Title: Comparative Efficacy of Silodosin vs Tamsulosin for Ureteric Calculus: A Single Centre Double Blind Randomised Controlled Trial
Authors: Dr Arun Antony, Dr Jayaprakasha G, Dr N Imdad Ali
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.106
Abstract
Background: Ureteric calculus is now emerging as a major health concern irrespective of age of the patient due to the lifestyle changes. It can be managed both medically (MET) and surgically depending on various factors like it’s size number, site and comorbidities of patient. For Medical expulsion therapy we use α-blockers like tamsulosin, terazosin, doxazosin, silodosinetc but the effectiveness varies with each drug. So in this study we aim to compare the success rates of silodosin to tamsulosin for medical expulsive therapy of ureteral stones.
Aim: As per many urological guidelines the patient can be started on MET unless there is absolute indication for intervention. Selective alfa 1 -adrenergic antagonists are now first-line drugs in MET. We conducted a prospective single-blind, parallel group, randomized, controlled trial to compare the effectiveness and safety of the alfa 1 –blocker silodosin versus tamsulosin in the treatment ureteric calculus.
Materials and Methods: For this prospective single centre, double blind, randomised, placebo-controlled trial, our study group included adults aged 18-65 years undergoing expectant management for a single ureteric stone identified by CT. Participants were randomly assigned in a 1:1 ratio to tamsulosin 400 μg or silodosin 8 mg taken daily for up to 2 weeks. The primary outcome was the proportion of participants who did not need further intervention for stone clearance within 2 weeks. 173 patients were studied from October 2014 to July 2017 at VIMS, Ballari. This study was done after due clearance from ethical committee.
Results: In our present study, the stone clearance rate was significantly higher in the silodosin group compared with the tamsulosin group, at 53% and 34%, respectively (P = 0.009). The status of stones was re assessed after 2 weeks using NCCT-KUB as the diagnostic modality. Those patients who could not expel stones after 2 weeks of MET were subjected to Ureteroscopic removal of stone.
Conclusions: In conclusion, silodosin is more effective than tamsulosin as MET (Medical Expulsive Therapy) for ureteric calculus.
Keywords: Ureteric calculus, MET (Medical expulsion therapy).
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