Distal üreter taşı olan hastalarda taş düşürmede medikal ekspulsif tedavi olarak tamsulosinin silodosine karşı etkinliği: Geriye dönük tek merkezli bir çalışma

Abstract

Amaç: Bu çalışma ile, semptomatik komplike olmayan distal üreter taşı olan hastalarda medikal ekspulsif tedavi olarak tamsulosin ve silodosinin etkinliği karşılaştırılması amaçlandı. Gereç ve Yöntemler: Haziran 2019 ile Ocak 2022 tarihleri arasında 4-10 mm boyutlarında distal üreter taşı olan ve medikal ekspulsif tedavi uygulanan erişkin hastaların verileri geriye dönük olarak belgelendi. Hastalar iki gruba ayrıldı. Grup 1‘deki hastaları 4 mg silodosin tedavisi verilen ve Grup 2’deki hastaları 0,4 mg tamsulosin verilen hastalar oluşturdu. Tedaviye maksimum 3 hafta devam edildi. Taş düşürme oranı, taş düşürme süresi, taş yükü ve taş boyutu kaydedildi. Yardımcı tıbbi tedavi olarak tamsulosin ve silodosinin etkinliği belirlendi. Bulgular: Çalışmaya toplam 152 hasta dahil edildi. Demografik veriler iki grup arasında benzerdi. 116 (%76,3) hasta takip sonunda taşsızdı. Grup 1’ de 47 hastada (%73,4), Grup 2’ de 69 hastada (%78,4) taşın düştüğü hesaplandı (P = 0,477). Çok değişkenli analizde taşın üreterovezikal bileşkeye olan mesafesi, başarılı taş düşürme ile anlamlı şekilde ilişkiliydi (P=0,032). Sonuç: Distal üreter taşları için medikal ekspulsif tedavi olarak tamsulosin ve silodosin arasında anlamlı bir üstünlük yoktu. Taşın üreterovezikal bileşkeye olan mesafesi, çok değişkenli analizde taş düşürülmesinin tek bağımsız belirleyicisiydi.

Keywords

• Medikal ekspulsif tedavi
• üreter taşı
• silodosin
• tamsulosin

Efficacy of tamsulosin versus silodosin as medical expulsive therapy on stone expulsion in patients with distal ureteral stone: A retrospective single center study

Abstract

Objective: This study aimed to compare the efficacy of tamsulosin and silodosin as medical expulsive therapy in patients with symptomatic uncomplicated distal ureteric stones. Material and Methods: The data of adult patients who had distal ureteric stones in size between 4 and 10 mm and were treated with medical expulsive therapy between June 2019 and January 2022 were retrospectively documented. Patients were divided into two groups. Patients in Group 1 received silodosin 4 mg, and Group 2 received tamsulosin 0.4 mg. Therapy was given for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, stone burden, and stone size were recorded. The efficacy of tamsulosin and silodosin as adjunctive medical therapy was determined. Results: A total of 152 patients were included in the study. Demographic profiles were comparable between the 2 groups. 116 (76.3%) patients were stone-free at the end of the follow-up. The stone expulsion rate was calculated in 47 patients (73.4%) in Group 1, and 69 patients (78.4%) in Group 2 (P = 0.477). The distance of the stone to the ureterovesical junction was significantly associated with successful stone expulsion in multivariate analysis (P=0.032). Conclusion: There was no significant superiority between tamsulosin and silodosin as medical expulsive therapy for distal ureteral stones. The distance of the stone to the reterovesical junction was the only independent predictor of stone expulsion in multivariate analysis.

Keywords

• Medical expulsive therapy
• ureteral stone
• silodosin
• tamsulosin

References

1. 1. Trinchieri A, Coppi F, Montanari E, Del Nero A, Zanetti G, Pisani E. Increase in the prevalence of symptomatic upper urinary tract stones during the last ten years. Eur Urol. 2000;37:23–5. https://doi.org/10.1159/000020094
2. 2. Pak CY. Kidney stones. Lancet. 1998; 351: 1797-1801. https://doi.org/10.1016/S0140-6736(98)01295-1
3. 3. Somani BK, Aboumarzouk O, Traxer O, Baard J, Kamphuis G, de la Rosette J. Medical expulsive therapy for ureteral stones: where do we go from here? Nat Rev Urol. 2016;13(10):608–612. https://doi.org/10.1038/nrurol.2016.146
4. 4. Troxel SA, Jones AW, Magliola L, Benson JS. Physiologic effect of nifedipine and tamsulosin on contractility of distal ureter. J Endourol. 2006;20(8):565-568. https://doi.org/10.1089/end.2006.20.565
5. 5. Türk C, Petrík A, Sarica K, et al. EAU guidelines on diagnosis and conservative management of urolithiasis. Eur Urol. 2016;69:468–474. https://doi.org/10.1016/j.eururo.2015.07.040
6. 6. Assimos D, Krambeck A, Miller NL et al: Surgical management of Stones: American Urological Association/Endourological Society Guideline, PART I. J Urol. 2016; 196: 1153. https://doi.org/10.1016/j.juro.2016.05.090
7. 7. Meltzer AC, Burrows PK, Wolfson AB, et al. Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA Intern Med 2018;178:1051-1057. https://doi.org/10.1001/jamainternmed.2018.2259
8. 8. Liu H, Wang S, Zhu W, Lu J, Wang X, Yang W. Comparative efficacy of 22 drug interventions as medical expulsive therapy for ureteral stones: a systematic review and network meta-analysis. Urolithiasis. 2020;48(5):447-457. https://doi.org/10.1007/s00240-019-01159-5

