Efectividad del tratamiento médico expulsivo con el bloqueador alfa tamsulosina en pacientes adultos que consultan por cálculo ureteral distal en un servicio de urgencias chileno / Effectiveness of medical expulsive therapy with the alfa-adrenergic blocker tamsulosin for distal ureterolithiasis in adults attended in an emergency department in Chile

Objetivo. Evaluar la efectividad del tratamiento médico expulsivo con tamsulosina. Método. Ensayo clínico prospectivo aleatorizado doble ciego realizado en un servicio de urgencias. Se incluyen adultos con ureterolitiasis distal única no complicada, que fueron asignados aleatoriamente a tamsulosina 0,4 mg/día más antiinflamatorio no esteroideo (AINE) (grupo A), o con placebo más AINE (grupo B), durante 21 días. Resultados. No se observaron diferencias estadísticamente significativas en la tasa de expulsión de litiasis entre ambos grupos (p = 0,29) ni en el tiempo de expulsión de esta (p = 0,91). Conclusiones. La terapia expulsiva con tamsulosina no se asocia a una mayor tasa de expulsión de litiasis ureteral

Objective. To assess the effectiveness of medical expulsive therapy with tamsulosin. Methods. Randomized double-blind controlled trial in an emergency department. We enrolled adults with uncomplicated distal ureterolithiasis and no other complaint. Patients were randomized to take either tamsulosin (0.4 mg/d) plus a nonsteroidal anti-inflammatory drug (NSAID) or placebo plus the NSAID for 21 days. Results. The stone expulsion rate did not differ statistically between the 2 groups (P=.29). Time until expulsion was also similar (P=.91). Conclusion. Medical expulsive therapy with tamsulosin does not improve the rate of distal ureteral stone expulsion

Silodosina en el tratamiento médico expulsivo para los cálculos ureterales distales / Silodosin in medical expulsive therapy for distal ureteral calculi

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The efficacy and safety of silodosin for the treatment of ureteral stones: a systematic review and meta-analysis.

BACKGROUND: To evaluate the efficacy and safety of silodosin as a medical expulsive therapy for ureteral stones by means of a systematic review and meta-analysis. METHODS: We searched MEDLINE, EMBASE and the Cochrane Controlled Trials Register to identify randomized controlled trials (RCTs) of silodosin in the treatment of ureteral stones. The reference lists of retrieved studies were also investigated. RESULTS: Six RCTs, including 916 participants and comparing silodosin with controls, were used in the meta-analysis. Silodosin was superior to controls in terms of stone expulsion rate, the primary efficacy end point in all six RCTs (odds ratio [OR] for expulsion 2.16, 95 % confidence interval [CI] 1.62 to 2.86, p <0.00001). Silodosin was also more effective for secondary efficacy end points; the stone expulsion time (standardized mean difference [SMD] -3.66, 95 % CI -6.61 to -0.71; p =0.01) and analgesic requirements (SMD -0.89, 95 % CI -1.19 to -0.60; p < 0.00001) were significantly reduced compared with those of controls. Other than the incidence of abnormal ejaculation, which was higher in the silodosin groups (OR 2.84, 95 % CI 1.56 to 5.16, p =0.0006), few adverse effects were observed. CONCLUSION: This meta-analysis indicates silodosin is an effective and safe treatment option for ureteral stones with a low occurrence of side effects.

The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis.

INTRODUCTION: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion. OBJECTIVE: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis. EVIDENCE ACQUISITION: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus. EVIDENCE SYNTHESIS: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3). CONCLUSION: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain. PATIENT SUMMARY: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.

