| Objective:To evaluate the efficacy and the safety of alpha1-blockers (Tamsulosin) for the adjuvant expulsive therapy in patients with upper urinary tract calculi after extracorporeal shock wave lithotripsy (ESWL).Methods:A total of 300 patients were definitely diagnosed as solitary radiopaque upper urinary tract calculi 6 to 20 mm in diameter. All of the patients underwent a ESWL session enrolled from October 2006 to April 2008.Patients were divided into three groups according to the location of the stones. Group A consisted of 140 patients with renal calculi, randomly assigned to two groups (70 patients in each group), group A1 as the experimental group and group A2 as the control group. Group B consisted of 70 patients with upper ureteral calculi, randomly assigned to two groups (35 patients in each group), group B1 as the experimental group and group B2 as the control group. Group C consisted of 90 patients with middle and lower ureteral calculi, randomized to two groups (45 patients in each group), group C1 as the experimental group and group C2 as the control group. Among the 300 patients , 162cases with stone less than 10mm were assigned as group a (80 case in the experimental group assigned as a1 and 82 cases in the control group assigned as a2) ,138 patients with stone 10mm to 20mm were assigned as group b (the experimental group assigned as b1 had 70 cases and the control group assigned as b2 had 68 cases).After ESWL,the control group received chinese traditional medicine (Niaoshitong 4g BID) and antibiotic (Sparfloxacin 200mg QD), the experimental group received Tamsulosin 0.2 mg daily together with Niaoshitong and Sparfloxacin. All patients were suggested to drink water 3L every day and keep the normal amount of exercise daily. All patients were followed up for 3 months.Results: 1 The stone expulsion rate of the total experimental group and control group was 84.0% and 65.3% respectively, with a statistics significant difference between the two groups(P<0.001). The difference of the stone expulsion rate between group A1 and A2(P=0.009),group C1 and C2(P=0.035),group b1 and b2(P<0.001)was significant.2 The mean stone expulsion time of the total experimental group and control group was 3.01d and 5.37d respectively,with a statistics significant difference between the two groups(P<0.001).The difference of the stone expulsion time between group A1 and A2(P<0.001),group B1 and B2(P<0.001),group C1 and C2(P<0.001),group a1 and a2(P <0.001),group b1 and b2(P <0.001)was significant.3 The stone free rate of the total experimental group and control group was 66.0% and 55.3% respectively, with a statistics significant difference between the two groups(P=0.025). The difference of the stone free rate between group b1 and b2(P=0.011)was significant.4 After one ESWL session, the stone street formation rate of the total experimental group and control group was 1.3% and 8.7% respectively, with a statistics significant difference between the two groups(P=0.004). The difference of the stone street formation rate between group A1 and A2(P=0.028),group b1 and b2(P=0.004)was significant.5 The mean renal colic person times of the total experimental group and control group was 0.10 and 0.27 respectively, and the mean analgesics used person times was 0.05 and 0.21 respectively, with a statistics significant difference between the two groups(P=0.001, P<0.001).The difference of the renal colic person times between group A1 and A2(P=0.012),group a1 and a2(P=0.007),group b1 and b2(P=0.005)was significant, as well as the difference of the analgesics used person times between group A1 and A2(P=0.002),group a1 and a2(P=0.046),group b1 and b2(P<0.001).6 A total of 15 cases (10%)had drug side effect in the experimental group ,and 12 cases (8%)maybe due to Tamsulosin.4 cases(2.7%) in the control group had drug the side effect. No one withdrew from treatment due to the drug side effect. Conclusions:For the patients with upper urinary tract calculi who underwent ESWL, Tamsulosin can improve the stone expulsion rate and stone free rate, shorten the stone expulsion time. Furthermore it can decrease the stone street formation rate and reduce the frequency of renal colic and analgesics used. Morever, it is safe for the patients. |
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