ABSTRACT
Medical expulsion therapy has been shown to be a useful adjunct to observation in the management of ureteral stones. Alpha-1-adrenergic receptor antagonists have been studied in this role. Experimental study. This study was conducted Urology at GMMMC Hospital Sukkur from January 2008 to December 2010. In this study 480 patients were selected, with stones located in the distal tract of the ureter with stone diameters of 5 to 10mm were enrolled in the present study and were randomized into 4 equal groups. Group 1 received hyoscine N-butyl bromide [HBB], Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received teraozin. The subjects were prescribed diclofenac injection [75 mg] intramuscularly on demand for pain relief and were followed-up after two weeks with x-rays of the kidneys, ureters, bladder and urinary ultrasonography every week. The number of pain episodes, analgesic dosage and the number of days of spontaneous passage of the calculi through the ureter were also recorded. The average stone size for groups 1, 2, 3 and 4 was comparable [6.13, 5.83, 5.59 and 5.48 mm respectively]. Stone expulsion was observed in 11%, 52.9%, 62%, and 46% in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 +/- 6.21 days in group 1, 738 +/- 5, 55 days in group 2, 785 +/- 5.11 days in group 3 and 7.45 +/- 5.32 days in group 4. Alpha blockers were found to be superior to HBB [p <0.05]. Medical treatment of distal ureteral calculi with alfuzosin, doxazosin and terazosin resulted in a significantly increased stone-expulsion rate and decreased expulsion time when compared with HBB, HBB seems to have a negative effect on stone-expulsion rate