Zaytoun Osama M, Yakoubi Rachid, Zahran Abdel Rahman M, Fouda Khaled, Marzouk Essam, Gaafar Salah, Fareed Khaled
Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Urol Res. 2012 Aug;40(4):327-32. doi: 10.1007/s00240-011-0410-x. Epub 2011 Aug 12.
Alpha-blockers have been established as medical expulsive therapy for urolithiasis. We aimed to assess the effect of tamsulosin and doxazosin as adjunctive therapy following SWL for renal calculi. We prospectively included 150 patients who underwent up to four SWL sessions for renal stones from June 2008 to 2009. Patients were randomized into three groups of 50 patients each, group A (phloroglucinol 240 mg daily), group B (tamsulosin 0.4 mg once daily plus phloroglucinol), and group C (doxazosin 4 mg plus phloroglucinol). The treatment continued up to maximum 12 weeks. Patients were evaluated for stone expulsion, colic attacks, amount of analgesics and side-effects of alpha-blockers. There were no significant differences between the groups regarding stone expulsion rates (84; 92 and 90%, respectively). The mean expulsion time of tamsulosin was significantly shorter than both control group (p = 0.002) and doxazosin (p = 0.026). Both number of colic episodes and analgesic dosage were significantly lower with tamsulosin as compared to control and doxazosin. Steinstrasse was encountered in 10 (6.7%) patients with no significant difference between the groups. 16 patients on tamsulosin and 21 on doxazosin experienced adverse effects related to postural hypotension. Moreover, 2 (4%) patients in the tamsulosin group reported ejaculatory complaints. In conclusion, adjunction of tamsulosin or doxazosin after SWL for renal calculi decreases the time for stone expulsion, amount of the analgesics and number colic episodes. There was no benefit regarding the overall stone expulsion rate. The side-effects of these agents are common and should be weighted against the benefits of their usage.
α受体阻滞剂已被确立为治疗尿石症的药物排石疗法。我们旨在评估坦索罗辛和多沙唑嗪作为肾结石体外冲击波碎石术（SWL）后辅助治疗的效果。我们前瞻性纳入了2008年6月至2009年期间接受多达4次肾结石SWL治疗的150例患者。患者被随机分为三组，每组50例，A组（每日240毫克间苯三酚），B组（每日一次0.4毫克坦索罗辛加间苯三酚），C组（4毫克多沙唑嗪加间苯三酚）。治疗持续最长12周。对患者进行结石排出、绞痛发作、镇痛药用量及α受体阻滞剂副作用的评估。三组在结石排出率方面无显著差异（分别为84%、92%和90%）。坦索罗辛的平均排石时间显著短于对照组（p = 0.002）和多沙唑嗪组（p = 0.026）。与对照组和多沙唑嗪组相比，坦索罗辛组的绞痛发作次数和镇痛药用量均显著更低。10例（6.7%）患者出现石街，组间无显著差异。16例服用坦索罗辛和21例服用多沙唑嗪的患者出现与体位性低血压相关的不良反应。此外，坦索罗辛组有2例（4%）患者报告射精相关主诉。总之，肾结石SWL术后加用坦索罗辛或多沙唑嗪可缩短结石排出时间、减少镇痛药用量和绞痛发作次数。在总体结石排出率方面并无益处。这些药物的副作用较为常见，应权衡其使用的益处。
