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September 29, 2006

Many urinary stones can be treated without surgery

Medicines used to treat high blood pressure, enlarged prostate may replace need for surgery in many patients with urinary stone disease, U-M Health System study finds

ANN ARBOR, MI – For many patients with urinary stone disease, treatment with a calcium-channel blocker or an alpha blocker can greatly improve their likelihood of passing their urinary stones, which may help these patients avoid surgery, according to an analysis by the University of Michigan Health System.

Brent K. Hollenbeck, M.D.Urinary stone disease is highly prevalent, afflicting 13 percent of men and 7 percent of women in the United States. While many urinary stones are treated today with minimally invasive techniques, there is growing evidence to suggest that medications can be an effective treatment.

Calcium-channel blockers and alpha blockers are used commonly for management of high blood pressure and enlarged prostates. In this study, published in the Sept. 30 issue of The Lancet, researchers identified and analyzed numerous studies and found that both medications were a successful alternative for treatment of an acute urinary stone episode.

“Surgery is still a necessary treatment for many patients with urinary stones,” says senior author Brent K. Hollenbeck, M.D., assistant professor of urology at the U-M Medical School and Comprehensive Cancer Center. “However, for many people, a more conservative approach beginning with a trial of a calcium-channel blocker or an alpha blocker is proving to be efficacious.”

Researchers looked at articles about this issue and ultimately analyzed nine trials that included 693 patients. The trials examined the use of calcium-channel blockers or alpha blockers to assist with the passage of urinary stones. In all, they found that patients treated with one of the medications had a 65 percent greater chance of passing the stones spontaneously than patients not given these drugs.

“This suggests that treatment with these medications is an important first step for patients with an acute urinary stone episode,” says lead author John M. Hollingsworth, M.D., fifth-year surgery resident with the Department of Urology at the U-M Medical School.

Hollingsworth also notes that the cost of medical treatment for urinary stones would be far lower than with surgery. Nearly 2 million outpatient visits are made annually by patients with urinary stones, with costs for inpatient and outpatient claims totaling $2.1 billion.

In addition to Hollingsworth and Hollenbeck, researchers on the study were Mary A.M. Rogers, Ph.D., M.S., research director with the Patient Safety Enhancement Program; Samuel R. Kaufman, M.A., research associate with the Division of General Medicine, Department of Internal Medicine; Timothy J. Bradford, fifth-year surgery resident with the Department of Urology; Sanjay Saint, M.D., M.P.H., director of the Patient Safety Enhancement Program and an associate professor of general medicine; and John T. Wei, M.D., M.S., associate professor of urology.

The researchers were supported by a National Institutes of Health research-training grant, Blue Cross Blue Shield of Michigan Foundation awards, an Agency for Healthcare Research and Quality award, National Institute of Diabetes and Digestive and Kidney Diseases awards, a Department of Defense Idea Development with Nested Resident and Medical Student Traineeship award, an Advanced Career Development award from the Department of Veterans Affairs Health Services Research and Development Office, a Merit Award from the VA Health Services Research and Development Office, a National Institute of Child Health and Human Development award, National Cancer Institute awards, the John and Suzanne Munn Endowed Research Fund of the University of Michigan Comprehensive Cancer Center, and the Clinical Scholars Science Program at the University of Michigan.

Wei and Saint have been paid consultants to Sanofi Aventis within the past five years, though no Sanofi Aventis products were used in the trials that were reviewed.

Citation: The Lancet, Sept. 30, 2006, Vol. 368, ”Medical therapy to facilitate urinary stone passage: a meta-analysis.”

Written by Katie Gazella

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