The use of alpha-1 adrenergic blockers in children with distal ureterolithiasis: a systematic review and meta-analysis

Introduction: Urinary lithiasis is the main urologic cause of emergency treatment in adult patient. In the past years, the incidence in children population has increased. However, literature about the use of alpha-1 adrenergic blockers in pediatric population with distal ureterolithiasis is still scarce. The drug acts by decreasing ureter contractions, especially in the distal portion, facilitating calculus expulsion. Objective: This review has the objective to evaluate the use of alpha-1 adrenergic blockers as medical expulsive treatment in children with distal ureterolithiasis. Evidence Acquisition: An electronic literature search was performed using the MEDLINE, COCHRANE, and LILACS databases. We further searched manually the references of the primary studies. Searches were concluded on October 4th, 2014. Articles were selected, independently and in pairs, by the respective titles and summaries. Any divergence was resolved by consensus. Evidence Synthesis: Alpha-1 adrenergic antagonists increased the probability of calculus expulsion by 27% (NNT=4). Calculi smaller than 5mm, increased by 33% (NNT=3). Larger than 5mm, increased by 34% (NNT=3). Conclusion: Alpha-1 adrenergic blocker use is related with a greater incidence of expulsion of ureteral calculi, smaller or greater than 5mm, and fewer episodes of pain when compared to ibuprofen. However it is necessary larger samples to enhance the power analysis of the expulsion of ureteral calculi larger than 5mm and the episodes of pain. Patient Summary: This review analyzed the outcome of alpha adrenergic antagonist in children with ureteral calculi. We conclude that it is the best medicine for use, since it helps the expulsion of the stone.

Tratamiento médico expulsivo de la litiasis ureteral con bloqueadores adrenérgicos alfa / Expulsive medical treatment of ureteral stone with adrenergic alfa-blockers

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Comparative evaluation of efficacy of use of naftopidil and/or celecoxib for medical treatment of distal ureteral stones.

We performed a randomized, prospective study to assess the possible role of combined a1D-receptor antagonist naftopidil and nonsteroidal anti-inflammatory hormones celecoxib for the spontaneous expulsion of distal ureteral stones. Patients were randomized to one of the three treatment groups. Treatment group 1 patients received naftopidil 50 mg/day, group 2 patients received naftopidil 50 mg/day plus celecoxib 200 mg (Take two capsules (400 mg) by mouth immediately, then take one capsule (200 mg) by mouth every 12 h), and group 3 patients received celecoxib 200 mg (Take two capsules (400 mg) by mouth immediately, then take one capsule (200 mg) by mouth every 12 h). All patients were instructed to drink at least 2 L of fluids daily. Pain descriptions were recorded by the patients using the visual analog scale. All patients were followed up for 2 weeks. A total of 105 patients provided consent and 103 patients completed the study. Stone expulsion was observed in 29 patients in group 1 (29 of 35, 82.86 %), 33 patients in group 2 (33 of 35, 94.29 %) and 20 patients in group 3 (20 of 33, 60.61 %). A statistically significant difference was noted with Chi-square testing for stone expulsion rate between groups 1 and 3, and groups 2 and 3 (P = 0.04 and P = 0.000, respectively). Kaplan-Meier curves were plotted to access the expulsion rate of each group over time. A significant difference was shown for the expulsion rate between the group 3 and the other two groups. (P < 0.001 by log-rank test).Average time to expulsion for groups 1, 2 and 3 was 8.00 ± 2.07, 7.70 ± 2.34 and 10.65 ± 2.92 days, respectively (P = 0.000). Treatment with naftopidil and celecoxib appears to be beneficial in distal ureter stone clearance, shortened the expulsion time, and could be used reliably and successfully to reduce the frequency and intensity of the pain episodes particularly.

Tamsulosin for treatment of unilateral distal ureterolithiasis: a systematic review and meta-analysis.

OBJECTIVES: The lifetime prevalence of ureterolithiasis is approximately 13% for men and 7% for women in the United States. Tamsulosin, an α-antagonist, has been used as therapy to facilitate the expulsion of lithiasis. Whether it is a good treatment for distal lithiasis remains controversial. We conducted a systematic review and meta-analysis to evaluate the effect of tamsulosin on the passage of distal ureterolithiasis. METHODS: A systematic search was conducted using MEDLINE, EMBASE, and Cochrane Central. Trial eligibility was evaluated by two investigators. All randomized controlled trials (RCTs) comparing tamsulosin to standard therapy or placebo for the treatment of a single distal ureterolithiasis ≤ 10 mm in adult patients with renal colic confirmed by radiographic imaging were included. Data extraction was conducted in duplicate. Primary outcome was the expulsion rate, and secondary outcomes were the mean time for ureterolithiasis expulsion, analgesic requirements, and side effects. Mantel-Haenszel random effect models were used, and heterogeneity was assessed using I² statistics. Data were presented with relative risks (RRs). RESULTS: The search strategy identified 685 articles, of which 22 studies were included. Combined results suggested a benefit for the expulsion of ureterolithiasis (≤ 10 mm) when tamsulosin was used compared to a standard treatment (RR 1.50 [95% CI 1.31-1.71], I²  =  70%). A decrease in the average time of expulsion of the ureterolithiasis of 3.33 days in favour of tamsulosin was observed (95% CI -4.23, -2.44], I²  =  67%). CONCLUSION: Tamsulosin increases the rate of spontaneous passage of distal ureterolithiasis (≤ 10 mm).

