Abstract
ABSTRACTPurpose:To compare the effects of tadalafil, tamsulosin, and placebo as a medical expulsive therapy (MET) for distal ureteral calculi.Materials and Methods:This prospective randomized double-blind clinical trial was conducted on 132 renal colic patients with distal ureteric stones (≤10mm) over a period of 12 months. Patients were randomly divided into three groups. Patients in group A received tamsulosin 0.4mg, in group B received tadalafil 10mg, and in group C received placebo. Therapy was given for a maximum of 4 weeks. The rate of stone expulsion, duration of stone expulsion, the dose and the duration of nonsteroidal anti-inflammatory drugs (NSAIDs), analgesic use, and adverse effects of drugs were recorded.Results:Demographic profiles were comparable between the 3 groups. Although the stone expulsion rate in group A (72.7%) was higher in comparison to group B(63.6%) and group C(56.8%), it was not considered statistically significant (P=0.294). Shorter mean time to stone expulsion was significantly observed in group A (17.75±75), than group B(21.13±1.17) and group C(22.25±1.18) (P=0.47). The mean number of analgesic use was 9.8±5.09 days in group A, 14.6±7.9 days in group B, and 12.6±22.25 days in group C, this difference was significant (P=0.004). The analgesic requirement (doses of NSAIDs and pethidine) in group A was significantly lower than other groups (P<0.05). Also, patients in group A reported fewer headaches compared to other groups (P=0.011).Conclusion:Tamsulosin as medical expulsive therapy is more effective for distal ureteric stones with less need for analgesics and less stone expulsion time than tadalafil.
Highlights
Nephrolithiasis is one of the most commonly diagnosed urologic diseases with a rising prevalence, with great economic and clinical burden on the health care system [1]
Since the reported results of the studies cannot conclusively answer the question of whether the rate and time of stone expulsion and analgesic requirement time are the same among patients treated with tamsulosin, and tadalafil or not, in this study, we aimed to evaluate the results of using tamsulosin, which is currently controversial in passing renal stone [13, 15] with tadalafil, among patients with distal ureteral stone
Many studies reported that tadalafil is more effective than tamsulosin in facilitating stone expulsion [20,21,22,23], in the current study, the rate of stone expulsion in the tamsulosin group was higher than tadalafil and placebo groups (72.7%, 63.6% and 56.8%, respectively)
Summary
Nephrolithiasis is one of the most commonly diagnosed urologic diseases with a rising prevalence, with great economic and clinical burden on the health care system [1]. Studies reported different incidence rate of nephrolithiasis and it varies in different population around 12% in adult men and up to 6% in adult women. The prevalence of nephrolithiasis reaches its peak in population aged 20-40 years. The probability of a urinary stone varies according to several factors such as age, sex, race and geographical area [2, 3]. The clinical presentation of stones mainly includes colic pain and urinary symptoms such as urinary frequency [4]. A number of factors are involved in determining the treatment of ureteric stones. These factors are divided into four broad categories including stone factors, clinical factors, anatomic factors and technical factors. In many cases, based on the patient’s preference and consideration in achieving higher stone-free and lower side effects of the procedure, more than one treatment method is appropriate [2, 5,6,7]
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