Alpha Blockers May Improve SWL Outcomes

Men taking alpha blockers for benign prostatic hyperplasia (BPH) have better outcomes from shock wave lithotripsy (SWL) for kidney stones than men not taking the medications, according to investigators in Turkey.

A team at Baskent University in Ankara led by Umit Gul, MD, studied 248 men who underwent SWL for urinary stones (kidney, ureteral, or both) in 264 renal units (RUs) in 248 men older than 50 years. Thirty-four of the RUs were in men taking alpha blockers for BPH and 230 were in men not on the medications.

SWL achieved stone-free status in 30 RUs (88.2%) in the alpha blocker group compared with 165 RUs (71.7%) in the group not taking alpha blockers, a significant difference between the groups, according to findings published online ahead of print in the Journal of Endourology. The improved results with alpha blockers were independent of alpha blocker type.

The men taking alpha blockers had a significantly higher mean age than those not taking the drugs (63.2 vs. 58.6 years). The two groups were similar with respect to stone size, number of SWL sessions, and number of shock waves.

Previous studies have resulted in conflicting findings. A study by Bora Küpeli, MD, and colleagues at Gazi University School of Medicine in Ankara (Urology 2004;64:1111-1115) found that adding the alpha blocker tamsulosin to conventional treatment improved clearance of lower ureteral stones, especially when the drug was combined with SWL. However, a study by Stavros Gravas, MD, and coworkers at the University Hospital of  Larissa in Larissa, Greece (Urol Res 2007;35:231-235) demonstrated no significant difference in stone clearance rates among patients with lower ureteral stones 6 mm or larger in diameter who received diclofenac without or without tamsulosin after SWL.

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