[The effectiveness of use of prolit in patients with ureteral stone].

The study was aimed to the evaluation of the efficacy of prolit in patients with urolithiasis and localization of stone in the ureter. 225 patients with various localization of solitary ureteral calculi ranged from 0.4 to 0.7 cm were under observation. Depending on the treatment, the patients were divided into two groups. The study group (n = 175) has received prolit for 30-40 days, control group (n = 50) has received standard therapy. As a result of treatment, spontaneous discharge of ureteral stone was registered in 158 (90.3%) patients of study group and only in 21 (42%) patients of control group. Renal colics during treatment were recorded four times more often among patients of control group. The intensity of pain in patients receiving prolit was less pronounced.

Treatment of ureteral lithiasis with tamsulosin: literature review and meta-analysis.

OBJECTIVE: Ninety percent of ureteral calculi <4 mm are expelled over a period of 3 months; if they are >6 mm the elimination possibilities are reduced to 30%. Presently, investigations in the treatment of ureteral lithiasis have the objective of modifying ureter contractibility with the aid of calcium antagonist and alpha-blocking drugs. The objective of this study is to analyze the effect of tamsulosin in the treatment of the distal ureter lithiasis and to make a systematic analysis of the literature. PATIENTS AND METHODS: In a prospective study 70 cases of distal ureter lithiasis were divided into 2 groups: group 1 = 35 cases treated with ibuprofen (600 mg/12 h) and 2,000 ml water/24 h with tramadol on demand, and group 2 = 35 cases with the same treatment as described before plus tamsulosin 0.4 mg/day over 3 weeks. The number of stone-free patients, time to expulsion and the necessity for analgesia were evaluated. A literature review (2002-2007) and meta-analysis of 11 studies was performed. Statistical analysis included relative risk (RR), number needed to treat (NNT) and chi(2) test. RESULTS: Group 1 reported 19 stone expulsions (54.3%) and group 2 30 expulsions [85.7%, chi(2) = 8.23 (p < 0.01), RR = 1.58, NNT = 3 (95% CI 2-9)]. The mean time to expulsion was 14 days in group 1 and 8 days in group 2. No side effects were detected. Meta-analysis included 792 patients: 392 patients in group 1 and 400 patients in group 2. Group 1 reported 211 stone expulsions (53.8%) and group 2 reported 332 expulsions [83%, chi(2) = 78.17 (p < 0.01), RR = 1.54, absolute benefit = 29.2% (95% CI 23-35.3%), NNT = 3 (95% CI 3-4)]. The mean time to expulsion was 9.45 days in group 1 and 6.07 days in group 2 treated with tamsulosin; a significant difference was observed in all studies. CONCLUSIONS: Tamsulosin increases the elimination of distal ureter lithiasis of <10 mm.

The effect of alpha-blockade in emergency department patients with ureterolithiasis.

