Impact of Tamsulosin on Clearance of Renal Calculi after Extracorporeal Shock Wave Lithotripsy

MOHAMED ABO EL-ENEN, MOHAMED GABER, * MOHAMED SAMY Urology and *Radiology Departments, Tanta University, Tanta, Egypt. Aim of the work: Is to investigate the role and effect of tamsulosin as adjuvant therapy in treatment of symptomatic renal calculi after extracorporeal shock wave lithotripsy (ESWL). Patients and Methods: A total 120 patients with single renal pelvic stone <20mm subjected for ESWL. The patients subdivided randomly by the closed envelop technique into 2 equal groups (n=60) according to tamsulosin adminstration after ESWL. Group I (control group) received no specific treatment while group II received tamsulosin orally (0.4 mg/day). Follow-up was performed at 2, 4 and 6 weeks including history taking, clinical examination, urinalysis, serum creatinine, plain X-ray of urinary tract and abdominal ultrasonography and/or non contrast spiral CT. Definition of success was stone-free state or presence of insignificant asymptomatic residual fragments <4 mm at 6 weeks or earlier. The efficacy of treatment was determined by analysis of stone clearance rate and time, steinstrasse formation, frequency of pain episodes, number and dose of analgesia, side effects of medications and report of admission for severe pain, hematuria or fever. Results: Out of 120 patients, 113 had a full data and enrolled in the study. Group I included 55 patients and 58 in group II. The overall clearance rate was 95% (55 of 58) in the tamsulosin group and 78% (43 of 55) in the control group (p< 0.05). With larger stones (11 to <20 mm) the difference in the clearance rate was significant (p<0.05) but not with smaller stones (p>0.05). The average dose of analgesic requirment was less with tamsulosin than with controls but with no statistical significance. Steinstrasse resolved spontaneously in tamsulosin group whereas 29% (2 of 7) required intervention in the control group. No significance was detected between both groups for age, sex and stone size. Conclusions: Shock wave lithotripsy plays a pivotal important role as non-invasive modality in management of renal calculi. Tamsulosin use appear to augment the outcome of ESWL by improving the overall stone clearance rate and time, especially with the larger calculi. Also, it seems to improve the outcome of steinstrasse as it reduce the need of re-admission and intervention. However, further researches are needed to confirm these findings and evaluate tamsulosin as cost effectiveness therapy in stone expulsion.