Pirzada Abdul Jabbar, Anwar Adeel, Javed Atif, Memon Imran, Mohammad Ariz
J Ayub Med Coll Abbottabad. 2011 Apr-Jun;23(2):125-9.
Renal stone disease is a significant and worldwide health problem. Recent advances in stone management have allowed kidney stones to be treated using extracorporeal shock wave lithotripsy (ESWL), uretero-renoscopy (URS), and percutaneous nephrostolithotomy (PCNL). Recently, medical expulsion therapy (MET) has been investigated as a supplement to observation in an effort to improve spontaneous stone passage rates.
This study was a randomized, controlled, prospective study to determine whether the administration of Alpha-1-adrenergic receptor antagonists as an adjunctive medical therapy, increases the efficacy of ESWL to treat renal stones. Sixty patients with renal stones of 0.5-1.5 Cm in size (average size 1.2 Cm) were included in this study underwent ESWL followed by administration of Alpha-1-adrenergic receptor antagonists at department of Urology Liaquat National Hospital Karachi from Feb 2008 to Sept 2008. This was a comparative study and patients were divided into two groups. In group A patients received conventional treatment Diclofenac sodium, Anti Spasmodic (Drotverine HCl) as required and Proton Pump inhibitor (Omeprazole 20 mg) once daily after shock wave lithotripsy. In group B patients received alpha-1 blocker, Alfuzosin HCI 5 mg twice daily in addition to conventional treatment. All patients were instructed to drink a minimum of 2 litres water daily. Ultrasound guided Dornier Alpha Impact Lithotripter was utilised for shock wave lithotripsy.
Of the 60 patients, 76.7% of those receiving Alfuzosin and 46.7% of controls had achieved clinical success at 1 month (p = 0.01). The mean cumulative diclofenac dose was 485 mg per patient in the Alfuzosin group and 768 mg per patient in the control group (p = 0.002). This difference was statistically significant.
Alfuzosin therapy as an adjunctive medical therapy after ESWL is more effective than lithotripsy alone for the treatment of patients with large renal stones and is equally safe. It increases the expulsion rates of stones, decreases time to expulsion, and decreases need for analgesia during stone passage.
肾结石病是一个重大的全球性健康问题。结石治疗的最新进展使得肾结石可以通过体外冲击波碎石术（ESWL）、输尿管肾镜检查（URS）和经皮肾镜取石术（PCNL）进行治疗。最近，药物排石疗法（MET）作为观察治疗的补充手段进行了研究，旨在提高结石自然排出率。
本研究是一项随机、对照、前瞻性研究，旨在确定给予α-1肾上腺素能受体拮抗剂作为辅助药物治疗，是否能提高ESWL治疗肾结石的疗效。2008年2月至2008年9月期间，在卡拉奇利亚卡特国家医院泌尿外科，60例肾结石大小为0.5 - 1.5厘米（平均大小1.2厘米）的患者纳入本研究，接受ESWL治疗，随后给予α-1肾上腺素能受体拮抗剂。这是一项对比研究，患者被分为两组。A组患者在冲击波碎石术后接受常规治疗，按需服用双氯芬酸钠、解痉药（盐酸屈他维林），并每日服用一次质子泵抑制剂（奥美拉唑20毫克）。B组患者除接受常规治疗外，还每日两次服用α-1阻滞剂盐酸阿夫唑嗪5毫克。所有患者均被要求每日至少饮用2升水。采用超声引导的多尼尔Alpha Impact碎石机进行冲击波碎石术。
60例患者中，接受阿夫唑嗪治疗的患者在1个月时临床成功率为76.7%，对照组为46.7%（p = 0.01）。阿夫唑嗪组患者双氯芬酸钠的平均累积剂量为每人485毫克，对照组为每人768毫克（p = 0.002）。这一差异具有统计学意义。
ESWL术后给予阿夫唑嗪治疗作为辅助药物治疗，对于治疗大肾结石患者比单纯碎石术更有效，且同样安全。它提高了结石排出率，缩短了排出时间，并减少了结石排出期间的镇痛需求。
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