Long-term prescription of α-blockers decrease the risk of recurrent urolithiasis needed for surgical intervention-a...

Area of Science:

• Urology
• Pharmacology
• Nephrology

Background:

• Alpha-1 (α1) receptors are present in the human pelvis and calyces.
• Alpha-blocker (α-blocker) treatment may aid kidney stone passage.
• Long-term α-blocker use might lower the risk of recurrent urolithiasis.

Purpose of the Study:

• To investigate if α-blocker use for 180 days or more decreases the risk of recurrent urolithiasis necessitating surgical intervention.
• To evaluate the impact of long-term α-blocker therapy on preventing repeat kidney stone procedures.

Main Methods:

• Analysis of a large Taiwanese National Health Insurance database (1,000,000 patients) from 2000-2010.
• Prospective follow-up of 1,259 patients post-first upper urinary stone removal procedure for a second procedure (stone recurrence).
• Quartile analysis of α-blocker exposure duration and a nested case-control study were performed.

Main Results:

• During 3,980 person-years of follow-up, 167 patients underwent a second surgical procedure for recurrent urolithiasis.
• The highest quartile of α-blocker exposure showed a significantly reduced risk of recurrence (adjusted hazard ratio = 0.46; adjusted odds ratio = 0.23).
• Results were consistent across different measures of drug exposure, including cumulative defined daily doses.

Conclusions:

• Sustained use of α-blockers for 180 days or longer is associated with a decreased risk of recurrent urolithiasis requiring surgery.
• Long-term α-blocker prescription may be a beneficial strategy for patients prone to recurrent kidney stones to avoid repeat surgical interventions.