長期服用甲型阻斷劑降低尿路結石復發需接受手術治療的風險性-全國人口基礎性研究
劉家駒1-3 謝惠敏4 吳佳芳4 謝翠娟5 黃書彬1,2 周以和1,2 黃俊農1,2 吳文正1,2 吳明蒼4,6*
高雄醫學大學附設醫院 泌尿科1
高雄醫學大學 醫學系 泌尿學科2
行政院 衛生福利部 屏東醫院 泌尿科3
高雄醫學大學 公共衛生系4
高雄醫學大學 醫學遺傳系5
高雄醫學大學附設醫院 家庭醫學科6
Long-term prescription of α-blockers decrease the risk of recurrent urolithiasis needed for surgical intervention-a nationwide population-based study
Chia-Chu Liu1-3 , Hui-Min Hsieh4 , Chia-Fang Wu4, Tusty-Jiuan Hsieh5, Shu-Pin Huang1,2, Yii-Her Chou1,2, Chun-Nung Huang1,2 , Wen-Jeng Wu1,2, Ming-Tsang Wu4,6*
1Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
3Depratment of Urology, Pingtung Hospital, Ministry of Health and Welfare, Executive Yuan, Pingtung, Taiwan
4Department of Public Health, Kaohsiung Medical University, Kaohsiung City, Taiwan
5Department of Medical Genetics, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
6Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan;
Purpose: α1 receptors and subtypes have been confirmed to distribute in human pelvis and calyces recently. As used in ureteral stones, α-blocker treatment may facilitate kidney stone passage and long-term prescription of α-blocker may decrease the risk of recurrent urolithiasis. The aim of this study is to determine if use of a-blockers 180 days or more can decrease the risk of recurrent urolithiasis needed for surgical intervention.
Methods: A representative database of 1,000,000 patients from Taiwan’s National Health Insurance was analyzed. Eligible patients were those who had received the first-time procedure for upper urinary stone removal, including extracorporeal shock-wave lithotripsy, ureterorenoscopic lithotripsy, or both, between 2000 and 2010. After completing a 180-day treatment for first event, patients were prospectively followed-up until a second set of stone procedures was performed (proxy of stone recurrence), loss to follow-up, or end of study. The effect of percentage of total number of days of a-blocker use on need for second set of stone procedures within a post treatment 180-day follow-up period was analyzed by quartile. A nested case-control study was also performed.
Results: 1,259 patients were eligible for final analyses. During 3,980 person-years follow-up, 167 patients had recurrent urolithiasis needed for surgical intervention. From first to fourth quartile of drug exposure, recurrence rates were 45.64, 47.19, 43.11, and 18.52 per 1,000 person-years. The adjusted hazard ratio was 0.46 (95% CI = 0.24 to 0.89) for the fourth quartile (vs. quartile 1). In the nested case-control study, adjusted ORs was 0.23 (95% CI = 0.10 to 0.53) in the fourth quartile (vs. quartile 1).
Conclusions: Use of a-blockers for 180 days or more decrease the risk of recurrent urolithiasis needed for surgical intervention. In patients at higher risk of recurent urolithiasis, long term prescription of α-blockers might help them prevent further surgical intervention.