Efficacy of combined therapy with alpha-1-adrenergic blockers and polarized light after extracorporeal shock wave lithotripsy in children with urolithiasis: a prospective randomized study

Introduction. Effective evacuation of stone fragments is a critical stage determining the success of extracorporeal shock wave lithotripsy (ESWL) in children with urolithiasis. However, optimal approaches to postoperative lithokinetic therapy in pediatric practice remain a subject of debate.

Objective: comparative analysis of the efficacy and safety profile of combined lithokinetic therapy, including alpha-1-adrenergic blockers and polychromatic polarized light, for improving the elimination of stone fragments after extracorporeal shock wave lithotripsy (ESWL) in children with urolithiasis.

Methods. This prospective randomized study included 250 children aged 2 to 18 years who underwent ESWL. All patients were randomized into three groups: a control group (n=150) receiving standard postoperative therapy, Group 2 (n=50) receiving a course of PPL exposure, and Group 3 (n=50) receiving a combination of alpha-1-adrenergic blockers (tamsulosin/silodosin) and a course of PPL exposure. To assess efficacy, the following parameters were analyzed: stone-free rate (SFR), time to stone expulsion, level of pain, and frequency of postoperative complications.

Results. Combined lithokinetic therapy resulted in the highest stone-free rate (88.0%), which was significantly higher than in the control group (60.0%; p<0.001). The SFR in the PPL group was 76.0%. The dynamics of SFR achievement differed, occurring earlier in Groups 2 and 3. The lowest need for analgesia was noted in the combination therapy group (82.0% of patients required no pain relief). Dynamic ultrasound showed a significantly faster reduction in the size of residual fragments in the study groups. Postoperative complications were less frequent in Groups 2 and 3. No adverse effects from the use of alpha-1-adrenergic blockers were noted.

Conclusion. Combined lithokinetic therapy with alpha-1-adrenergic blockers and PPL may be associated with a higher rate of complete stone fragment passage after ESWL in children compared with standard therapy, as well as with a reduced need for analgesics.