Comparative Study of Efficacy and Safety of Tamsulosin plus Tadalafil Combination Therapy versus Tamsulosin Monotherapy as Medical Expulsive Therapy of Ureteric Stone

Abstract

Introduction: If surgical intervention is not indicated, current international guidelines and evidences recommend medical expulsive therapy (MET) involving the administration of drugs to improve spontaneous stone passage. Medical expulsive therapy has now become an established modality of treatment, and employs the use of various drugs that act on the ureter with different mechanisms. It is hypothesised that elevation of cyclic guanosine monophosphate in ureteral smooth muscle by phosphodiesterase type 5 (PDE5) inhibitors may result in ureteral relaxation and increased stone clearance. Aims/ objective: To investigate whether we can achieve better ureteric relaxation and reduction in intramural pressure in order to facilitate stone passage by tamsulosin plus tadalafil combination therapy. Materials and Method: Stone expulsion rate of tamsulosin + tadalafil when compared to tamsulosin was our primary endpoint. (Assessed by subjective response and confirmed by repeat plain X ray abdomen and if needed CT scan abdomen). The efficacy of the individual drugs was analysed and compared with the help of Pearson chi square test. p value <0.05 were considered as statistically significant. Results: 33 patients (66%) receiving tamsulosin and 43 patients (86%) receiving combination therapy showed positive outcome (expulsion of stones). So, tamsulosin plus tadalafil combination therapy had significantly better efficacy. In tamsulosin group 30 patients among 33 (90.9%) expelled the stone in less than 5 days. In tamsulosin plus tadalafil group, 37 patients among 43 (86%) expelled in less than 5 days. But the difference was not statistically significant. Both drugs were well tolerated by the study patients. Conclusion: Tamsulosin plus tadalafil is more efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones compared to tamsulosin. Medical expulsive therapy also doesn’t carry post-operative morbidities as compared to surgical methods.