Renal Stone Patients Benefit from Post-SWL Tamsulosin
Pain episodes and need for adjuvant intervention decreased, but the alpha blocker did not improve renal stone clearance rates.
Daily tamsulosin treatment after shock wave lithotripsy (SWL) does not enhance clearance of renal stone fragments, but it decreases the number of pain episodes as well as the need for analgesia and adjuvant intervention.
Abul-fotouh Ahmen, MD, of Al-Azhar University in Cairo, Egypt, and colleagues prospectively studied 271 patients who underwent single-session SWL for a solitary renal stone smaller than 20 mm. After the procedure, the investigators randomly assigned patients to a treatment arm (0.4 mg daily dose of tamsulosin for 12 weeks plus traditional post-SWL analgesia) and a control arm (traditional analgesia alone).
Of the 271 patients, 249 completed the study: 123 in the tamsulosin group and 126 in the placebo group. The overall stone-free rate (SFR) was 73.5%--78% in the tamsulosin-treated patients and 69% in the placebo recipients, a non-significant difference between the groups, Dr Ahmen and his colleagues reported online in Urologia International. The proportion of patients who experienced at least 1 episode of acute renal/ureteral colic during the follow-up period was significantly lower in the tamsulosin than the placebo arm (8.1% vs. 19.8%).
The mean cumulative analgesia dosage per patients was significantly lower in the tamsulosin than the placebo group (313 vs. 346 mg). Overall, steinstrasse developed in 14 patients, and 6 of them—all in the control arm—needed urgent intervention.
“Our study demonstrated that the adjunctive tamsulosin therapy did not enhance the SFR but reduced pain episodes and analgesia dosage, overall and for smaller and larger stones,” the authors concluded.