Abstract
Introduction Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. Conclusion Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.
Highlights
Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter
A colicky pain of various grades presents with ureteric stone. is is one of the most common problems that compel a patient to an emergency room [4]
Out of 190 patients, 176 met the inclusion criteria who were randomly assigned into 2 groups. ree patients from Group A and four patients from Group B lost their followup for various reasons
Summary
Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Ere was a significant higher stone passage rate in group A than group B (64 vs 50; P 0.025) and shorter expulsion time (1.66 vs 2.32 weeks P 0.001) and less number of emergency room visits and colic episodes. Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm. Medical expulsive therapy (MET) has become the most used modality of a treatment for urolithiasis During this treatment, the ureter smooth muscle is treated via various drugs by different mechanisms. Significant pathological changes can occur when ureteric stones are impacted. is can cause inflammatory reaction with mucosal edema which could further worsen the ureteric obstruction, increasing the risk
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