Use of Doxazosin for Pediatric Distal Ureter Stones: Results from Prospective Randomised Study
Purpose It has been previously demonstrated that alpha adrenoreceptors are prevalent in distal ureter. We evaluated the position of doxazosin as adjunctive therapy by a prospective randomized study in patients with stones of distal ureter. Material and Methods 39 patients from two different institutions patients with distal ureteral stone of size between 6mm to 15 mm of diameter were enrolled. Children either underwent extracorporeal shockwave lithotripsy (ESWL) or admitted by distal ureter stone at start. Patients with anatomical abnormalities, previously known reflux, voiding dysfunction, steinstrasse following ESWL were excluded from the study. Patients were randomly divided into two treatment groups: 20 patients (mean age 5.1 years, range 2-11) in Group 1 received only non steroidal anti-inflammatory drug (NSAID) whereas 19 (mean age 6.2 years, range 2-12) in Group 2 received additional doxazosin 1 mg everyday. Follow up was performed by plain film and ultrasound scan at 1,2 and 3weeks. Results All patients completed the study and none were excluded due to side effects. No significant differences were found between the groups for age, gender distribution and stone size. The stone expulsion rates were 85% (17/20) for Group1 and 95% (18/19) Group 2 (p>0.05) The mean expulsion time of 10.9 and 8.9 days were recorded respectively and did not achieve statistical significance. The mean NSAID dose was similar in both groups. Conclusions Doxazosin for distal ureteral stones (size between 6-15mm) does not improve expulsion rate, time or analgesic need. Since pediatric ureter known to be more elastic further studies with larger stone borders might show potential benefit of alpha blockers as shown in adult.