Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy
of renal calculi: randomized controlled trial.
Author(s): Zaytoun OM, Yakoubi R, Zahran AR, Fouda K, Marzouk E, Gaafar S, Fareed K.
Affiliation(s): Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
Publication date & source: 2012, Urol Res. , 40(4):327-32
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.
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