Ahmed Abul-Fotouh, Shalaby Essam, El-Feky Mohamed, Kotb Ayman, Elsotohi Ebrahim, El-Kholy Mohamed, Ragab Ahmed, Salem Emad
Department of Urology, Al-Azhar University, Cairo, Egypt.
Urol Int. 2016;97(3):266-272. doi: 10.1159/000445840. Epub 2016 Apr 16.
To evaluate the efficacy of adjunctive tamsulosin therapy after extracorporeal shockwave lithotripsy (SWL) for renal stones.
This prospective study was conducted on patients who underwent single-session SWL for solitary renal stone less than 20 mm. Post-SWL, patients were randomly divided into 2 groups; the tamsulosin group (TG), received a daily dose of tamsulosin 0.4 mg, for a maximum of 12 weeks, with post-SWL traditional analgesia and control group (CG), received the traditional analgesia alone.
The study enrolled 271 patients and eventually only 249 (123 in TG and 126 in CG) completed the study. The overall stone free rate was 73.5%: 78.0% in TG and 69.0% in CG (p = 0.108). In TG, 8.1% of patients experienced at least one episode of acute renal/ureteral colic compared with 19.8% of controls (p = 0.008). The mean cumulative analgesia dosage per subject was 313 mg in TG and 346 mg in CG (p < 0.001). Overall, 14 patients developed steinstrasse and 6 of them (all in CG) needed urgent intervention (p = 0.031).
Daily tamsulosin therapy does not enhance the clearance of stone fragments but decreases the pain episodes, analgesia dosage and need for adjuvant intervention after SWL for renal stones.
评估体外冲击波碎石术（SWL）治疗肾结石后辅助使用坦索罗辛的疗效。
本前瞻性研究针对接受单次SWL治疗小于20mm孤立肾结石的患者进行。SWL术后，患者被随机分为两组；坦索罗辛组（TG），每日服用坦索罗辛0.4mg，最长服用12周，同时给予SWL术后传统镇痛；对照组（CG），仅接受传统镇痛。
该研究共纳入271例患者，最终仅249例（TG组123例，CG组126例）完成研究。总体结石清除率为73.5%：TG组为78.0%，CG组为69.0%（p = 0.108）。TG组中，8.1%的患者至少经历过一次急性肾/输尿管绞痛，而对照组为19.8%（p = 0.008）。TG组每位受试者的平均累积镇痛剂量为313mg，CG组为346mg（p < 0.001）。总体而言，14例患者形成了石街，其中6例（均在CG组）需要紧急干预（p = 0.031）。
每日服用坦索罗辛治疗并不能提高结石碎片的清除率，但可减少肾结石SWL术后的疼痛发作、镇痛剂量及辅助干预的需求。
