The Effect of Tamsulosin and Combination of Terpenes (Rowatinex) on the Clearance of Renal Stone Gravels After Single Session of Extracorporeal Shock Wave Lithotripsy (ESWL)


Background: Extracorporeal shock wave lithotripsy (ESWL) is currently considered one of the main lines of treatments for urolithiasis. The effectiveness of pharmacologic therapies in facilitating stones expulsion after ESWL has been reported.Objectives: To evaluate the effect of Tamsulosin and terpenes combination (Rowatinex) on the clearance of stone gravels after extracorporeal shock wave lithotripsy (ESWL) of renal stone.Methods: From May 2010 to June 2011 (84) patients with single radio opaque renal stone presented to urologic consultation department at Al-Ramadi teaching hospital/Iraq were included in this prospective, case-control study. All patients were examined by ultrasonography, and intravenous urography. Their age ranged from 19 to 62 years. All patients underwent ESWL and randomly divided into three groups, group A, of 28 patients, received conservative medical therapy alone and served as the control group, group B, of 28 patients, received tamsulosin 0.4 mg once daily in addition to conservative medical treatment and group C, of 28 patients, received Rowatinex capsules, 1 capsule before food 3 times daily in addition to conservative medical therapy. All patients were followed up by clinical examination, urine analysis, ulrasonography and abdominal radiograph (KUB) at 4 and 8 weeks and the number of patients with clinical success was recorded. Clinical success defined as stone-free status or clinically insignificant stone. Results: The age of patients ranged from 19 to 60 years in group A (mean 35.7±6), 20-62 years in group B (mean 36.6±13.25) and 20-61 years in group C (mean 36.2±13.02), there was no significant statistical difference between the age, gender and site and size of renal stones among the three groups (p value > 0.05). The percentage of patients with clinical success after ESWL at 4 weeks was 23% in group A, 44% in group B and 40% in group C and increased to 46%, 80% and 76% in group A, B and C respectively at 8 weeks. The clinical success was statistically more significant in group B and C compared to group A at both 4 and 8 weeks ( p value < 0.05). There was no statistically significant difference in the clinical success between group B and C (p value > 0.05). Although the incidence of drugs side effects in group B and C occurred more than in group A, but no significant side-effect was detected so as to require exclusion of a patient from the study and medical intervention was not performed in any of the patients because of side-effects.Conclusion: The use of medical expulsion in this study by tamsulosin or terpenes combination (Rowatinex) was well tolerated and it demonstrated that it is clinically meaningful and statistically it has significant improvement in the clearance of stone fragments after ESWL of renal stone. The effect on tamsulosin and terpenes combination (Rowatinex) is comparable.