Abstract
To evaluate hyoscine N-butyl bromide (HBB) and three different alpha-1 blockers in the treatment of distal ureteral stones. A total of 140 patients with stones located in the distal tract of the ureter with stone diameters of 5 to 10mm were enrolled in the present study and were randomized into 4 equal groups. Group 1 received HBB, Group 2 received alfuzosin, Group 3 received doxazosin and Group 4 received terazosin. The subjects were prescribed diclofenac injection (75 mg) intramuscularly on demand for pain relief and were followed-up after two weeks with x-rays of the kidneys, ureters, bladder and urinary ultrasonography every week. The number of pain episodes, analgesic dosage and the number of days of spontaneous passage of the calculi through the ureter were also recorded. The average stone size for groups 1, 2, 3 and 4 was comparable (6.13, 5.83, 5.59 and 5.48 mm respectively). Stone expulsion was observed in 11%, 52.9%, 62%, and 46% in groups 1, 2, 3 and 4 respectively. The average time to expulsion was 10.55 ± 6.21 days in group 1, 7.38 ± 5.55 days in group 2, 7.85 ± 5.11 days in group 3 and 7.45 ± 5.32 days in group 4. Alpha blockers were found to be superior to HBB (p < 0.05). Medical treatment of distal ureteral calculi with alfuzosin, doxazosin and terazosin resulted in a significantly increased stone-expulsion rate and decreased expulsion time when compared with HBB. HBB seems to have a negative effect on stone-expulsion rate.
Highlights
Medical expulsion therapy (MET) has been investigated as a supplement to observation in an effort to improve spontaneous stone passage rates
The proposed mechanism of their action is the selective relaxation of ureteral smooth muscle, which results in the inhibition of ureteral spasms and the dilatation of the ureteral lumen, especially the distal part of the ureter
A total of 140 adult patients who were admitted to the Urology Clinic with complaints of renal colic were prospectively evaluated between August 2008 and April 2009
Summary
Medical expulsion therapy (MET) has been investigated as a supplement to observation in an effort to improve spontaneous stone passage rates. Several agents have been studied as potential METs. Glyceryltrinitrate, calcium channel antagonists, corticosteroids, parasympatholytic agents and alpha-blockers have all been evaluated as therapies to promote ureteral stone expulsion, with inconsistent results [1,2,3]. Alpha-blockers are a promising class of stone-expulsive agents [4]. Anti-spasmodic agents, such as hyoscine -Nbutylbromide, are often prescribed by general practitioners or by emergency services as soon as renal colic is diagnosed. HBB may help provide analgesia by inducing smooth muscle relaxation, which decreases ureteral spasm. For this reason, anti-spasmodic agents are still recommended in the treatment of renal colic, usually as adjuvant therapy to NSAIDS and/or opioids [5]
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