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Background: The lifetime risk of kidney stones is between 5% and 10% and rates of recurrence are as high as 50%. Majority of the ureteric stones (70%) are found in the lower third of the ureter. Available setup, type, size of the stone, and expertise of the surgeon are the major factors affecting the treatment modality. Medical expulsive therapy has shown promising results in previous studies. Aim of the study was to assess the efficacy of tamsulosin and deflazacort combination therapy for stone expulsion in relation with site and size of stones.Methods: A total of 97 patients with ureteric calculi of size 10 mm or less attending the urology out-patient department were included. Received medical expulsive therapy using tamsulosin (0.4 mg) and deflazacort (30 mg) for 7 days. Patients were evaluated for stone expulsion on 7th day by non-contrast computed tomography of kidney ureter bladder. Site, side and size of stones were noted.Results: Ureteric calculi was more prevalent in the age group of 21-30 years 38 (39.2%). Male preponderance was observed (76.28%) with male female ratio being 3.2:1. Lower site 64 (65.97%) ureteric calculi were most common. The majority had a stone size of 4-6 mm (42%). Stones were expelled on 7th day in 69 (71.13%) patients. Expulsion rates were highest for the stone size of 2-4 mm (94.4%) followed by 4-6 mm (88.1%). The highest expulsion rates were observed for Lower ureteric stones (84.4%).Conclusions: Medical expulsive therapy using tamsulosin and deflazacort is an effective treatment modality for the management of ureteric stones, especially those present in lower ureter and those ≤8 mm in size.
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Introduction: The increasing prevalence of ureteric stone is a matter of concern in this era and it may be linked to improvedquality of life. Medical expulsive therapy, including alpha-blockers, steroids, and calcium channel blockers, has been extensivelystudied for improving the rate of stone passage in patients who do not require immediate urologic intervention.Aim: The aim of this study is to compare the efficacy of tamsulosin and tadalafil in expulsive treatment for distal ureteralstones.Materials and Methods: This was a prospective comparative study included 120 adult patients (>18 years of age) presentingwith distal ureteric stones were randomized into 60 patients with tamsulosin 0.4 mg once daily (Group A) or 60 patients withtadalafil 10 mg once daily (Group B) treatment. Therapy was given for a maximum of 4 weeks.Results: About 85% of study patients had a size between 5 mm and 7 mm and 18 patients had size between 8 mm and 10 mm.There was no statistical difference noted in the pain duration and analgesic usage of both groups. In Group A, 67% of patientshad expulsion of stones; in Group B, 63% of patients had expulsion of stones. About 90% of patients in 40 cases of expelledstones are in <5 days in Group A and 89% of patients 38 cases of expelled stones are in <5 days in Group B. There was nostatistical difference noted between both groups.Conclusion: Tamsulosin and tadalafil have shown similar expulsion rate. Both of them simultaneously provides better paincontrol and significantly lower the needs for analgesia.
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Background: Lower ureteric stones (LUS) comprises of 70% of ureteric stones. Spontaneous passage depends on stone size and location in ureter. Impacted calculi initiate smooth muscles contractions causing ureteric spasms. ?-1 blockers like tamsulosin and calcium channel blocker like nifedipine relaxes ureteric smooth muscle, facilitating spontaneous expulsion. Pain and discomfort associated with urolithiasis, hospitalization and surgical cost can be minimized by medical expulsive therapy. Many studies had compared efficacy of tamsulosin with nifedipine, only few have explored the combination. This study compared efficacy of nifedipine and tamsulosin versus tamsulosin alone.Methods: 64 patients with LUS (5-10 mm) were assigned into 2 groups. Group 1 received tamsulosin and nifedipine and group 2 only tamsulosin. Rate of expulsion, time to expulsion, analgesic frequency and pain VAS score were analyzed. Chi-square or Fisher’s exact test to analyze categorical data, Mann Whitney U test or unpaired t test for differences between groups and Wilcoxon matched-pairs signed rank test for within group. A p<0.05 was statistically significant.Results: Rate of expulsion was 87.5% in group 1 and 65.6% in group 2 (p<0.05). Mean expulsion time was 6.68±1.89 days for group 1 and 8.52±2.62 in group 2 (p<0.05). Analgesic requirement was similar. Adverse effects were headache, dizziness and postural hypotension.Conclusions: Combination therapy yielded better rate of expulsion and reduction in stone expulsion time than tamsulosin alone. Thus, combination therapy can be considered for effective treatment outcomes.
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Introduction: Urinary stone disease is a major health problemnot only because of high prevalence but also because it affectsthe young and productive population of the society. The currentstudy was performed to assess and compare the expulsiveeffects of orally administered Afluzosin as medically expulsivetherapy for distal ureteral calculi less than 8 mm in diameterwhen administered upto 21 days after the first painfulmanifestation.Materials and Methods: A total of 60 patients with distalureteric calculi were enrolled in the study and were divided intwo groups. The control group comprised of 30 patients withdistal ureteric calculi who were given Cap. Becosule (Vitamin BComplex) (Placebo) once a day for clearance of ureteric calculiwith plenty of fluids and analgesics as and when required. Thestudy group comprised of 30 patients with distal ureteric calculiwho were given Tab. Alfuzosin hydrochloride 10 mg once aday for clearance of ureteric calculi with plenty of fluids andanalgesics as and when required. The outcome was measuredin terms of passage of calculi, no. of days taken for passage ofcalculi and no. of analgesic tablets consumed until passage.The statistical analysis was done using chi-square test forproportions and Independent samples "t" test for comparingmeans between the two groups and a p value less than 0.05indicated statistically significant difference.Results: In study group, stone was passed within 21 days ofstudy period in 26 (86.7%) subjects whereas in control group, itcould pass in only 14 (46.7%) patients thus showing asignificant statistical difference between two groups (p=0.001).Mean analgesic intake was 6.63±1.38 tablets in study groupand 8.63±3.26 tablets in control group, thus showing that themean analgesic intake was significantly high in control groupas compared to study group (p=0.009).Conclusion: In our study Patients in Alfuzosin groupdemonstrated a higher incidence of spontaneous stonepassage, more rapid stone passage and a decreased need foranalgesic. This selective α1 blocker should therefore beincluded in different schedules used worldwide, when aconservative approach to this very common urological problemis considered.
