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).

1. Hollingsworth JM, Rogers MA, Kaufman SR, Bradford TJ, Saint S, Wei JT, Hollenbeck BK. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet. 2006;368(9542):1171–1179. doi: 10.1016/S0140-6736(06)69474-9. [PubMed] [Cross Ref]
2. Seitz C, Liatsikos E, Porpiglia F, Tiselius HG, Zwergel U. Medical therapy to facilitate the passage of stones: what is the evidence? Eur Urol. 2009;56(3):455–471. doi: 10.1016/j.eururo.2009.06.012. [PubMed][Cross Ref]
3. Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (2014) Guidelines on urolithiasis. In: EAU guidelines, edition presented at the 29th EAU annual congress, Stockholm
4. Kupeli B, Irkilata L, Gurocak S, Tunc L, Kirac M, Karaoglan U, Bozkirli I. Does tamsulosin enhance lower ureteral stone clearance with or without shock wave lithotripsy? Urology. 2004;64(6):1111–1115. doi: 10.1016/j.urology.2004.07.020. [PubMed] [Cross Ref]
5. Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K. Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int J Urol Off J Jpn Urol Assoc. 2007;14(8):749–753. [PubMed]
6. Sasaki S, Tomiyama Y, Kobayashi S, Kojima Y, Kubota Y, Kohri K (2011) Characterization of alpha1-adrenoceptor subtypes mediating contraction in human isolated ureters. Urology 77(3):762 e713–767. doi:10.1016/j.urology.2010.09.034 [PubMed]
7. Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol. 2005;173(6):2010–2012. doi: 10.1097/01.ju.0000158453.60029.0a. [PubMed][Cross Ref]
8. Porpiglia F., Destefanis P., Fiori C., Fontana D. Effectiveness of nifedipine and deflazacort in the management of distal ureter stones. Urology. 2000;56:579–583. [PubMed]
9. Dellabella M., Milanese G., Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol. 2005;174:167–172.[PubMed]
10. Rossi M., Roumeguère T. Silodosin in the treatment of benign prostatic hyperplasia.  Drug Des Dev Ther. 2010;27(4):291–297. [PMC free article][PubMed]
11. Coll D.M., Varanelli M.J., Smith R.C. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol. 2002;178[PubMed]
12. Gupta S., Lodh B., Singh A.K., Somarendra K., Meitei K.S., Singh S.R. Comparing the efficacy of tamsulosin and silodosin in the medical expulsion therapy for ureteral calculi. J Clin Diagn Res. 2013;7:1672–1674. [PubMed]
13. Kumar S., Jayant K., Agrawal M.M., Singh S.K., Agrwal S., Parmar K.M. Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study) Urology. 2015;85:59–63. [PubMed]
14. Imperatore V., Fusco F., Creta M., Di Meo S., Buonopane R., Longo N. Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin. Arch Ital Urol Androl. 2014;86:103–107. [PubMed]
15. Sur R.L., Shore N., L’Esperance J., Knudsen B., Gupta M., Olsen S. Silodosin to facilitate passage of ureteral stones: a multi-institutional, randomized, double-blinded, placebo-controlled trial. Eur Urol. 2015;67:959–964. [PubMed].

Dr Arun Antony

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