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Alfuzosin Is Effective For Spontaneous Expulsion Of Urinary Stones

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Alfuzosin Is Used For The Spontaneous Expulsion of The Urinary Stone

Background Information

Urinary stones can range from <5mm to <10mm. The stone position can vary; it can be an upper ureteral stone or a lower ureteral stone. The removal of the stone is very essential. The present study involves the stone expulsion rate of patients on alfuzosin treatment in comparison with a control group.

Aim

The aim of the study was to assess the passage rate of urinary stone in the patients getting treated by alfuzosin and to assess the pain status of the alfuzosin group and the control group

Study criteria

The study involved patients with acute ureteric stone of 5-10mm.
Patients with the following conditions were excluded from the study:

  • Radiolucent stone, paper thin cortex, and non-functioning kidney
  • Intolerant to alfuzosin
  • Renal insufficiency, concurrent use of alpha blocker, calcium channel blocker, steroid, frusemide usage
  • Pregnancy, hypotension, history of ureteral stricture, history of treatment for urinary stones, allergy towards studymedication, patients on double-J ureteric stunting or percutaneous nephrostomy drainage, and uncontrolled urosepsis.

Study design

The study was a randomized controlled trial with 67 patients being randomized by a computer generated random table. Patients had upper and lower ureteral stones in the size of 5-10mm. Telephonic interview was done at the end of 2nd week for enquiry about the pain. Kidney-Ureter-Bladder X-ray was performed at the end of 5th week for any evidence of stone passage.

Procedure

  • Patients were selected for the study based on the stone confirmation by Kidney-Ureter-Bladder X-ray and non-
    contrast computerized tomography.
  • Serum white blood cell count, serum creatinine level, and urine for routine microscopy and culture were measured.
  • Patients were randomized into medical expulsive therapy (MET) group and a control group.
  • Blood pressures were checked and the mean was taken.
  • MET group patients (33) received alfuzosin slow release 10mg daily-4 weeks and dologesic (paracetamol +
    detropropoxyphene) 4 tablets on demand basis for 2 weeks.
  • Control group patients (34) were given dologesic tablets alone for 2 weeks.
  • If pain control was suboptimal, diclofenac sodium SR on demand was given for 2 weeks in addition.
  • Patients were discharged once the pain was controlled. Pain status and the passage of stone were enquired over the phone after 2 weeks.
  • After 5 weeks, stone passage was enquired by KUB X-ray.

Parameters recorded

The parameters recorded were

  • Mean blood pressure
  • Spontaneous stone passage rate
  • The number of analgesic (dologesic) and NSAID (diclofenac) tablets consumed
  • Time taken to reduce the pain

Results

There was no significance in the stone size between both the groups.
There was no difference in the blood pressures before and after the treatment in the medical expulsion therapy group.

Stone size in medical expulsion therapy group and the control group

Conclusion

Alfuzosin acts on the alpha 1D 1A adrenoceptors more pronouncedly, which are present on the upper ureter. Therefore, the MET with Alfuzosin acts more on the upper ureteral stones and causes the quick stone expulsion.

Reference

Lysander Hin Chau et al. Medical expulsive therapy using alfuzosin for patient presenting with ureteral stone less than 10 mm: A prospective randomized controlled trial. Int J Urol. 2011 Jul;18(7):510-4.

Available at http://www.ncbi.nlm.nih.gov/pubmed/21592234/

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