Elsevier

Urology

Volume 75, Issue 6, June 2010, Pages 1285-1288
Urology

Endourology and Stones
Preliminary Study of Efficacy of Doxazosin as a Medical Expulsive Therapy of Distal Ureteric Stones in a Randomized Clinical Trial

https://doi.org/10.1016/j.urology.2009.10.069Get rights and content

Objectives

To assess the clinical efficacy of doxazosin as the medical-expulsive therapy for distal ureterolithiasis.

Methods

A total of 65 patients with a symptomatic 4-7 mm distal ureteral stone were included in the study. Patients were randomized to 1 of the 2 treatment groups. Group 1 (n = 32 patients) was the control group and received diclofenac sodium 50 mg for their pain and group 2 (n = 33 patients) received doxazosin (2 mg daily at the night) along with diclofenac sodium 50 mg. The treatment duration was until stone expulsion or 28 days, whichever come first. The primary endpoint of the study was the stone expulsion rate. The secondary endpoints included time to stone expulsion, use of analgesics, and number of emergency room visits, hospitalizations, and drug side effects. Statistical analyses were performed using chi-square test and Fisher exact test.

Results

Both groups were comparable in terms of demographic, clinical, and stone-related parameters. Stone expulsion rate was significantly higher in the treatment group (38% for group 1 and 70% for group 2, P = .009) while the expulsion time was significantly lesser in group 2 patients (P = .005). During the treatment period, we observed significant differences between the 2 groups in the number of pain episodes and analgesic used (P = .0001). None of the patients in either groups reported adverse drug-related events.

Conclusions

Doxazosin significantly improves stone expulsion and is associated with decreased colic frequency and use of analgesia. It is also well tolerated with no adverse drug-related events.

Section snippets

Material and Methods

The patients included in the study are with stones in the distal part of the ureter (juxtavesical tract and ureterovesical junction) 4-7 mm in size. Subjects with urinary tract infection, ureteric stricture, diabetes, ulcer disease, history of hypersensitivity to doxazosin, solitary kidney, severe hydronephrosis, serum creatinine more than 2 mg/dL, multiple ureteral stones, hypotension, pain not controlled on analgesia and pregnant women were excluded from the study. Informed consent and

Results

There were no statistically significant differences between the 2 groups, with respect to age, gender, height, weight, stone size, and location. The demographic distribution of the patients is summarized in Table 1. The calculi passed spontaneously in 12 of 32 patients in the control group (38%) and in 23 of 33 patients in the study group (70%). In the study group, the ratio of spontaneous passage of the calculi was found to be higher compared with that in the control group (P = −.009). The

Comment

The use of medications during expectant management of distal ureteral stone is largely related to the patient's symptom besides stone size and degree of obstruction. Inability to control pain usually becomes the most common indication for an active intervention. The colic pain results from an increase in the intraureteral and intrarenal pressure secondary to the inability of ureteral peristalsis to move the urine distal to the obstructing stone. The main factors associated with stone

Conclusions

In an open-label trial of doxazosin we observed that its use increased pain tolerance and decreased frequency of colic, with minimal side effects of the drug. α1-Blockers can be a part of conservative treatment in patients with stone of size <7 mm. The limitation of the current work includes smaller patient population and lack of placebo control and blinding. We propose a larger study in view of comparing the selective vs nonselective α-adrenergic antagonists for ureteric stones at all

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