***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES In delayed extracorporeal shock wave lithotripsy ( ESWL ) treatment , increasing stone impaction is associated with delayed stone clearance . Whether colic patients treated by rapid ESWL have the same time to stone clearance as noncolic patients , which supports the thesis that stones in both groups are nonimpacted , has not been investigated yet , and was the objective of this study . METHODS A total of 82 patients were prospect ively enrolled and treated with piezoelectric ESWL for a solitary proximal ureteral stone . Of these , 56 patients experienced at least one colic episode compared with 26 noncolic patients .  Hydronephrosis has been assessed with the use of  ultrasound and intravenous urography ( IVU ) . Time to stone clearance after the first ESWL and stone-free rates after a follow-up period of 3 mo were recorded . RESULTS In colic and noncolic patients , mean stone size was 7.8 mm ( p=0.7 ) . Ultrasound-detected hydronephrosis was present in 88 % versus 39 % ( p<0.0001 ) , whereas IVU-detected hydronephrosis was present in 60 % versus 7.7 % ( p=0.0001 ) . Mean number of impulses applied was 8000+/-4000 versus 6700+/-3400 ( p=0.1 ) . Mean time to stone clearance was 9.5+/-12.1 d versus 4.6+/-3.8 d ( p=0.1 ) . Colic and noncolic patients were considered as treatment success in 83 % and 81 % after 3 mo of follow-up ( p=0.9 ) . CONCLUSIONS Treatment outcome and time to stone clearance after rapid ESWL in colic patients compared with noncolic patients is comparable and independent of concomitant hydronephrosis . This finding suggests an absence of significant impaction in proximal ureteral stones treated within 24h after a first colic episode , enforcing the concept of performing rapid ESWL in patients harbouring proximal ureteral stones PURPOSE We evaluated the effect of the alpha-blocker tamsulosin on stone clearance , analgesic requirements and steinstrasse in shock wave lithotripsy for solitary renal and ureteral calculus . MATERIAL S AND METHODS A prospect i ve , double-blind , r and omized placebo controlled study was performed during 1 year involving 60 patients with a solitary renal or ureteral calculus undergoing shock wave lithotripsy .  The control group ( 30 ) received 0.4 mg tamsulosin and the study group ( 30 ) received placebo daily until stone clearance or for a maximum of 30 days . An oral preparation of dextropropoxyphene hydrochloride and acetaminophen was the analgesic used on an on-dem and basis . The parameters assessed were stone size , position , clearance time , effect on steinstrasse and analgesic requirement . RESULTS The overall clearance rate was 96.6 % ( 28 of 29 ) in the study group and 79.3 % ( 23 of 29 ) in the control group ( p = 0.04 ) . With larger stones 11 to 24 mm the difference in the clearance rate was significant ( p = 0.03 ) but not so with the smaller stones 6 to 10 mm ( p = 0.35 ) . The average dose of analgesic used was lower with tamsulosin than with controls , without statistical significance . Steinstrasse resolved spontaneously in the tamsulosin group whereas 25 % ( 2 of 8) required intervention in the placebo group . There was no difference between the 2 groups with regard to age , stone size or location . CONCLUSIONS The alpha-blocker tamsulosin seemed to facilitate stone clearance , particularly with larger stones during shock wave lithotripsy for renal and ureteral calculus . It also appeared to improve the outcome of steinstrasse .  Tamsulosin may have a potential role in routine shock wave lithotripsy Background : Alpha – 1 blockers decrease the tension and release the spasm of smooth muscles and thus lessen the obstruction and irritation symptoms in the lower urinary tract ( LUTS ) . They make a faster passing of calculi from the terminal part of the ureters possible . Objectives : The goal of this study was to objective ly assess the improvement of difficulties caused by obstructions in ureterolithiasis localized in the lower part of the ureters of 104 r and omly chosen patients ( pts . ) in a double-blind study . Methods : During a period of 2 and half years ( June 1999–January 2002 ) 104 pts . suffering from ureterolithiasis of the lower urinary tract were treated and observed . Patients were divided