Long-term prescription of α-blockers decrease the risk of recurrent urolithiasis needed for surgical intervention-a nationwide population-based study

PLoS One. 2015 Apr 13;10(4):e0122494. doi: 10.1371/journal.pone.0122494. eCollection 2015.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic alpha-Antagonists / administration & dosage*
  • Adult
  • Aged
  • Case-Control Studies
  • Female
  • Humans
  • Kidney Calculi / drug therapy*
  • Kidney Calculi / pathology
  • Kidney Calculi / surgery
  • Lithotripsy
  • Male
  • Middle Aged
  • Recurrence
  • Taiwan
  • Urolithiasis / drug therapy*
  • Urolithiasis / pathology
  • Urolithiasis / surgery

Substances

  • Adrenergic alpha-Antagonists

Grants and funding

This work was supported by Kaohsiung Medical University (KMU-DT103004), Kaohsiung Medical University Hospital (KMUH101-1I04; KMUH102-2R58; KMUH102-2M40; KMUH103-3R44), the National Science Council (NSC 101-2314-B-037-037-MY3), Ministry of Science and Technology (MOST 103-2314-B-037-066-MY2), and Taiwan’s National Health Research Institutes (NHRI-EX102-10209PI), none of which had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.