URG-L: colique nephritique

[Martin Pham-Dinh]

Alpha-blockers equally effective for treating nephrolithiasis

Clinical question
Are various a1-adrenergic blockers equally efficacious in the treatment of distal ureteral renal stones?

Bottom line
Alpha1-adrenergic blockers increase the frequency of spontaneous passage of distal ureteral renal stones. All 3 agents -- tamsulosin (Flomax), terazosin (Hytrin), and doxazosin (Cardura) -- were equally effective. (LOE = 1b)

Reference
Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H. The comparison and efficacy of 3 different a1-adrenergic blockers for distal ureteral stones. J Urology 2005; 173:2010-12.

Study design: Randomized controlled trial (nonblinded)

Setting: Outpatient (specialty)

Synopsis
Alpha1-adrenergic blockers increase the rate of spontaneous passage of distal ureteral stones. To compare efficacy of various agents these investigators enrolled 114 patients, aged 18 to 65 years, with radiopaque stones 10 mm or smaller located in the distal ureter. Subjects were randomly assigned (allocation assignment uncertain) to 1 of 4 treatment groups: (1) tamsulosin (Flomax) 0.4 mg daily; (2) terazosin (Hytrin) 5 mg daily; (3) doxazosin (Cardura) 4 mg daily; or (4) no treatment. All medications were given for up to 1 month and patients were allowed to use symptomatic therapy with injections of diclofenac (Voltaren) as needed. The authors do not state whether individuals assessing outcomes were blinded to treatment group assignment. No patients were lost to follow-up. Although the authors do not specify using intention-to-treat analysis, it appears that they did. There was no significant difference in the rates of stone passage between the 3 treatment groups (76% to 79%), but the rate of spontaneous passage of stones was significantly lower in the control group (54%; number needed to treat = 4; 95% CI, 2 - 21). The number of pain episodes, average time to stone expulsion, and analgesic dosage consumed was equivalent among the 3 treatment groups but significantly lower than in the control group.

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-----Message d'origine-----
De : urg-l@urgences.ca [mailto:urg-l@urgences.ca] De la part de Michael Garner
Envoyé : August 15, 2005 2:47 PM
À : [EMAIL PROTECTED]
Objet : URG-L: colique nephritique

Bonjour,

Serait-il possible d'envoyer les références sur la liste ?

A ma souvenance, le seul article que j'avais lu à cet effet donnait des résultats non significatifs sur le plan clinique

Michel Garner
On 14-Aug-05, at 1:37 PM, julie ellrodt wrote:

> Bonjour,
> > >
> > > J'aimerais savoir si dans certains centres on prescrit d'emblée
> > > des bloqueurs alpha-adrénergiques (Flomax) aux patients avec
> > > colique néphritique en plus de l'analgésie, surtout ceux avec
> > > CT-scan
> démontrant
> > > calculs à la (ou proche) de la jonction urétéro-vésicale. J'ai
> récemment
> > > lu quelques articles à ce sujet et je dois les présenter en
> Journal Club.
> > > J'aimerais savoir si c'est une pratique répandue.
> > >
> > > Merci
> > >
> > > Valéry Rossbach
> > > R1 médecine familiale
> > > Moncton, NB
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