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Background and Objectives: Though medical expulsive therapy for ureteric stones is increasingly used these days, some recent randomized controlled trials have questioned its benefit. This study evaluates the result of treatment of ureteric stones with tamsulosin. Materials and Methods: This prospective study involved ultrasonographically confirmed cases of uncomplicated unilateral ureteric stones. All patients received tamsulocin 0.4 mg daily for 2 to 6 weeks. The primary end point was stone expulsion. The secondary endpoints were the use of analgesics and adverse events. Results: One hundred and sixty two patients completed the study. Ninety seven patients were male and male to female ratio was 3:2. The mean age was 34.9 ± 9.8 (range: 18-71) years. The mean stone size was 6.17 ± 1.68 (range: 3.3-11.2) mm. By the end of 2, 4 and 6 weeks, cumulative stone expulsion rate was 110 (69.1%), 121 (74.7%) and 126 (77.8%) respectively. For the 49 stones of size £ 5 mm, the expulsion rate was 47 (95.9%) by the end of 6 weeks. The expulsion rates for stones of size > 5 - 7 mm, > 7 – 9 mm and ³ 9 mm were 59 (85.5%), 17 (53.1%) and 3 (25%) respectively by the end of 6 weeks. Lower ureteric stones had the highest expulsion rate of 106 (87.6%) by the end of 6 weeks, and the rate was lowest for upper ureteric stones (34.6%). Ten (6.1%) patients required additional analgesics during the course of treatment. Eleven (6.8%) patients complained of mild light-headedness and dizziness which subsided in a few days. Conclusion: Tamsulocin appears to facilitate expulsion of ureteric stones especially the distal ones. The benefit of tamsulocin seems to be maximum for the stones of size up to 9 mm. Further large scale randomized controlled trial should better define the real benefit and more rationale use of tamsulocin in routine clinical practice.
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Objective To compare the efficacy and safety of tamsulosin with nifedipine for medical expulsive therapy (MET) in patients with lower ureteral stones (LUS).Methods Randomized controlled trials(RCTs) in comparison of tamsulosin and nifedipine in treatment of LUS published in Pubmed, Cochrane Library,Embase,CNKI,CBM, Wanfang and VIP from databases establishment to July 2015 were retrieved.According to Cochrane handbook, the quality of included RCTs were assessed, and the relevant data including the number of participants, stone size, stone expulsion rate, time to stone expulsion, drug-related side effect,the incidence of ESWL or ureteroscopy lithotripsy (URSL) after MET and analgesic dose were extracted by two reviewers independently.The statistical software RevMan 5.2 was used for meta-analysis with regard to the stone expulsion rate, the incidence of ESWL or URSL and adverse effects.This study lasted more than one month from June to July 2015.Results A total of 13 RCTs with 4 831 patients were eligible.The results showed that the stone expulsion rate and the incidence rate of ESWL or URSL after MET were 92％ (2 221/2 423) and 8％ (27/333) in the tamsulosin group,and 73％ (1 748/2 408) and 20％ (67/328) in the nifedipine group.There are statistically significant differences (RR =1.24,95 ％ CI 1.13-1.37, P ＜ 0.05;RR =0.40,95 ％ CI 0.27-0.60, P ＜ 0.05, respectively).The subgroup analysis indicated no statistically significant differences in drug-related adverse effects between tamsulosin and nifedipine with 5％ (99/1 804)and 7％ (117/1 796) minor adverse effects respectively and less than 1％ severe adverse effects in both groups (RR =0.85,95％ CI 0.65-1.10, P =0.21;RR =0.49,95 ％ CI 0.09-2.59, P =0.40).Conclusion Compared to nifedipine, tamsulosin has higher stone expulsion rate and lower incidence rates for ESWL or URSL.Since there was no obvious adverse effects, tamsulosin could be considered as a preferable option for patients with LUS.
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PURPOSE: To evaluate hyoscine N-butyl bromide (HBB) and three different alpha-1 blockers in the treatment of distal ureteral stones. MATERIALS AND METHODS: A total of 140 patients 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 HBB, Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received terazosin. 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. RESULTS: 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 percent, 52.9 percent, 62 percent, and 46 percent in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 ± 6.21 days in group 1, 7.38 ± 5.55 days in group 2, 7.85 ± 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). CONCLUSIONS: Medical treatment of distal ureteral calculi with alfuzosin, doxazosin and terazosin resulted in a signi?cantly increased stone-expulsion rate and decreased expulsion time when compared with HBB. HBB seems to have a negative effect on stone-expulsion rate.