Effect of α1-Adrenergic Antagonists on Lower Ureteral Stones With Extracorporeal Shock Wave Lithotripsy

ObjectiveTo evaluate the efficiency of α1-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones.MethodsA total of 107 patients with solitary lower ureteral stones and who underwent single ESWL sessions were divided into two 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 treatment.ResultsTwenty-four of the 52 patients in group 1 (46.2%) and 41 of 55 patients in group 2 (74.5%) (p =0.002) were found to be stone-free. Among patients with stones 10-15 mm in diameter, the stone-free rate was 36.4% in group 1 and 73.0% in group 2 (p = 0.003). Average stone expulsion time was 11.6 days and 8.1 days in groups 1 and 2, respectively (p = 0.000). Ureteral colic occurred in 10 patients (19.2%) in group 1 but only 3 patients (5.5%) in group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 2 of the 55 (3.6%) patients in group 2.ConclusionAdjunctive therapy with α1-adrenergic antagonists after ESWL is more effective than, and equally as safe as lithotripsy alone in the treatment of patients with lower ureteral stones. The use of α1-adrenergic antagonists is more useful for stones with a large dimension, and can also reduce stone expulsion time and episodes of ureteral colic.