Preoperative use of alpha-1 receptor blockers in male patients undergoing extracorporeal shock wave lithotripsy for a ureteral calculus: a retrospective cohort study

Purpose To characterize the preoperative use of alpha-1 adrenergic receptor (AR) blockers and investigate its impact on the outcome of single-session extracorporeal shock wave lithotripsy (SWL) for a ureteral calculus in male patients. Methods We conducted a retrospective single-center cohort study involving 193 patients who underwent SWL for a single ureteral calculus between 2006 and 2016. We reviewed their medical records to obtain the data on the preoperative use of alpha-1 AR blocker and, if any, the reason for the prescription. The primary outcome was treatment success after single-session SWL, defined as complete stone clearance or residual fragments <4 mm in size by X-ray imaging. We performed a multivariable logistic regression analysis adjusting for clinically important confounders to examine the association between preoperative use of alpha-1 AR blockers and the treatment success of SWL. We further analyzed this association according to the reason for the prescription. Results Among the 193 patients, 15 (7.8%) were taking an alpha-1 AR blocker preoperatively with 8 (4.1%) for medical expulsive therapy (MET) and 7 (3.7%) for the treatment of benign prostatic hypertrophy (BPH). A multivariate analysis showed that the preoperative use of alpha-1 AR blocker was a significant negative predictor for treatment success of SWL (adjusted odds ratio [aOR] 0.17; 95% confidence intervals [CI], 0.04–0.74). Moreover, the use of alpha-1 AR blocker for MET, but not for BPH, was associated with lower rate of successful treatment (aOR 0.14 and 0.23; 95% CI, 0.02-0.90 and 0.03-1.97, respectively). Conclusions Our findings suggest that the preoperative use of alpha-1 AR blocker, especially for MET, was a negative predictor for treatment success of SWL in male patients with a single ureteral calculus. Clinicians should pay more attention to the preoperative drug use in determining an appropriate stone therapy modality.