Chien-Hsing Chang

Efficacy of an α1 Blocker in Expulsive Therapy of Lower Ureteral Stones

PURPOSE To evaluate the clinical role of an alpha(1a-1d)-specific blocker in the medical expulsive therapy of symptomatic lower ureteral stones. MATERIALS AND METHODS This prospective study was carried out from May 2005 to December 2006 and involved 95 patients. All patients, who had symptomatic lower ureteral stones <10 mm diameter, were enrolled in this prospective study, and were randomly divided into three groups using the statistical software programs Plus 1.0 and Plus 2.10. Group 1 (32 patients) received tamsulosin (0.4 mg daily), group 2 (32 patients) received terazosin (2 mg daily), group 3 (31 patients) acted as controls. All patients were diagnosed with x-rays of the kidneys, ureters, and bladder, urinary ultrasonography, and intravenous urography. All patients received the same analgesic regimen and sublingual buprenorphine on demand. The number of colic episodes, lower urinary tract symptoms, analgesic dosages, and the number of days required for spontaneous passage of the stones were all recorded in a diary. RESULTS Expulsion was observed in 26 of 32 patients in group 1 (81%), 25 of 32 in group 2 (78%), and 17 of 31 in group 3 (55%). The average expulsion time for groups 1, 2, and 3 were 6.3, 6.3, and 10.1 days, respectively. Mean analgesic dosage per patient in groups 1, 2, and 3 were 231, 256, and 347 mg, respectively. A statistically significant difference was observed between groups 1 and 2 with respect to group 3 for all three of these parameters. Adverse effects were also seen in 5 of 32 patients in group 2 (16%), a statistically significant difference with regard to groups 1 and 3. CONCLUSIONS Medical treatment with alpha(1a-1d)-blocker proved to be safe and effective as demonstrated by the increased stone expulsion rate and reduced expulsion time, as well as the need for analgesics.

Low Dose Oral Desmopressin for Nocturnal Polyuria in Patients With Benign Prostatic Hyperplasia: A Double-Blind, Placebo Controlled, Randomized Study

PURPOSE We evaluated the long-term efficacy and safety of low dose oral desmopressin in elderly patients with benign prostatic hyperplasia with more than nocturnal voids and nocturnal polyuria more than 30% of total daily urine volume. MATERIALS AND METHODS Eligible patients with benign prostatic hyperplasia older than 65 years with nocturia, nocturnal polyuria and International Prostate Symptom Score 14 or greater were included in the study. All patients received placebo or 0.1 mg desmopressin orally at bedtime. Patients were required to visit the outpatient clinic from the first visit, and after 1, 3, 6 and 12 months of treatment. Patients maintained flow volume charts and used diaries to record voiding data throughout the study. During followup urinalysis, urine sodium, urine osmolality, serum electrolytes, prostate specific antigen, International Prostate Symptom Score, quality of life, transrectal ultrasonography of prostate, uroflowmetry and post-void residual urine volume were performed at each visit. RESULTS A total of 115 patients were enrolled in the study and randomized as 58 in the placebo group and 57 in the desmopressin group. Desmopressin significantly decreased nocturnal urine output and the number of nocturia episodes, and prolonged the first sleep period (p < 0.01). Compared to before treatment desmopressin gradually decreased serum sodium and induced statistically but not clinically significant hyponatremia after 12 months of treatment. No serious systemic complications were found during medication. CONCLUSIONS Low dose oral desmopressin is an effective and well tolerated treatment for nocturnal polyuria in the lower urinary tract symptoms of patients with benign prostatic hyperplasia. Long-term desmopressin therapy gradually decreases serum sodium and it might induce hyponatremia even in patients without initial hyponatremia. For long-term desmopressin administration serum sodium should be assessed carefully, at least at 1 week after treatment.

Effects of Tamsulosin on Lower Urinary Tract Symptoms due to Double-J Stent: A Prospective Study

Objective: To evaluate the effect of tamsulosin in improving symptoms in, and quality of life of, patients with indwelling double-J ureteral stents. Patients and Methods: This prospective study lasted from January 2005 to February 2007. All the patients with symptomatic lower ureteral stones with <15 mm diameter were enrolled in this prospective study, and were prospectively randomized (programs Plus 1.0 and Plus 2.10; S-Plus, Taiwan) into two groups. There was a total of 146 patients with insertion of a double-J ureteral stent after ureteroscopic stone removal. In group 1, 71 patients were enrolled and they received placebo for 2 weeks. Group 2 included 75 patients who received 0.4 mg of tamsulosin, once daily for 2 weeks. All patients completed a 10-cm linear visual analogue scale (VAS) for evaluating pain and voiding flank pain, and irritative domain of the International Prostate Symptom Scale (IPSS) before double-J stent removal 2 weeks later. Results: The mean VAS for pain was 4.01 in group 1, 1.52 in group 2, and for voiding flank pain it was 3.3 in group 1 and 1.93 in group 2. The mean score of frequency in IPSS was 3.7 in group 1 and 1.55 in group 2. The mean score of urgency in IPSS was 3.82 in group 1 and 1.43 in group 2. The mean score of nocturia in IPSS was 2.01 in group 1 and 0.65 in group 2. The mean score of quality of life in IPSS was 4.21 in group 1 and 1.6 in group 2. All p values are <0.0001 with statistical significances. Conclusions: Tamsulosin improved a subset of stent-related urinary symptoms, pain, voiding flank pain and quality of life.

