The dynamics of urinary stone disease of the proximal ureter and the effectiveness of silodosin for treatment of urolithiasis after extracorporeal shock wave lithotripsy

Belousov I.I., Yassine Akef Maaruf, Kogan M.I.

Introduction. According to the clinical recommendations of the Russian society of urologists and of the European and American urological associations, it was determined that the therapy aimed at removal of urinary stones combined with application of alpha-blockers during or immediately after extracorporeal shock wave lithotripsy (ESWL) promotes the significant increase of the level of spontaneous concrement elimination, compared to ESWL monotherapy in patients with urolithiasis. Meanwhile, there are still no regulations for treating patients, who received ESWL and did not have discharge of stones afterwards but did not have any clinical symptoms or had minor ones.

Materials and methods. The study included 34 patients with proximal ureteral urolithiasis, who received ESWL. The final valuation of the effectiveness of lithotripsy was conducted 90 days after the termination of treatment. The patients were divided into groups with relation to the effectiveness of ESWL. Those patients who had residual stones, additionally received silodosin (an alpha-blocker) during two weeks at therapeutic dose. Statistical analysis was performed with Stasistica 10 software pack (StatSoft Inc) using nonparametric methods.

Results. Application of ESWL for treating patients with proximal ureteral urolithiasis promoted concrement elimination only in 44.1% of patients during the first 12 days. At the same time, all proximal stones migrated to the middle (23.1%) and distal (76.9%) parts of the ureter. In all cases we managed to result in the decrease of the size and density of the concrements. In other patients, who received silodosin expulsive therapy 3 months after ESWL, it was possible to achieve spontaneous discharge of stones in 86.4% of observations. Lithokinetic therapy consisting of silodosin administration was effective in the long term for treating patients, who underwent ESWL of proximal ureteral urolithiasis, if the sizes of residual stones were less than 8 mm and if they were localized in the middle and distal parts of the ureter.

Authors declare lack of the possible conflicts of interests.

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urolithiasis, ureterolithiasis, remote shock wave lithotripsy, alpha blockers, lithokinetic therapy