Palmisano Franco, Spinelli Matteo Giulio, Luzzago Stefano, Boeri Luca, De Lorenzis Elisa, Albo Giancarlo, Gadda Franco, Gelosa Marco, Longo Fabrizio, Dell'Orto Paolo Guido, Montanari Emanuele
Urol Int. 2019;102(2):145-152. doi: 10.1159/000493158. Epub 2018 Sep 18.
To assess the safety and efficacy of bromelain plus tamsulosin versus tamsulosin alone as medical expulsive therapy (MET) for promoting spontaneous stone passage (SSP) of symptomatic distal ureter stones.
One-hundred-fourteen patients with a 4-10 mm distal ureteral stone were enrolled (Group A). Patients self-administered daily bromelain with tamsulosin for 30 days or until SSP or intervention was mandatory. Patients were compared to those from a control group taking tamsulosin as MET (Group B) and matched for the following factors: sex, age ±10%, stone diameter. A logistic regression model evaluated bromelain and the ureteral stone diameter as explanatory variables.
SSP rates were 87.7 vs. 75.4% for group A vs. group B respectively (p = 0.016); with no difference observed for the time to self-reported stone expulsion (11.68 vs. 11.57 days; p = 0.91). Considering larger stones (> 5 mm), the SSP rate was 83.3% in group A and 61% in group B (p < 0.01). With each millimeter increment of stone diameter, the probability of SSP decreased by 59.1% (p < 0.0001), while it increased of 3.3 when bromelain was present. Only 3 cases of tamsulosin-related adverse events were recorded.
The association of bromelain and tamsulosin as MET increases the probability of SSP of symptomatic distal ureteral stones, with no bromelain-related side effects recorded.
评估菠萝蛋白酶联合坦索罗辛与单用坦索罗辛作为药物排石疗法（MET）促进有症状的远端输尿管结石自然排石（SSP）的安全性和有效性。
纳入114例远端输尿管结石直径为4 - 10 mm的患者（A组）。患者每日自行服用菠萝蛋白酶联合坦索罗辛，持续30天，或直至结石自然排出或必须进行干预。将这些患者与作为MET服用坦索罗辛的对照组患者（B组）进行比较，并在以下因素上进行匹配：性别、年龄±10%、结石直径。采用逻辑回归模型评估菠萝蛋白酶和输尿管结石直径作为解释变量。
A组和B组的自然排石率分别为87.7%和75.4%（p = 0.016）；自我报告的结石排出时间无差异（11.68天对11.57天；p = 0.91）。对于较大结石（> 5 mm），A组的自然排石率为83.3%，B组为61%（p < 0.01）。结石直径每增加1毫米，自然排石的概率降低59.1%（p < 0.0001），而使用菠萝蛋白酶时该概率增加3.3%。仅记录到3例与坦索罗辛相关的不良事件。
菠萝蛋白酶与坦索罗辛联合作为MET可增加有症状的远端输尿管结石自然排石的概率，且未记录到与菠萝蛋白酶相关的副作用。