into two groups : A ( n:53 ; later only 51 were evaluated ) which was subjected to st and ard treatment and group B ( n:51 ) where the st and ard treatment was supplemented by the alpha – 1 blocker . As alpha – 1 blocker one capsule of Tamsulosin /OMNIC 0.4 / was administered daily . Results : With alpha – 1 blocker , we have registered a more speedy passing of calculi from the terminal parts of ureters in 17.6 % of pts . Recurrence of renal colics was less frequent and occurred in one of eight pts . as compared with group A ( without the alpha – 1 blocker ) where a recurrence of the renal colic was observed in about every fifth pts . In group A ( n:51 ) , 62.8 % of the pts . passed the calculi , whereas in group B ( n:51 ) , where st and ard treatment was supplemented by the administration of the alpha – 1 blocker Tamsulosin , this percentage increased to 80.4 % . Conclusion : The treatment by alpha – 1 blockers considerably decreased not only LUTS but also helped to accelerate the passing of minor calculi from the terminal parts of the ureters of 80.4 % of pts . It seems that alpha – 1 blockers potentiate the spasmoanalgetic action of drugs used in st and ard methods of treatment OBJECTIVES To design a r and omized , no-treatment , controlled , prospect i ve study to determine whether the administration of tamsulosin , as adjunctive medical therapy , increases the efficacy of one extracorporeal shock wave lithotripsy ( ESWL ) session to treat renal stones and decreases the use of analgesic drugs after the procedure . METHODS A total of 130 patients underwent a single ESWL session to treat solitary radiopaque renal stones 4 to 20 mm in diameter . After treatment , all patients were r and omly assigned to receive our st and ard medical therapy alone ( controls ) or in association with 0.4 mg tamsulosin daily for a maximum of 12 weeks . All 130 patients were followed up for 3 months or until an alternative treatment was given . RESULTS Of the 130 patients , 78.5 % of those receiving tamsulosin and 60 % of controls had achieved clinical success at 3 months ( P = 0.037 ) . When we stratified patients according to stone size , for those with a stone size larger than 10 mm , the success rate was significantly greater in the tamsulosin group ( P = 0.028 ) . Renoureteral colic occurred in 76.9 % of patients treated with st and ard therapy but in only 26.1 % of those receiving tamsulosin ( P < 0.001 ) . The mean cumulative diclofenac dose was 375 mg per patient in the tamsulosin group and 675 mg per patient in the control group ( P < 0.001 ) . CONCLUSIONS The results of our study have demonstrated that tamsulosin therapy , as an adjunctive medical therapy after ESWL , is more effective than lithotripsy alone for the treatment of patients with large renal stones and is equally safe . In addition , our results also indicated that adjunctive treatment with tamsulosin could decrease the use of analgesic drugs after ESWL Extracorporeal shock wave lithotripsy ( ESWL ) is currently considered one of the main treatments for ureteral stones . Some studies have reported the effectiveness of pharmacologic therapies ( calcium antagonists or alpha-blockers ) in facilitating ureteral stone expulsion after ESWL . We prospect ively evaluated the efficacy , after ESWL , of nifedipine on upper-middle ureteral stones , and tamsulosin on lower ureteral stones , both associated to ketoprofene as anti-edema agent . From January 2003 to March 2005 we prospect ively evaluated 113 patients affected by radiopaque or radiolucent ureteral stones . Average stone size was 10.16 ± 2.00 mm ( range 6–14 mm ) . Thirty-seven stones were located in the upper ureter , 27 in the middle ureter , and 49 in the lower ureter . All patients received a single session of ESWL ( mean number of shock waves : 3,500 ) by means of a Dornier Lithotripter S ( mean energy power for each treatment : 84 % ) . Both ultrasound and X-ray were used for stone scanning . After treatment , 63 of 113 patients were su bmi tted to medical therapy to aid stone expulsion : nifedipine 30 mg/day for 14 days administered to 35 patients with upper-middle ureteral stones ( group A1 ) and tamsulosin 0.4 mg/day for 14 days administered to 28 patients with stones located in the distal ureter ( group A2 ) . The remaining 50 patients were used as a control group ( 29 upper – middle ureteral stones — B1— and 21 lower ureteral stones — B2— ) , receiving only pain-relieving therapy . No significant difference in stone size between the groups defined was observed . Stone clearance was assessed 1 and 2 months after ESWL by means of KUB , ultrasound scan and /or excretory urography . A stone-free condition was defined as complete stone clearance or the presence of residual fragments smaller than 3 mm in diameter . The stone-free rates in the expulsive medical therapy group were 85.7 and 82.1 % for the nifedipine ( A1 ) and tamsulosin ( A2 ) groups respectively ; stone-free rates in the control groups were 51.7 and 57.1 % ( B1 and B2 , respectively ) . Five patients ( 14.3 % ) in group A1 , 5 ( 17.8 % ) in group A2 , 14 ( 48.3 % ) in group B1 and 9 ( 42.8 % ) in group B2 were not stone-free after a single ESWL session and required ESWL re-treatment or an endoscopic treatment . Medical therapy following ESWL to facilitate ureteral stone expulsion results in increased 1- and 2-month stone-free rates and in a lower percentage of those needing re-treatment . The efficacy of nifedipine for the upper-mid ureteral tract associated with ketoprofene makes expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for ureteral stones Drugs are increasingly being used to promote stone passage in renal colic .  Diclofenac , nifedipine and tamsulosin cause ureteric smooth muscle relaxation in vitro ; however , in clinical trials nifedipine and tamsulosin promote stone passage whereas diclofenac has no apparent benefit . We adapted a ureteric pressure transducer catheter in an attempt to compare the human ureteric response to these drugs in vivo . The catheter was inserted into the contralateral ureter following ureteroscopy for stone disease . Contraction frequency , pressure and velocity measurements were recorded at 24 h. Each patient was r and omly allocated to receive oral diclofenac , nifedipine or tamsulosin . Measurements were taken following drug administration . Eighteen patients ( mean age 50 years ) were recruited . Two patients were excluded intraoperatively and three required early removal of the catheter . Prior to drug administration , the mean number of contractions recorded was 0–4.1/min and the peak contraction pressure ranged from 11 to 35 mmHg . Conduction velocity ranged from 1.5 to 2.6 cm/s . Ureteric peristalsis persisted in all patients despite these drugs . Diclofenac and nifedipine produced inconsistent ureteric pressure responses but had little effect on contraction frequency .  Tamsulosin significantly reduced ureteric pressure but had no effect on contraction frequency . There are many limitations associated with the use of ureteric catheters , however , they may provide some useful information when used to record the response to an intervention in the same patient . These preliminary results suggest a reduction in pressure generation may be the essential factor in the promotion of stone passage . More work is required but these drugs may work by preventing the increased , uncoordinated muscular activity seen in renal colic whilst maintaining peristalsis , thereby promoting stone passage PURPOSE To evaluate the efficacy of the addition of tamsulosin to our st and ard expulsive pharmacologic therapy for the treatment of distal-ureteral stones . PATIENTS AND METHODS A series of 96 patients referred to our department for the management of symptomatic distal-ureteral calculi were r and omly divided into group 1 ( N = 46 ) who received diclofenac ( 100 mg/daily ) plus aescin ( 80 mg/daily ) and group 2 ( N = 50 ) who received the same therapy plus tamsulosin ( 0.4 mg/daily ) for a maximum of 2 weeks . There were no differences between the groups with respect 
    Output:
    
Pooled analyses suggest that MET with alpha-blockers or calcium channel blockers augments stone expulsion rates , reduces the time to stone expulsion , and lowers analgesia requirements for ureteral stones with and without ESWL for stones < or = 10 mm .
There is some evidence that a combination of alpha-blockers and corticosteroids might be more effective than treatment with alpha-blockers alone .
Renal stones after ESWL also seem to profit from MET .