Effectiveness of Medical Management in Spontaneous Expulsion of Lower Ureteral Calculi: A Prospective Study

Azher Mushtaq,Yassar Arafat,Malik Suhail Ahmad,Fahad Ul Islam Mir,Sheikh Imran Farooq

doi:10.4236/ss.2016.77046

Abstract

Purpose: We evaluated the efficacy of combined drug therapy with alpha1-adrenergic antagonist tamsulosin and corticosteroid deflazocort for conservative expulsive therapy in patients with lower ureteric calculi. Materials and Methods: A total of 100 consecutive symptomatic patients with stones located in the Lower ureter were selected for the study who received oral tamsulosin 0.4 mg daily for 4 weeks and deflazocort 30 mg daily for 10 days and diclofenac IM/Oral on demand. Ultrasound follow-up and medical visits and X ray KUB were performed weekly for 4 weeks. Stone passage rate and time, pain episodes and endoscopical intervention were evaluated. Results: The stone expulsion rate was 87.8%. Mean stone size was 6.5 ± 2.14 mm. Mean expulsion time was 8 ± 1.84 days. Mean pain episodes were 1.50 ± 0.87 days. 11 patients needed intervention for stone retrieval. There was no statistically significant difference between the expulsion rates of right and left ureteral stones (P value = 0.31). Conclusions: Medical therapy with a combination of α1 adrenergic blocker and corticosteroid achieve good stone expulsion rates, lower pain episodes and should be considered in all patients with lower ureteral stones of size less than 10 mm who are not having any contraindications for medical therapy.

Highlights

Urolithiasis affects 5% - 15% of the population worldwide [1]
The stones may be present anywhere along the urinary tract; the pelvicalyceal system or in the ureter which may be proximal ureter or distal ureter, with the point of division being the narrow part of the ureter over the iliac vessels
An extensive meta-analysis found that most ureteral calculi

Summary

Introduction

Urolithiasis affects 5% - 15% of the population worldwide [1]. as the literature reports the diseaseHow to cite this paper: Mushtaq, A., Farooq, S.I., Ahmad, M.S., Mir, F.I. and Arafat, Y. (2016) Effectiveness of Medical Management in Spontaneous Expulsion of Lower Ureteral Calculi: A Prospective Study. (2016) Effectiveness of Medical Management in Spontaneous Expulsion of Lower Ureteral Calculi: A Prospective Study. Α1-adrenergic receptor antagonists represent the treatment of choice for lower urinary tract symptoms, as shown in many randomized controlled trials as well as in several studies [6] [9]-[11]. They act by inhibiting the basal tone, peristaltic wave frequency and the ureteral contraction in the intramural parts of the ureter.

Methods

Results

Conclusion