INTRODUCTION: Steinstrasse is a well-known complication following extracorporeal shock wave lithotripsy (ESWL). It has been identified in 5-10% of patients with large stone burdens (> 2 cm) and may necessitate surgical intervention if medical treatment fails. The objective of the present randomized, controlled study was to evaluate the efficacy of tamsulosin as a conservative management of steinstrasse.
METHODS: The participants were 88 patients with unilateral steinstrasse who were treated between January 2005 and December 2008. The patients were randomly allocated into 2 equal groups of 44 patients. There were no significant differences between groups for age, sex, stone location, stone length, or stone fragment size (P > .05). Patients in group 1 (study group) received a single daily morning dose of tamsulosin (0.4 mg) for a maximum of 4 weeks, in addition to pain-relieving therapy. Patients in group 2 (control group) received only the pain-relieving therapy. All patients were checked weekly with a plain x-ray of the urinary tract (PUT), urinary ultrasonography, urine analysis, and serum creatinine level. Pain episodes, day of spontaneous stone expulsion, total analgesic dosage, and drug side effects were recorded. The data were analyzed using chi-square.
RESULTS: Stone expulsion occurred in 32 of the 44 patients (72.7%) receiving tamsulosin and in 25 of the 44 patients (56.8%) in the control group. Patients receiving tamsulosin had a significantly higher stone expulsion rate (P = .017). There were no significant differences between groups for mean stone expulsion time or number of analgesics used. Twelve patients (27.3%) in the group receiving tamsulosin and 19 patients (43.3%) in the control group needed hospitalization; the group difference was statistically significant (P = .017).
CONCLUSION: When compared with no treatment, tamsulosin can significantly facilitate expulsion of retained ureteral stone fragments following ESWL with less need for hospitalization.
KEYWORDS: Tamsulosin; Steinstrasse; Extracorporeal shock wave lithotripsy (ESWL)
CORRESPONDENCE: Esam Eldin Salem, MD, Department of Urology, University Hospital, 22 Mubarak Street, Sohag, 67543, Egypt ( ).
CITATION: Urotoday Int J. 2010 Feb;3(1).
doi:10.3834/uij.1944-5784.2010.02.09