those with a transverse diameter of >8 mm (P < 0.01). Non-stented patients had a stone-free rate of 89.2% (313/348), compared to 75.2% (85/113) for stented patients (P < 0.01). Conclusions The site and transverse diameter of the stone and the presence of a ureteral stent are the only significant predictors of success of ESWL therapy for ureteric stones.
Evaluation of emergency extracorporeal shock wave lithotripsy for obstructing ureteral stones
International braz j urol, 2008
To assess the efficacy of extracorporeal shockwave lithotripsy (ESWL) for ureteral calculi during acute renal colic. Materials and Methods: From January 2002 to March 2007, 108 patients were treated by ESWL for obstructing ureteral stones causing acute renal colic. ESWL was performed within 24 hours of the onset of renal colic. Results: The mean age of the patients was 39.5 years (11-72 years). Male/female ratio was 85/23. Mean stone size was 8.45 mm (4-20 mm). They were located in the pelvic (n = 53), iliac (n = 28) or lumbar (n = 27) region. Fragmentation after a single session was complete in 56 patients (52%), incomplete in 28 (26%), and absent in 24 (22%). Patients presenting incomplete fragmentation underwent a second (n = 28) or even a third session (n = 11). Of the 24 patients in whom ESWL had no impact on the stone, 21 underwent ureteroscopy, and in one case open ureterolithotomy for a patient with a hard 17 mm stone, while spontaneous passage occurred in two patients with small stones. Conclusion: Emergency ESWL for obstructing ureteral stones has a satisfactory success rate and very low morbidity. The stone-free rate of retreating ureteral calculi with ESWL decreases significantly after failed initial treatment. Stone size may be the main predictive factor for retreatment. We suggest that no more than 3 treatments should be given for a particular stone due to minimal improvement in the subsequent cumulative treatment success rate.