Alfuzosin for Medical Expulsion Therapy of Ureteral Stones

Condition(s) targeted: Kidney Stones

Intervention: Alfuzosin (Drug); nifedipine (Drug); doxazosin (Drug); prazosin (Drug)

Phase: Phase 3

Status: Recruiting

Sponsored by: United States Naval Medical Center, San Diego

Official(s) and/or principal investigator(s):
Brian K. Auge, M.D., Principal Investigator, Affiliation: NMCSD
Sean P. Stroup, M.D., Principal Investigator, Affiliation: NMCSD

Overall contact:
Brian K. Auge, M.D., Phone: 619-532-7200

The goal of this study is to conduct a prospective controlled trail of four currently

approved Department of Defense (DOD) - formulary medications for use as medical expulsion

therapy (MET) for kidney stones. Between 8% and 15% of Americans will develop symptomatic urolithiasis in there life. Several medications, including steroids, calcium channel blockers, alpha-adrenergic antagonists and non-steroidal anti-inflammatory drugs, have been utilized to aid in the spontaneous passage of distal ureteral calculi. Recently, use of selective alpha-blockers has shown promise for medical expulsion therapy (MET) of distal ureteral calculi. None of these studies have been widely publicized outside the specialty of urology. Recent studies have shown a success rate of nearly 90% when the selective alpha-blocker tamsulosin (Flomax) was used for MET. MET has also been shown to result in a decreased narcotic requirement, shorter time to stone passage, and reduced requirement for further interventions. The investigators will evaluate the effectiveness of MET as initial management for kidney stones using DOD-approved formulary medications.

Official title: Evaluation of Alfuzosin as Medical Expulsion Therapy for Ureteral Stones

Study design: Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Primary outcome: The primary measures are percent of stones passed and rates of occurrence of various side effects (categorical variables), and time to pass, pain scale, and amount of pain medication taken (continuous variables).

Detailed description: Patients presenting to Naval Medical Center San Diego with symptomatic ureteral stones visible on CT and KUB, and who are medically stable will be offered enrollment. Upon consent, patients will be randomly assigned to one of four outpatient treatment arms,

randomized 1: 1:1: 1 and include; Group 1 - Alfuzosin 10 mg daily, Group 2 - Nifedipine 30 mg

daily, Group 3 - Doxazosin 4 mg daily, or Group 4 - Prazosin 1 mg twice daily. The primary

endpoint is stone expulsion rate and secondary endpoints are time to expulsion, need for additional intervention, degree of pain control, amount of narcotic use, and evaluation of study drug side effects. The treatment regimens consist of daily medication until the stone passes or 21 days, whatever is shorter. Patients will also receive oral pain medication as needed.

Minimum age: 18 Years. Maximum age: N/A. Gender(s): Both.

Criteria:

Inclusion Criteria:

- Age >/= 18 years

- Single ureteral stone < 1 cm in greatest dimension

Exclusion Criteria:

- Age < 18 years

- Active unstable angina

- History of or active postural hypotension (>20 mmHg drop in orthostatic SBP)

- Allergy to alpha-blockers

- Acute or Chronic Renal Failure as demonstrated by a serum creatinine of > 1. 4 mg/dl

- Urinary tract infection

- Multiple ureteral stones

- Current uncontrolled diabetes

- Alpha-blocker therapy within 30 days for any reason

- Current pregnancy or lactation

- Patient desire for immediate stone removal

Brian K. Auge, M.D., Phone: 619-532-7200

Naval Medical Center San Diego, San Diego, California 92134, United States; Recruiting
Brian K Auge, M.D., Phone: 619-532-7200
Sean P. Stroup, M.D., Phone: 619-532-7200
Brian K. Auge, M.D., Principal Investigator
Sean P. Stroup, M.D., Principal Investigator

Starting date: January 2008
Last updated: April 25, 2012