BACKGROUND: Recent studies suggest that alpha-blockade with tamsulosin may be useful in the treatment of ureterolithiasis by increasing the success of, and decreasing the time to, stone passage. OBJECTIVES: We sought to determine stone passage success rates in patients diagnosed with ureterolithiasis and discharged from our Emergency Department (ED) with tamsulosin. METHODS: We conducted a non-randomized retrospective cohort study over a 1-year period during which we made monthly follow-up telephone calls to patients discharged from our ED with a diagnosis of ureterolithiasis determined by computed tomography (CT) scan. Stone size and location (proximal, middle, or distal ureter) were determined from radiologist reports and prescriptions were determined from electronic medical records. Patients were asked if they spontaneously passed their stone, how much time was required before stone passage, and if any subsequent hospital visit was required after discharge due to pain or complication resulting from the ureteral stone. RESULTS: During the study, a total of 213 patients were discharged from the ED with ureterolithiasis diagnosed by CT scan; of these, 119 (56%) were successfully contacted and 113 (53%) agreed to participate. Of the 113 patients, 83 (73%) had been prescribed tamsulosin and 30 (27%) had not. Overall age (43 years), gender (67% male), median stone size (3 mm, interquartile range 2-4 mm), and location (71% distal ureter) were similar in the two cohorts. Of tamsulosin recipients, 84% (95% confidence interval [CI] 75-91%) reported passing their stone, whereas 60% (95% CI 42-75%) of non-recipients passed their stone. CONCLUSION: Patients with ureterolithiasis discharged from our ED and given tamsulosin by prescription had moderately high ureteral stone passage success rates in our non-randomized retrospective cohort study. Compared to non-recipients of tamsulosin, patients receiving tamsulosin seemed to have greater success in stone passage.

Uso de alfuzosina para la expulsión de cálculos del tercio distal del uréter / Use of alfuzosin for expulsion of stones in the distal third of ureter

Introducción: La enfermedad litiásica ureteral afecta a alrededor del 12% de la población mundial y se ha incrementa de forma importante los últimos años en los países del oeste. De todos los cálculos ureterales, el 70% se encuentra en el tercio distal. Varios factores tienen una fuerte influencia en el paso espontáneo de los cálculos ureterales, tales como su tamaño, configuración y localización. En la actualidad, se atribuye un papel posible en la expulsión rápida de los cálculos en el tercio distal del uréter a los bloqueadores alfa. Material y métodos: Se analizó a 30 pacientes, divididos en 2 grupos de 15, con diagnóstico de litiasis del tercio distal del uréter; estos eran de 4-10 mm. Al primer grupo se le administró buscapina 10 mg cada 8 h más ketorolaco 10 mg cada 8 h y al segundo alfuzosina10 mg cada 24 h. Resultados: En el grupo 1 el tamaño de los cálculos en promedio fue de 6,4 mm; sólo4 pacientes expulsaron los cálculos y la expulsión se presentó en un promedio de 11,4 días. En el grupo 2, el tamaño promedio de los cálculos fue de 5,8 mm; se expulsaron 13 cálculos; sólo 2 pacientes tenían cálculos mayores, uno de 9 mm y el otro de 10 mm. El promedio de expulsión de cálculos fue de 3,3 días. Conclusiones: El uso de bloqueadores alfa adrenérgicos en la litiasis del tercio distal del uréter ha demostrado su eficacia en la aceleración e incluso en aumentar el número de cálculos expulsados, así como disminuir la sintomatología más rápidamente (AU)

Introduction: Ureteral stones occur in approximately 12% of the population worldwide, and their incidence has significantly increased in recent years in Western countries. Seventy percent of ureteral stones are located in the distal third of the ureter. Several factors have a strong influence on spontaneous passage of ureteral stones, including stone size, shape, and location. Alpha blockers are currently attributed a potential role in rapid expulsion of stones in the distal third of the ureter. Materials and methods: Thirty patients diagnosed of stones in the distal third of ureter of sizes ranging from 4 mm and 10 mm were divided into two groups. The first group was given Buscopan 10 mg plus ketorolac 10 mg every 8 hours, while the second group received alfuzosin 10 mg every 24 hours. Results: In group 1, mean stone size was 6.4 mm. Stone expulsion occurred in only 4 patients after a mean of 11.4 days. In group 2, mean stone size was 5.8 mm, and stone expulsion occurred in 13 patients after a mean of 3.3 days. The two stones that were not passed where the biggest ones (9 mm and 10 mm).Conclusions: Use of alpha-adrenergic blockers for ureteral distal third stones has been shown to be effective for increasing the stone expulsion rate and even the number of stones passed, and for faster symptom relief (AU)