Abstract
Various treatment modalities are available in the market for the treatment of distal ureteric stone. This study was conducted to evaluate the efficacy of tamsulosin as an expulsive pharmacologic therapy for the treatment of distal ureteral stone.100 patients over 15 years of age who were diagnosed as a case of distal ureteric calculi of size less than or equal to 8mm were included in the study and they were randomized blindly into two groups with 50 patients in each group . Group A Patients were given Cap Tamsulosin 0.4 mg, 1 daily up to 4 weeks while group B patients were given placebo, 1 Cap daily up to 4 weeks. Both groups were given tab diclofenac Sodium 50 mg, 1 tab 8 hourly for pain control on required basis and advice to drink plenty of water. Patients were evaluated with plain X-Ray KUB and USG whole abdomen after one week, two week, three week and four weeks. The primary endpoint was expulsion rate. Expulsion time, need for analgesics, need for hospitalization and drug side effects were secondary endpoints. Both group contains 50 patients .Mean age of patients in Group A is 31.90±5.76 and in Group B is 33.14±5.97.Mean stone size was 6.87mm in greatest dimension. Regarding age, sex, stone size and stone lateralization (right/left), there was no significant difference between the group A and B. A stone expulsion rate of 78% (39 patients) was noted in group A and 48% (24 patients) in group B. Group A revealed a statistically significant advantage in term of stone expulsion rate (p=0.0018).By using tamsulosin a higher stone expulsion rates can be achieved in a shorter time.
References
- Matlaga BR, Lingeman JE. Surgical management of upper urinary tract calculi. In: Campbell-Walsh Urology.10th ed. Edited by AJ Wein, LR Kavoussi, AC Novick, AW Partin, CA Peters. Philadelphia: PA, Elsevier Saunders; 2012:1357-410. http://dx.doi.org/10.1016/b978-1-4160-6911-00048-7
- Stoller ML. Urinary stone disease. In: Tanagho EA, McAninch JW. Smith’s general urology. 17th ed. Mc Graw hill, New York 2008;246–77.
- Ukhal M, Malomuzh O, Strashny V. Administration of doxazosine for speedy elimination of stones from lower part of ureter. Eur Urol 1999;35(Suppl 2):4.
- Sigala S, Dellabella M, Milanese G, et al. Evidence for the presence of _1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn. 2005;24(2):142-148.
- Davenport K, Timoney AG, Keeley FX. A comparative in vitro study to determine the beneficial effect of calcium-channel and _1-adrenoceptor antagonism on human ureteric activity. BJU Int. 2006;98(3):651-655.
- Troxel SA, Jones AW,Magliola L, Benson JS. Physiologic effect of nifedipine and tamsulosin on contractility of distal ureter. J Endourol. 2006;20(8):565-568
- Kenny BA, Miller AM, Williamson IJR, O’Connell J, Chalmers DH, Naylor AM.Evaluation of the pharmacological selectivity profile of _1 adrenoceptor antagonists at prostatic _1 adrenoceptors: binding, functional and in vivo Br J Pharmacol. 1996;118(4):871-878.
- MuramatsuI, Taniguchi T,OkadaK. Tamsulosin:_1-adrenoceptor subtype-selectivity and comparison with terazosin. Jpn J Pharmacol. 1998;78(3):331-335.
- Lotan Y, Gettman MT, Roehrborn CG, Cadeddu JA, Pearle MS. Management of ureteral calculi: A cost comparison and decision making analysis. J Urol 2002;167(4):1621–9.
- Ueno A, Kawamura T, Ogawa A, Takayasu H. Relation of spontaneous passage of ureteral calculi to size. Urology 1977;10(6):544–6. 10.
- Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 1999;162(3):688–90.
- Pricop C, Novac C, Negru D, Ilie C, Pricop A, T nase V. Can selective alpha-blockers help the spontaneous passage of the stones located in the uretero-bladder junction? Revista medico-chirurgical a Societ ii de Medici i Naturali ti din Ia i.108:128.
- Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol. 2003;170:2202-5.
- De Sio M, Autorino R, Di Lorenzo G, Damiano R, Giordano D, Cosentino L, et al. Medical expulsive treatment of distal ureteral stone using tamsulosin: a single- center experience. J Endourol 2006;20 (1):12–5.
Corresponding Author
Dr Prateek Shakya
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