Küpeli Bora, Irkilata Lokman, Gürocak Serhat, Tunç Lütfi, Kiraç Mustafa, Karaoğlan Ustünol, Bozkirli Ibrahim
Department of Urology, Gazi University School of Medicine, Ankara, Turkey.
Urology. 2004 Dec;64(6):1111-5. doi: 10.1016/j.urology.2004.07.020.
To evaluate whether alpha1-blockers have any impact on stone clearance in patients with lower ureteral stones who underwent either shock wave lithotripsy (SWL) or were followed up with standard hydration, analgesics, and anti-inflammatory treatment.
A total of 78 patients (56 men and 22 women) who had lower ureteral stones located at the distal 5 cm of the ureter were divided into four groups. The first group consisted of 30 patients (38.5%) with stones less than 5 mm (range 3 to 5) who were randomly divided into two subgroups. Group 1 consisted of 15 patients (19.2%) who were followed up with oral hydration and diclofenac sodium. Group 2 consisted of 15 patients (19.2%) who received tamsulosin 0.4 mg daily in addition to the standard regimens. The second two groups consisted of 48 patients (61.5%) with stones greater than 5 mm (range 6 to 15) who underwent SWL. These patients were also randomly divided between those who did not (group 3, n = 24) and those who did (group 4, n = 24) receive tamsulosin 0.4 mg daily. All patients were re-evaluated with plain abdominal x-rays and helical computed tomography 15 days after the beginning of treatment.
Of the 78 patients, 36 (46.2%) became stone free. The stone-free rate was 20%, 53.3%, 33.3%, and 70.8% for group 1, 2, 3, and 4, respectively. The best results were achieved in those who underwent SWL plus tamsulosin treatment (group 4). The differences between the stone-free rates for groups 3 versus 4 (P = 0.019) and the tamsulosin versus control groups (P = 0.0015) were statistically significant.
The addition of tamsulosin to conventional treatment seemed beneficial in terms of stone clearance of lower ureteral stones, and this effect was more evident for larger stones, especially when combined with SWL.
评估α1受体阻滞剂对接受冲击波碎石术（SWL）或接受标准水化、镇痛及抗炎治疗的输尿管下段结石患者的结石清除率是否有影响。
总共78例输尿管下段结石（位于输尿管远端5 cm处）患者（56例男性，22例女性）被分为四组。第一组由30例（38.5%）结石小于5 mm（范围3至5 mm）的患者组成，这些患者被随机分为两个亚组。第1组由15例（19.2%）接受口服水化及双氯芬酸钠治疗的患者组成。第2组由15例（19.2%）除标准治疗方案外还每日服用0.4 mg坦索罗辛的患者组成。后两组由48例（61.5%）结石大于5 mm（范围6至15 mm）且接受SWL的患者组成。这些患者也被随机分为未接受（第3组，n = 24）和接受（第4组，n = 24）每日0.4 mg坦索罗辛治疗的两组。所有患者在治疗开始15天后通过腹部平片和螺旋计算机断层扫描进行重新评估。
78例患者中，36例（46.2%）结石清除。第1、2、3和4组的结石清除率分别为20%、53.3%、33.3%和70.8%。接受SWL加坦索罗辛治疗的患者（第4组）取得了最佳结果。第3组与第4组的结石清除率差异（P = 0.019）以及坦索罗辛组与对照组的差异（P = 0.0015）具有统计学意义。
在传统治疗中添加坦索罗辛似乎对输尿管下段结石的清除有益，且这种效果在较大结石中更明显，尤其是与SWL联合使用时。
