PURPOSE: α1 receptors and subtypes have been confirmed to distribute in human pelvis and calyces recently.
As used in ureteral stones, α-blocker treatment may facilitate kidney stone passage and long-term prescription of α-blocker may decrease the risk of recurrent urolithiasis. The aim of this study is to determine if use of α-blockers 180 days or more can decrease the risk of recurrent urolithiasis needed for surgical intervention.
MATERIALS AND METHODS: A representative database of 1,000,000 patients from Taiwan's National Health Insurance was analyzed. Eligible patients were those who had received the first-time procedure for upper urinary stone removal, including extracorporeal shock-wave lithotripsy, ureterorenoscopic lithotripsy, or both, between 2000 and 2010. After completing a 180-day treatment for first event, patients were prospectively followed-up until a second set of stone procedures was performed (proxy of stone recurrence), loss to follow-up, or end of study. The effect of percentage of total number of days of α-blocker use on need for second set of stone procedures within a post treatment 180-day follow-up period was analyzed by quartile. A nested case-control study was also performed.
RESULTS: 1,259 patients were eligible for final analyses. During 3,980 person-years follow-up, 167 patients had recurrent urolithiasis needed for surgical intervention. From first to fourth quartile of drug exposure, recurrence rates were 45.64, 47.19, 43.11, and 18.52 per 1,000 person-years. The adjusted hazard ratio was 0.46 (95% CI = 0.24 to 0.89) for the fourth quartile (vs. quartile 1). In the nested case-control study, adjusted ORs was 0.23 (95% CI = 0.10 to 0.53) in the fourth quartile (vs. quartile 1). The results remained similar even in patients categorized by cumulative defined daily dose (cDDD) quartiles and average cDDD per day quartiles.
CONCLUSION: Use of α-blockers for 180 days or more decrease the risk of recurrent urolithiasis needed for surgical intervention. In patients at higher risk of recurrent urolithiasis, long term prescription of α-blockers might help them prevent further surgical intervention.
Written by:
Liu CC, Hsieh HM, Wu CF, Hsieh TJ, Huang SP, Chou YH, Huang CN, Wu WJ, Wu MT. Are you the author?
Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Urology, Pingtung Hospital, Ministry of Health and Welfare, Executive Yuan, Pingtung, Taiwan; Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Medical Genetics, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan; Center of Environmental and Occupational Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Reference: PLoS One. 2015 Apr 13;10(4):e0122494.
doi: 10.1371/journal.pone.0122494
PubMed Abstract
PMID: 25875226