Evaluation of the efficacy of tamsulosin with or without deflazacort for stone clearance after extracorporeal shockwave lithotripsy for upper ureteral and renal calculi

Rajeev T. P., Nitin Gupta, Somour J. Baruah, Sasanka K. Barua


Background: Medical expulsive therapy in the form of alpha blockers, corticosteroids, calcium channel blockers is being used with success for medical treatment of lower ureteric calculus. Adjunctive use of these therapeutic agents in post extracorporeal shockwave lithotripsy period is also being tried.With this background, we evaluated the efficacy of tamsulosin with or without deflazacort for various outcome factors after ESWL of upper ureteral and renal calculi.

Methods: A Prospecive study during period from February 2014 to April 2015 including a total of 90 patients with solitary upper ureteral or renal calculus who underwent ESWL was conducted. Patients were divided into three groups. Group A(30 patients) were given standard therapy (analgesics and antibiotics for 5 days), Group B (30 patients) were given standard plus tamsulosin (0.4 mg once daily) for 4 weeks and Group C (30 patients) were given standard therapy plus tamsulosin (0.4 mg once daily) and deflazacort (6 mg twice daily) for 4 weeks . Patients were evaluated at 2 and 4 weeks post ESWL with X ray KUB and USG.

Results: At the end of 4 weeks, 10, 17, and 26 patients in group A, B and C respectively cleared their stones. Out of these 2, 6 and 19 patients in group A, B and C respectively cleared their stones in first 2 weeks. Clearance in group C was significantly higher as compared to group A and B.

Conclusions: Addition of alpha-blocker tamsulosin along with deflazacort post ESWL for renal and upper ureteric calculi increases the stone expulsion rate and reduces the expulsion duration as shown by highly statistically significant results in group C.



Tamsulosin, Deflazacort, Extracorporeal shockwave lihotripsy

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Malin JM, Deane RF, Boyarsky S. Characterisation of adrenergic receptors in human ureter. Br J Urol. 1970;42:171-4.

Sigala S, Dellabella M, Milanese G, Fornari S, Faccoli S, Palazzolo F. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodynamics. 2005;24:142-8.

Weiss RM. Physiology and pharmacology of the renal pelvis and ureter. In: Walsh PC, Retik AB, Vaughan Jr, Wein AJ, editors. Campbell’s Urology. 8th ed. Philadelphia: Saunders. 2002:399-400.

Weiss RM, Bassett AL, Hoffman BF. Adrenergic innervation of the ureter. Invest Urol. 1978;16:123-7.

Morita T, Wada I, Saeki H, Tsuchida S, Weiss RM. Ureteral urine transport: changes in bolus volume, peristaltic frequency, intraluminal pressure and volume of flow resulting from autonomic drugs. J Urol. 1987;137:132-5.

Davenport K, Timoney AG, Keeley FX. A comparative in vitro study to determine the beneficial effect of calcium-channel and alpha (1)-adrenoceptor antagonism on human ureteric activity. BJU Int. 2006;98:651-5.

Bhagat SK, Chacko NK, Kekre NS, Gopalakrishnan G, Antonisamy B, Devasia A. Is there a role for tamsulosin in shock wave lithotripsy for renal and ureteral calculi? The Journal of urology. 2007;177(6):2185-8.

Alsagheer GA, Munir N, Anwar AZM, Shaaban AM. Is there a role for alpha blockers after SWL for renal and upper ureteral stones? EL-Minia Med, Bull. 2008;19.

Hussein MM. Does tamsulosin increase stone clearance after shockwave lithotripsy of renal stones? A prospective, randomized controlled study. Scandinavian journal of urology and nephrology. 2010; 4491(1):27-31.

Park YH, Lee HE, Park JY, Lee SB, Kim HH. A prospective randomized controlled trial of the efficacy of tamsulosin after extracorporeal shock wave lithotripsy for a single proximal ureteral stone. Korean journal of urology. 2013;54(8):527-30.

Zhu Y, Duijvesz D, Rovers MM, Lock TM. Alpha-Blockers to assist stone clearance after extracorporeal shock wave lithotripsy: a meta-analysis. BJU international. 2010;106(2):256-61.

Dellabella M, Milanese G, Muzzonigro G. Medical-expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urology. 2005;66(4):712-5.

Porpiglia F, Destefanis P, Fiori C, Scarpa RM, Fontana D. Role of adjunctive medical therapy with nifedipine and deflazacort after extracorporeal shock wave lithotripsy of ureteral stones. Urology. 2002;59(6):835-8.

Mohammad HR, Kamal YM, Kareem NFA. Effect of Tamsulosin on calculus clearance after extracorporeal shock wave lithotripsy in patients with Renal Stone: a randomized, placebo-controlled study. American Journal of Research Communication. 2014;2(5):49-59.

Cheung MC, Leung YL, Wong BB, Chu SM, Lee F, Tam P. Prospective study on ultrasonography plus plain radiography in predicting residual obstruction after extracorporeal shock wave lithotripsy for ureteral stones. Urology. 2002;59(3):340-3.

Skolarikos A, Grivas N, Kallidonis P, Mourmouris P, Rountos T, Fiamegos A. Urology. 2015;86:1057-64.