Is medical expulsive therapy an option for ureteral calculi?

To compare tamsulosin with simple observation in terms of lower ureteral stone expulsion. Randomized controlled trial. Surgical C unit, Department of surgery, Khyber Teaching Hospital Peshawar, from February 2008 to January 2009. The patients were divided into two groups. Group A patients were offered medical expulsive therapy [tamsulosin] while group B patients treated with observation receiving analgesics only. Data regarding age, gender, stone expulsion rate and time, and analgesic requirement were collected and analyzed. Frequency and percentages were calculated for categorical variables while mean +/- SD was used to express continuous variables. Chi square test and Student t test were used to compare categorical and numerical variables respectively. After randomization, 56 patients in group A and 55 patients in group B were analyzed. The mean age of patients in group A and B was 37.37 +/- 7.51 years and 37.90 +/- 10.34 years, respectively [p 0.756]. The mean stone size was 6.39 +/- 1.78 mm in group A compared to 6.47 +/- 1.71 mm in group B [p 0.81]. In tamsulosin group, for stone size of 5mm, 48 [86%] patients expelled the stone, while for the same stone size, expulsion noted in 30 [56%] patients in the observation group [p 0.001]. The expulsion rate in group A and B, for stone size of more than 5 mm, was 91% and 38%, respectively [p<0.001]. The mean time taken for stone expulsion was 8.32 +/- 2.73 days in group A and 12.23 +/- 2.12 days in group B [p<0.001]. Patients taking tamsulosin experienced significantly less pain attacks compared to patients on observation therapy [p 0.017]. Alpha blocker [tamsulosin] is a safe and effective treatment modality for distal ureteral stones of appropriate size