Doppler ultrasound-guided percutaneous nephrolithotomy: a prospective randomized study.

OBJECTIVE To evaluate the role, safety, and effectiveness of Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL). METHODS The present study was a prospectively randomized controlled trial performed from March 2007 to February 2010. A total of 131 patients, scheduled for PCNL to remove huge renal stones (diameter>35 mm) and staghorn stones, were enrolled and prospectively randomized using a random numbers table into 2 groups. Of the 131 patients, 54 were randomized to ultrasound-guided puncture PCNL (group 1). Group 2 included 57 patients who received Doppler ultrasound-guided PCNL. A total of 30 patients were excluded from the study. The preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasonography, intravenous urography, and technetium-99m diethylenetriaminepentaacetic acid to determine the selective glomerular filtration rate. The intraoperative findings, operative time (from insertion of the puncture needle to the end of the procedure), and outcomes were also recorded. The complete blood count and serum creatinine were also checked. The modified Clavien grading system was used to evaluate the perioperative morbidity of PCNL. RESULTS No difference was found between the 2 groups with regard to the serum creatinine change, length of stay, return to normal activity, Clavien grade, relative perfusion rate, or glomerular filtration rate, as determined by technetium-99m diethylenetriaminepentaacetic acid clearance, preoperatively and postoperatively. However, the hemoglobin decrease (2.33±0.46 g/dL) in the ultrasound-guided puncture group was greater than that in the Doppler ultrasound-guided group, with statistically significant difference. CONCLUSION Doppler ultrasound-guided PCNL is accurate and safe and was associated with less blood loss. We believe that Doppler ultrasound can be an important alternative to B-mode ultrasound guidance.

Randomized Trial of NTrap for Proximal Ureteral Stones

OBJECTIVE To evaluate the role, safety, and effectiveness of NTtrap stone occlusion device in prevention of stone migration in proximal ureteral lithotripsy and whether such a procedure has less morbidity. MATERIALS AND METHODS This prospectively randomized controlled trial was carried out from January 2008 and December 2009. A total of 113 patients undergoing ureteroscopic stone manipulation for proximal ureteral stones (>9 mm) completed the study protocol: 57 patients in the control group, and 56 patients in the NTtrap group. Preoperative data included urinalysis, urine culture, complete blood count, biochemistry study, renal ultrasound, and intravenous urography. Intraoperative findings and outcome were also recorded. The stone-free rate was assessed using ultrasound and plain radiograph of the kidney, ureter, and bladder in patients with calcified stones and noncontrast computerized tomography in patients with radiolucent stones. RESULTS There was no difference between the groups with regard to follow-up time, stone impaction, return to normal activity, unplanned emergency department visits and complications rate. However, patients in the control group had a significantly higher rate of stone retropulsion. Meanwhile, operative time, visual analog scale, and analgesic consumptions were significantly higher in the NTtrap group. No ureteral stricture developed in either group. CONCLUSIONS This study confirms that the NTtrap stone occlusion device is efficient at preventing stone retropulsion during intracorporeal lithotripsy of proximal ureteral calculi.

Adjunctive Medical Therapy with an α-1A-Specific Blocker after Shock Wave Lithotripsy of Lower Ureteral Stones

Introduction: We assessed the efficacy of using an α-1A-specific blocker for improving the success rate in shock wave lithotripsy (SWL) for lower ureteral stones. Materials and Methods: This prospective study was conducted from June 2005 to December 2006 and involved 107 patients. All the patients underwent SWL with the PCK Stonelith. The patients were randomly divided into 3 groups: group 1 (34 patients) received tamsulosin, group 2 (35 patients) received terazosin, and group 3 (38 patients) received placebo. All patients were diagnosed by kidney-ureter-bladder X-ray, abdominal ultrasonography and intravenous urography. The number of colic episodes, lower urinary tract symptoms, analgesic dosage and days for spontaneous passage of the stones through the ureter were recorded by diary. Statistical analyses were performed using ANOVA, the χ2 test, Fisher’s exact test and the non-parametric Wilcoxon 2-sample t test. Results: There were no differences between the groups regarding age, stone size, expulsion time and expulsion rate. The number of colic episodes and the analgesic dosage were significantly lower in group 1 compared with groups 2 and 3. A statistically significant difference was observed in lower urinary tract symptoms: lower urinary tract symptoms were observed in 4 of 34 patients in group 1 (12%), in 8 of 35 in group 2 (23%), and in 13 of 38 in group 3 (34%). Adverse effects were noted in 5 of 32 patients in group 2 (16%), which was significantly different in comparison with group 3. Conclusions: Administration of an α-1A-specific blocker reduced analgesic dosage and colic episodes after SWL of lower ureteral stones. There was no benefit with regard to increasing stone expulsion rate or decreasing expulsion time.