An Clinical Investigation About Removing Ureteral Calculus And Releasing Nephric Colic By Tamsulosin

Objectives:Evaluate the effect of tamsulosin on removing ureteral calculus and releasing nephric colic of alpha-adrenergic antagonist and whether it can be used in clinical safely.Objects and Methods:154 patients of Huashan Hospital from Apr.2007 to Mar.2008 were slected,all of them were diagnosed ureteral calculus(diameter≤1cm) and with the symptoms of nephric colic.The unqualified cases have been rejected such as serious hydronephrosis(renal collecting system separation＞2.5cm),highfever(T＞38℃),serious infection,renal inadequacy and pregnancy.107 males aged 18-72 and 44 females aged 20-68.We memorized the psitions and sizes of stones of all cases.All cases were divided into three groups(A,B,C)randomly.We use Tamsulosin 0.4mg/d in Group A, Anisodamine(654-2)10mg tid/d in group B and Nifedipine 10mg tid/d in group C. We Recorded the time of removing calculus in 4 weeks.Result:1 Lithagogue rate and time contradistinction1.1 Lithagogue rate of group A is 86.5%(45/52),60.8%(31/51) in group B&60.8%(31/51) in group.Significant deviation is exist compare with control groups(P=0.003;P=0.003).Time of removing ureteral calculus of group A is 7.8±3.8d,10.4±4.7d in group B&9.9±4.0d in group C.Significant deviation is exist compare with control groups(P=0.004; P=0.009).1.2 Lithagogue rate and time with different positions contradistinction1.2.1 Lithagogue rate in proximal ureter contradistinction:the lithagogue rate of group A is 62.5%(5/8),33.3%(3/9) in group B&50.0%(5/10) in group C.There is no deviation compare with control groups(P=0.23; P=0.57).Lithagogue time in proximal ureter contradistinction: Lithagogue time of group A is 12.2±2.9d,11.7±6.0d in group B&11.8±4.7d in group C.There is no deviation compare with control groups(P=0.64,P=0.56). 1.2.2 Lithagogue rate in medial ureter contradistinction:the lithagogue rate of group A is 91.6%(11/12),54.5%(6/11)in group B&53.3%(8/15) in group C.Significant deviation is exist compare with control groups(P=0.04;P=0.03).Lithagogue time in medial ureter contradistinction:Lithagogue time of group A is 8.2±4.0d,12.0±3.3d in group B&11.9±3.9d in group C.Significant deviation is exist compare with control groups(P=0.03;P=0.03).1.2.3 Lithagogue rate in distal ureter contradistinction:the lithagogue rate of group A is 90.6%(29/32),71.0%(22/31)in group B&69.2%(18/26) in group C.Significant deviation is exist compare with control groups(P=0.04;P=0.04).Lithagogue time in medial ureter contradistinction:Lithagogue time of group A is 6.8±3.3d,9.9±4.9d in group B&8.6±3.5d in group C.Significant deviation is exist compare with control groups(P=0.005;P=0.04).2 Lithagogue rate and time with different size contradistinction:2.1 Lithagogue rate contradistinction(diameter≤5mm):the lithagogue rate of groupA is 87.0%(20/23),76.9%(20/26)in group B&68.0%(17/25) in group C.There is no deviation compare with control groups(P=0.2,P=0.1).2.2 Lithagogue time contradistinction(diameter≤5mm):the lithagogue time of group A is 6.3±3.0d,9.4±4.2d in group B&9.2±3.9d in group C.Significant deviation is exist compare with control groups(P=0.02;P=0.01).2.3 Lithagogue rate contradistinction(diameter≥5mm&≤1cm):the lithagogue rate of group A is 89.3%(25/28),44.0%(11/25)in group B&53.8%(14/26) in group C.Significant deviation is exist compare with control groups(P=0.002;P=0.004).2.4 Lithagogue time contradistinction(diameter≥5mm&≤1cm):the lithagogue time of group A is 7.8±4.4d,12.7±4.5d in group B&10.1±4.0d in group C. Significant deviation is exist compare with control groups(P=0.01; P=0.005).3 Symptomatic relief3.1 Contradistinction of releasing nephric colic.Evaluate the symptoms of nephric colic by numerical rating scales(NRS).The average points of group A is 6.8,rate of pain anesis is 86.5%(45/52).The average points after pain anesis is 3.5.The average points of group B is 6.5,rate of pain anesis is 68.6%(35/51).The average points after pain anesis is 4.9.The average points of group C is 7.1,rate of pain anesis is 74.5%(38/51).The average points after pain anesis is 4.5.Significant deviation is exist in A&B groups(P=0.03).There is no deviation in A&C groups(P=0.4).3.2 Contradistinction of urinary frequency and urgency anesis Sympton anesis rate in group A is 88.0%(22/25),62.5%(15/24) in group B&60.9%(14/23) in group C.Significant deviation is exist compare with control groups(P= 0.04;P=0.03).4 Side effect & adverse effectThere is no serious side effect in three group.Main side effects include dizziness, thirsty,diarrhea & dysuresia..Conclusion:1 Tamsolusin can increase the lithagogue rate in ureteral calculus,especially to the distal ureter calulus,it can obviously increase the lithagogue rate in ureteral calculus.decurtate time of removing calculus.2 For ureteral calculus whose diameter is no more than 5mm,Tamsolusin can not increase the lithagogue rate,but it can decurtate time of removing calculus.For ureteral calculus whose diameter is more than 5mm and no more than 1cm,Tamsolusin can not only increase the lithagogue rate but alsoit can decurtate time of removing calculus.3 Tamsolusin can also lessen the nephric colic,urinary frequency and urgency anesis.4 It's safe to treat patients with Tamsolusin 0.4mg/d and no serious side effects occurred.Compare with 654-2,less side effects of thirsty occured in tamsolusin group.To some old aged male patients with BPH,it can lessen the symptom of dysuresia.It can be used in clinical safely.