Watts Hannah F, Tekwani Karis L, Chan Cindy W, Rzechula Kathleen H, Kulstad Erik B
Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, Illinois 60453, USA.
J Emerg Med. 2010 Apr;38(3):368-73. doi: 10.1016/j.jemermed.2008.08.032. Epub 2009 Feb 13.
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.
We sought to determine stone passage success rates in patients diagnosed with ureterolithiasis and discharged from our Emergency Department (ED) with tamsulosin.
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.
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.
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.
近期研究表明，坦索罗辛进行α受体阻滞可能有助于治疗输尿管结石，可提高结石排出成功率并缩短排出时间。
我们试图确定诊断为输尿管结石并从急诊科出院时服用坦索罗辛的患者的结石排出成功率。
我们进行了一项为期1年的非随机回顾性队列研究，在此期间，我们每月对从急诊科出院且经计算机断层扫描（CT）诊断为输尿管结石的患者进行随访电话调查。结石大小和位置（输尿管上段、中段或下段）根据放射科医生的报告确定，处方从电子病历中获取。询问患者结石是否自行排出、排出结石需要多长时间，以及出院后是否因输尿管结石引起的疼痛或并发症而再次就诊。
研究期间，共有213例经CT扫描诊断为输尿管结石的患者从急诊科出院；其中，119例（56%）成功联系上，113例（53%）同意参与。在这113例患者中，83例（73%）曾开具坦索罗辛处方，30例（27%）未开具。两组患者的总体年龄（43岁）、性别（67%为男性）、结石中位数大小（3mm，四分位间距2 - 4mm）和位置（71%为输尿管下段）相似。服用坦索罗辛的患者中，84%（95%置信区间[CI]75 - 91%）报告结石已排出，而未服用者中这一比例为60%（95%CI 42 - 75%）。
在我们的非随机回顾性队列研究中，从急诊科出院并按处方服用坦索罗辛的输尿管结石患者输尿管结石排出成功率中等偏高。与未服用坦索罗辛的患者相比，服用坦索罗辛的患者结石排出成功率似乎更高。
