The Efficacy of Tamsulosin In The Treatment of Ureter Lower Stones: A Prospective Randomized Study

Öz

Objectives: We aimed to determine the efficacy of tamsulosin (0.4 mg/day) as oral expulsive medical therapy in patients who were followed for distal üreter calculi at urology clinic in Elazig Public Hospital. Material and Methods: The study was continued with 102 consecutive patients; 21 female and 30 male was included in Group A (51) with a mean age of 37.2±12.6 (16-62y) and 19 female and 32 male was included in Group B (51) with a mean age of 35.5±11.7 (17-63y). Group A consisted control patients treated with conservative therapy (analgesic, antiemetic), Group B included study patients treated with oral expulsive medical therapy (tamsulosin 0.4 mg/gün) and they were followed 28 days. 30 mg /day deflazacort, lansaprozole 30 mg/day and 2x500 mg /day cinolone with minimal side effects were performed to the groups maximum 10 days. To drink minimum 2 liters of water per a day was offered to all of the patients, 75 mg diclofenac sodium (1.2mg/kg) was performed intramusculary as analgesic when required. Patients who were Stone-free was excluded from the study in Group A and B. The pass of the stones and drug’s side effects were questionaired to the patients at weekly controls. Results: Results and Conclusion: In Group A, 19 patients (37.2%) expulsed stone meanly at 18.1±7.3 days, in Grup B, 40 patients (78.4%) expulsed stone meanly at 5.8±2.7 days. Conclusion: In conclusion, oral expulsive medical therapy can be an approach that must be thought in urether lower stones after the evaluation of the patient exactly. ©2007, Firat University, Medical Faculty

Anahtar Kelimeler

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Üreter Alt Uç Taşlarının Tedavisinde Tamsulosinin Etkinliği: Prospektif Randomize Bir Çalışma

Öz

Giriş: Elazığ Devlet Hastanesi üroloji polikliniğinde üreter alt uç taşı nedeniyle izlenen hastalarda oral atılım medikal tedavisi olarak tamsulosinin (0.4 mg/gün) etkinliğini prospektif randomize çalışmayla belirlemeyi hedefledik. Gereç ve Yöntem: Ocak 2003- Aralık 2005 tarihleri arasında, grup A (51) 21 kadın, 30 erkek ve ortalama yaşı 37.2±12.6 (16-62y), grup B (51) ise 19 kadın, 32 erkek ve ortalama yaşı 35.5±11.7 (17-63y) olan toplam 102 hasta ile çalışma sürdürüldü. Grup A, kontrol grubu hastaları olup konservatif tedaviyle (analjezik, antiemetik), grup B çalışma grubu olup, oral atılım medikal tedavisiyle ( tamsulosin 0.4 mg/gün ) 28 gün izlendi. Gruplara maksimum 10 gün minimal yan etkiye sahip 30 mg/gün deflazakort, lansoprazol 30 mg/gün ve 7gün 2x500 mg/gün kinolon oral yoldan verildi. Tüm hastaların günde en az 2 litre su alması önerildi, gerektiğinde ağrı kesici olarak 75 mg diklofenak sodyum (1.2mg/kg) intramuskuler yoldan uygulandı. Grup A ve grup B’de taşı düşüren hastalar takipten çıkarıldı. Haftalık kontrollerde hastaların taş düşürmesi ve ilaç yan etkisi sorgulandı. Grup A’da hastalar 113.2mg/hasta (4.04mg/hasta/gün), grup B’de 33.8mg/hasta (1.2mg/hasta/gün) analjezik kullandılar. Gruplar arası taş atılım oranı, taş atılma süresi, kullanılan analjezik miktarı yönünden önemli fark p:0.000 (p

Anahtar Kelimeler

• Üreter taşı, alfa bloker, medikal tedavi

Kaynakça

1. Hussain Z, Inman RD, Elves AW, ve ark. Use of glyceryl trinitrate patches in patients with ureteral stones: a randomized, double-blind, placebo-controlled study. Urology 2001; 58:521- 525.
2. Hochberg D, Johnson CW, Chen J, ve ark. Interstitial fibrosis of unilateral ureteral obstruction is exacerbated in kidneys of mice lacking the gene for inducible nitric oxide synthase. Lab Invest 2000; 80:1721-1728.
3. Cervenakov I, Fillo J, Mardiak J, ve ark. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker-- Tamsulosin. Int Urol Nephrol 2002; 34: 25-29.
4. Roberts WW, Cadeddu JA, Micali S, Kavoussi LR, Moore RG. Ureteral stricture formation after removal of impacted calculi. J Urol 1998; 159: 723-726.
5. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol 2003; 170(6 Pt 1): 2202-2205.
6. Yilmaz E, Batislam E, Basar MM, ve ark. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol 2005; 173: 2010-2012.
7. Morita T, Ando M, Kihara K, Oshima H. Function and distribution of autonomic receptors in canine ureteral smooth muscle. Neurourol Urodyn 1994; 13: 315-321.
8. Porpiglia F, Ghignone G, Fiori C, Fontana D, Scarpa RM. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol 2004; 172: 568-571.

9. Porpiglia F, Destefanis P, Fiori C, Fontana D. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology 2000; 56: 579-582.
10. Kupeli B, Irkilata L, Gurocak S, ve ark. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology 2004; 64: 1111-1115.
11. Segura JW, Preminger GM, Assimos DG, ve ark. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. J Urol 1997; 158: 1915-1921.
12. Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 1999; 162(3 Pt 1): 688-690.
13. Hubner WA, Irby P, Stoller ML. Natural history and current concepts for the treatment of small ureteral calculi. Eur Urol 1993; 24: 172-176.
14. Obara K, Takeda M, Schimura H, ve ark. Alpha -1 adrenoreceptor subtypes in the human üreter: characterization by RT-PCR and in situ hybridization. J Urol 1996; 155: 472.
15. Ukhal MI, Malomuzh OI, Strashnyi VV, Shumilin MV. The use of the alpha 1-adrenoblocker doxazosin in the pharmacotherapy of disorders of urine outflow of spastic origin. Lik Sprava 1998; :118-121.
16. Tekin A, Alkan E, Baysal M, ve ark. Alpha-1 receptor blocking therapy for lower üreteral stones: A randomized prospective trial. J Urol 2004; 171(4).
17. Autorino R, De Sio M, Damiano R, ve ark. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res 2005; 33:460-464.
18. O'Leary MP. Tamsulosin: current clinical experience. Urology 2001; 58: 42-48.
19. Borghi L, Meschi T, Amato F, ve ark. Nifedipine and methylprednisolone in facilitating ureteral stone passage: a randomized, double-blind, placebo-controlled study. J Urol 1994; 152:1095-1098.
20. Kabul Tarihi: 29.01.2007