Comparison of efficacy of alpha-adrenergic blockers: tamsulosin and doxazosin in the treatment of distal ureteral stones
V.Bekavac, B.Ružić(1), I.Gilja, D.Tomić ,M.Kordić, M.Tipurić, D.Zalihić, J.Baranik, M.Ignatkov, K.Pavlović,
Klinika za urologiju SKB Mostar, F BiH; (1) Klinika za urologiju Sestre Milosrdnice, Zagreb, Hrvatska
Backgound: Patients with ureteral stones and renal colices represent very important part of everyday urological practice. Alpha-adrenergic blockers increase the rate of spontaneous passage of ureteral stones smaller than 1 cm in a diameter.
Objective: To analyse if there was any difference between alpha-adrenergic blockers in time needed for stone removal, pain intensity during the phase of renal colices, cumulative dose of used analgetics. To analyse if there was any difference in the treated groups of patients in the number of indications for operative urological treatment if there was no spontaneous passage of ureteral stones.
Methods: The study was performed at the Clinic of urology of University clinical hospital Mostar in the period between January 1, 2012 and December 31, 2012 as prospective head-to-head clinical study. Sixty patients were included in this study, divided in two groups of 30 patients. The first group of patients received tamsulosin (0,4 mg daily) and the second group of patients received doxazosin (2 mg daily). In the case of additional pain diclofenac suppositories were used in doses 1 to 3 mg per kilo daily, i.e. 50 to 200 mg daily divided into 2 to 4 doses.
Results: There was no significant difference between groups regarding age (39,00 ± 12,32 and 37,73 ± 11,22 years), gender (χ2= 0,29, p = 0,59) or stone size (5,50 ± 1,32 mm and 5,50 ± 1,37 mm). Spontaneous passage of ureteral stones was found in 27 of 30 patients (90%) in tamsulosin group and in 24 of 30 patients (80%) in doxazosin group. There was significant difference between these groups in number of days needed for stone removal. In this regard tamsulosin group had a shorter period of time for stone removal (11,89 ± 5,69 days) than in doxazosin group (15,42 ± 6,81 days). There was no significant difference neither in number of renal colices (5,00 ± 1,87 i 5,00 ± 2,24 colices) nor in cumulative dose of analgetics (250,00 ± 105,37 mg and 300,00 ± 133,00 mg diclofenac suppositories). There was no difference in pain intensity between groups analysed by numerical pain scale (7,38 ± 1,18 and 7,50 ± 1,04). There was no significant difference neither between these groups regarding patients attitude toward pain and analgetics nor the number of operative procedures performed if stone removal was not achieved. Two patients from tamsulosin group had retrograde ejaculation. No other adverse events were observed regardless of alpha-adrenergic blockers used.
Conclusion: Alpha-adrenergic blockers have recently been shown to play important role in treating patients with distal ureteral stones and renal colices. Tamsulosin is advised for use in these patients more than doxazosin because of shorter period of time needed for stone removal.
Key words: renal colic, ureteral calculi, alpha-adrenergic blockers, tamsulosin, doxazosin