Comparing efficacy of α1D-receptor antagonist naftopidil and α1A/D-receptor antagonist tamsulosin in management of distal ureteral stones

Abstract

To compare the efficacy of α(1)D-receptor antagonist Naftopidil and α(1)A/D-receptor antagonist Tamsulosin in management of distal ureteral stones. A total of 131 patients with distal ureteral stones were included in the study from December 2008 to September 2010. The patients were randomized to 3 groups: group 1 (43 patients), those receiving 10 mg naftopidil once daily; group 2 (45 patients), those receiving 0.4 mg tamsulosin once daily; and group 3 (43 patients) were given a watchful waiting and served as control group. All patients were followed up for 2 weeks. Ultrasonography and kidney-ureters-bladder (KUB) were performed on day 7 and 14. At the end of the follow-up period, patients who failed to expel the stone were scheduled to undergo ESWL or ureteroscopy. Stone expulsion was observed in 31 patients in group 1 (72.1%), 37 patients in group 2 (82.2%), and 13 patients in group 3 (30.2%). A statistically significant difference was noted with Chi-square testing between groups 1 and 3, and groups 2 and 3 (P = 0.000 and P = 0.000, respectively). Average time to expulsion was 7.6 ± 2.26 days (range 1-12 days) in group 1, 7.7 ± 1.94 days (range 2-11 days) in group 2, and 9.4 ± 2.48 days (range 6-14 days) in group 3. A statistically significant difference was observed in time to expulsion between groups 1 and 3, and groups 2 and 3 (P = 0.000, P = 0.001, respectively) by ANOVA testing. The side effects encountered in the study groups were generally mild and did not require cessation of therapy in any patient. Naftopidil could significantly increase spontaneous passage of distal ureteral stones with low side effects. The stone expulsion rate is similar for the tamsulosin.