Arrabal-Martin Miguel, Valle-Diaz de la Guardia Francisco, Arrabal-Polo Miguel Angel, Palao-Yago Francisco, Mijan-Ortiz Jose Luis, Zuluaga-Gomez Armando
Department of Urology, San Cecilio University Hospital, Granada, Spain.
Urol Int. 2010;84(3):254-9. doi: 10.1159/000288224. Epub 2010 Apr 13.
Ninety percent of ureteral calculi <4 mm are expelled over a period of 3 months; if they are >6 mm the elimination possibilities are reduced to 30%. Presently, investigations in the treatment of ureteral lithiasis have the objective of modifying ureter contractibility with the aid of calcium antagonist and alpha-blocking drugs. The objective of this study is to analyze the effect of tamsulosin in the treatment of the distal ureter lithiasis and to make a systematic analysis of the literature.
In a prospective study 70 cases of distal ureter lithiasis were divided into 2 groups: group 1 = 35 cases treated with ibuprofen (600 mg/12 h) and 2,000 ml water/24 h with tramadol on demand, and group 2 = 35 cases with the same treatment as described before plus tamsulosin 0.4 mg/day over 3 weeks. The number of stone-free patients, time to expulsion and the necessity for analgesia were evaluated. A literature review (2002-2007) and meta-analysis of 11 studies was performed. Statistical analysis included relative risk (RR), number needed to treat (NNT) and chi(2) test.
Group 1 reported 19 stone expulsions (54.3%) and group 2 30 expulsions [85.7%, chi(2) = 8.23 (p < 0.01), RR = 1.58, NNT = 3 (95% CI 2-9)]. The mean time to expulsion was 14 days in group 1 and 8 days in group 2. No side effects were detected. Meta-analysis included 792 patients: 392 patients in group 1 and 400 patients in group 2. Group 1 reported 211 stone expulsions (53.8%) and group 2 reported 332 expulsions [83%, chi(2) = 78.17 (p < 0.01), RR = 1.54, absolute benefit = 29.2% (95% CI 23-35.3%), NNT = 3 (95% CI 3-4)]. The mean time to expulsion was 9.45 days in group 1 and 6.07 days in group 2 treated with tamsulosin; a significant difference was observed in all studies.
Tamsulosin increases the elimination of distal ureter lithiasis of <10 mm.
90%直径小于4毫米的输尿管结石会在3个月内排出；如果结石直径大于6毫米，排出的可能性则降至30%。目前，输尿管结石治疗研究的目标是借助钙拮抗剂和α受体阻滞剂来改变输尿管的收缩性。本研究的目的是分析坦索罗辛治疗远端输尿管结石的效果，并对相关文献进行系统分析。
在一项前瞻性研究中，70例远端输尿管结石患者被分为两组：第1组 = 35例，接受布洛芬（600毫克/12小时）治疗，每天饮水2000毫升，按需服用曲马多；第2组 = 35例，接受与第1组相同的治疗，另外在3周内每天加用0.4毫克坦索罗辛。评估结石排出患者的数量、排出时间以及镇痛的必要性。对2002年至2007年的11项研究进行了文献综述和荟萃分析。统计分析包括相对危险度（RR）、需治疗人数（NNT）和卡方检验。
第1组有19例结石排出（54.3%），第2组有30例排出[85.7%，卡方 = 8.23（p < 0.01），RR = 1.58，NNT = 3（95%可信区间2 - 9）]。第1组的平均排出时间为14天，第2组为8天。未检测到副作用。荟萃分析纳入792例患者：第1组392例，第2组400例。第1组有211例结石排出（53.8%），第2组有332例排出[83%，卡方 = 78.17（p < 0.01），RR = 1.54，绝对获益 = 29.2%（95%可信区间23 - 35.3%），NNT = 3（95%可信区间3 - 4）]。第1组接受坦索罗辛治疗的平均排出时间为9.45天，第2组为6.07天；在所有研究中均观察到显著差异。
坦索罗辛可增加直径小于10毫米的远端输尿管结石的排出率。
