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Purpose <p>The development of effective medical expulsive therapy (MET) following extracorporeal shock wave lithotripsy (ESWL) for pediatric urolithiasis is crucial for enhancing stone fragment clearance. This study aimed to evaluate the efficacy and safety of alpha-1 adrenergic blockers (tamsulosin and silodosin) in children after ESWL.</p> Methods <p>A prospective randomized comparative study was conducted involving 200 patients (aged 2–18 years) who underwent ESWL. Participants were allocated to a study group (<i>n</i> = 50, receiving α1-blockers: tamsulosin 0.2&#xa0;mg/day for ages 2–5, silodosin 4&#xa0;mg/day for ages &gt; 5) or a control group (<i>n</i> = 150, receiving standard therapy). Primary endpoints were stone-free rate (SFR) and stone expulsion time. Secondary endpoints included pain dynamics (visual analog scale, VAS), analgesic requirements, and adverse events. Statistical analysis was performed using StatTech v.4.8.3.</p> Results <p>The odds of being stone-free were 2.11 times higher with α1-blocker therapy (OR = 2.11; 95% CI: 1.02–4.37). The median expulsion time was reduced from 7 [5–9] days in the control group to 5 [4–7] days in the study group (<i>p</i> = 0.010). ROC analysis identified a 6-day threshold for stone passage (sensitivity 63.6%, specificity 72.1%, AUC = 0.627; <i>p</i> = 0.010). Pain intensity was significantly lower in the study group on postoperative day 1 (3 [0–4] vs. 6 [5–8] points, <i>p</i> &lt; 0.001), with reduced analgesic requirements (1 [0–2] vs. 2 [1–4] doses/day, <i>p</i> = 0.003). Adverse events were mild and infrequent (5 cases of nasal congestion, 2 of nausea).</p> Conclusion <p>Adjunctive therapy with α1-blockers after ESWL in children with urolithiasis improves treatment efficacy, shortens stone expulsion time, reduces pain, and demonstrates a favorable safety profile. An optimal timeframe for efficacy assessment is 6 days post-ESWL.</p>

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Efficacy and safety of α1-adrenergic blockers after extracorporeal shock wave lithotripsy in pediatric kidney stones

  • 期刊论文

  • 发表日期：

    2026年3月4日

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  • Ibragim A. Kyarimov,
  • Sergei N. Zorkin,
  • Alexandra T. Galuzinskaya,
  • Rimir R. Bayazitov,
  • Dmitry S. Shakhnovskiy

摘要

Purpose

The development of effective medical expulsive therapy (MET) following extracorporeal shock wave lithotripsy (ESWL) for pediatric urolithiasis is crucial for enhancing stone fragment clearance. This study aimed to evaluate the efficacy and safety of alpha-1 adrenergic blockers (tamsulosin and silodosin) in children after ESWL.

Methods

A prospective randomized comparative study was conducted involving 200 patients (aged 2–18 years) who underwent ESWL. Participants were allocated to a study group (n = 50, receiving α1-blockers: tamsulosin 0.2 mg/day for ages 2–5, silodosin 4 mg/day for ages > 5) or a control group (n = 150, receiving standard therapy). Primary endpoints were stone-free rate (SFR) and stone expulsion time. Secondary endpoints included pain dynamics (visual analog scale, VAS), analgesic requirements, and adverse events. Statistical analysis was performed using StatTech v.4.8.3.

Results

The odds of being stone-free were 2.11 times higher with α1-blocker therapy (OR = 2.11; 95% CI: 1.02–4.37). The median expulsion time was reduced from 7 [5–9] days in the control group to 5 [4–7] days in the study group (p = 0.010). ROC analysis identified a 6-day threshold for stone passage (sensitivity 63.6%, specificity 72.1%, AUC = 0.627; p = 0.010). Pain intensity was significantly lower in the study group on postoperative day 1 (3 [0–4] vs. 6 [5–8] points, p < 0.001), with reduced analgesic requirements (1 [0–2] vs. 2 [1–4] doses/day, p = 0.003). Adverse events were mild and infrequent (5 cases of nasal congestion, 2 of nausea).

Conclusion

Adjunctive therapy with α1-blockers after ESWL in children with urolithiasis improves treatment efficacy, shortens stone expulsion time, reduces pain, and demonstrates a favorable safety profile. An optimal timeframe for efficacy assessment is 6 days post-ESWL.