9. 9. Shah TT, Gao C, Peters M, et al. Factors associated with spontaneous stone passage in a contemporary cohort of patients presenting with acute ureteric colic: results from the Multi-centre cohort study evaluating the role of Inflammatory Markers In patients presenting with acute ureteric Colic (MIMIC) study. BJU Int. 2019;124(3):504-513. https://doi.org/ 10.1111/bju.14777
10. 10. Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol. 2002;178:101–103. https://doi.org/ 10.2214/ajr.178.1.1780101
11. 11. Bensalah K, Pearle M, Lotan Y. Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol. 2008; 53(2):411-418. https://doi.org/10.1016/j.eururo.2007.09.012
12. 12. Kızılay F, Ülker V, Çelik O, et al. The evaluation of the effectiveness of Gilaburu (Viburnum opulus L.) extract in the medical expulsive treatment of distal ureteral stones. Turk J Urol. 2019; 45(Supp. 1): S63-S69. https://doi.org/10.5152/tud.2019.23463
13. 13. Park HK, Choi EY, Jeong BC, Kim HH, Kim BK. Localizations and expressions of alpha-1A, alpha-1B and alpha-1D adrenoceptors in human ureter. Urol Res. 2007;35:325–329. https://doi.org/10.1007/s00240-007-0118-0
14. 14. Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K. Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol. 2007;14(8):749-753. https://doi.org/10.1111/j.1442-2042.2007.01812.x
15. 15. Pickard R, Starr K, MacLennan G, et al. Use of drug therapy in the management of symptomatic ureteric stones in hospitalised adults: a multicentre, placebo-controlled, randomised controlled trial and cost-effectiveness analysis of a calcium channel blocker (nifedipine) and an alpha-blocker (tamsulosin) (the SUSPEND trial). Health Technol Assess. 2015;19:1–171. https://doi.org/10.3310/hta19630
16. 16. Furyk JS, Chu K, Banks C, et al. Distal Ureteric Stones and Tamsulosin: A Double-Blind, Placebo-Controlled, Randomized, Multicenter Trial. Ann Emerg Med. 2016;67:86-95.e2. https://doi.org/10.1016/j.annemergmed.2015.06.001
17. 17. Ye Z, Zeng G, Yang H, et al. Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial. Eur Urol. 2018;73:385-391. https://doi.org/10.1016/j.eururo.2017.10.033
18. 18. Yuksel M, Yilmaz S, Tokgoz H, Yalcinkaya S, Baş S, Ipekci T, Yildiz A, Ates N, Savas M. Efficacy of silodosin in the treatment of distal ureteral stones 4 to 10 mm in diameter. Int J Clin Exp Med. 2015 Oct 15;8(10):19086-92 https://doi.org/26770537
19. 19. Sharma G, Pareek T, Kaundal P, et al. Comparison of efficacy of three commonly used alpha-blockers as medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int Braz J Urol 2021;47 (Online ahead of print) https://doi.org/10.1590/S1677-5538.IBJU.2020.0548
20. 20. Arda E, Cakiroglu B, Yuksel I, et al. Medical Expulsive Therapy for Distal Ureteral Stones: Tamsulosin Versus Silodosin in the Turkish Population. Cureus 2017; 9(11): e1848. https://doi.org/10.7759/cureus.1848
21. 21. Celik S, Akdeniz F, Yildirim MA, et al. Tadalafil versus alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive therapy for < 10 mm distal and proximal ureteral stones. Arch Ital Urol Androl 2018;90(2):117-122. https://doi.org/10.4081/aiua.2018.2.117
22. 22. Hsu Y-P, Hsu C-W, Bai C-H, Cheng S-W, Chen K-C, Chen C. Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis. PLoS ONE 2018;13(8): e0203035. https://doi.org/10.1371/journal.pone.0203035
23. 23. Sharma G, Kaundal P, Pareek T, et al. Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis. Int J Clin Pract. 2021;75(9):e14214. https://doi.org/ 10.1111/ijcp.14214
24. 24. Jendeberg J, Geijer H, Alshamari M, Cierzniak B, Liden M. Size matters: the width and location of a ureteral stone accurately predict the chance of spontaneous passage. Eur Radiol.2017; 27(11):4775–4785. https ://doi.org/10.1007/s0033 0-017-4852-6