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