Stone Expulsion Research Articles

An Observational Study on the Efficacy of Mirabegron in Medical Expulsive Therapy of the Lower Ureteric Calculus

Purpose: Medical expulsive therapy (MET) is used in lower ureteric calculus to reduce symptoms, to facilitate passage, and to decrease the requirement of endourological surgical interventions. Alpha-blockers, spasmolytics, and calcium channel blockers have been shown to be effective in clinical trials. Beta-3 receptor stimulation in the ureter has been shown to decrease the intraluminal pressure. Thus, Mirabegron, beta 3 receptor agonist, can be thought as alternative MET agent. Materials and Methods: We have done prospective observational study to see the efficacy of mirabegron for MET of lower ureteric calculus ≤10 mm in size. Patients were divided into two groups: Group A (n = 50) received diclofenac 50 mg twice daily for 5 days then on demand for 4 weeks and Group B (n = 50) received diclofenac 50 mg twice daily for 5 days than on demand and mirabegron 50 mg daily for 4 weeks. Patients were followed up weekly with clinical examination, ultrasound screening of kidney, ureter, and bladder (KUB) and noncontrast computed tomography scan KUB after the 28th day of therapy. Results: We found that the passage of stone is significantly higher in mirabegron group (Group A: 68% and Group B: 92%; P < 0.05), and this effect is also statistically significant for stones <7 mm size (Group A: 73.91%, Group B: 96.96%, P = 0.01026). Duration of stone expulsion in Group A: 20.29 ± 5.512 days and Group B: 10.65 ± 4.294 days (P = 0.00001) and the relief of storage symptoms are earlier in mirabegron group (Group A: 16.28 ± 5.65 days and Group B: 6.2 ± 2.58 days, P = 0.00001). Conclusion: Our study reveals that Mirabegron is effective for the treatment of lower ureteric stones ≤10 mm size, especially for stone of size <7 mm and it improves the storage symptoms in these patients.

Systematic Review of Efficacy and Safety of Silodosin in Medical Expulsive Therapy for the Management of Ureteral Stones – Based on Indian Evidences

Introduction: Urolithiasis is quite a common disorder affecting around two million people in India every year. Minimally invasive therapies are effective treatment measures in most of the cases. However, a watchful waiting approach with pharmacotherapy promotes the expulsion of stones in a shorter time. We hereby review the efficacy and safety of silodosin, a selective α-1A adrenoceptor antagonist, in medical expulsive therapy for the management of urolithiasis based on the evidences in Indian population. Methods: Medical Subject Headings (MeSH) keywords which were used to systematically search electronic databases: PubMed/Medline, Cochrane Library and Google Scholar from their inception to February 2020 were “Silodosin”, “Ureteral calculi”, “Medical expulsive therapy”, “India”, “randomised controlled trials” and “prospective observational studies”. A total of 29 relevant studies could be found and were included in our analysis. Results: The primary outcomes considered were the stone expulsion rate (SER) and stone expulsion time (SET) along with pain episodes and safety outcomes like orthostatic hypotension and retrograde ejaculation. Eight studies with a total of 1064 patients were identified as evidences considering Indian population which compared silodosin with controls like tamsulosin or tadalafil. Conclusions: Silodosin is highly effective in Indian population for increasing stone expulsion for those with ureteral stones (distal ureteral stones with diameter ≥5 mm and ≤10 mm) with shorter expulsion times along with fewer episodes of pain. It is also effective in post-lithotripsy for accentuating clearance rate and curtailing time to passage of the stones.

Diabetes Mellitus Promotes Smooth Muscle Cell Proliferation in Mouse Ureteral Tissue through the P-ERK/P-JNK/VEGF/PKC Signaling Pathway

Background and objectives: The aim of our study was to evaluate the role of diabetes mellitus (DM) as a significant factor affecting spontaneous stone expulsion, as suggested by previous research. Materials and methods: We investigated the influence of DM on the ureter using a murine model. The mouse-model arm of this study used 20 15 -week-old mice, including 10 normal (control) mice and 10 DM mice. We measured the proximal, middle and distal ureteral smooth muscle thickness in each mouse and the differences among ureteral sections were analyzed. Mouse ureteral specimens were also analyzed via western blotting to detect relative protein expression of phosphor–extracellular signal regulated kinases (P–ERK), phosphor–C–Jun N–terminal kinase (P–JNK), vascular endothelial growth factor (VEGF), and protein kinase C (PKC), which are representative factors involved in cell regulation. Results: We observed significant hyperproliferation of ureteral smooth muscle in DM mice compared to normal mice, which may provoke reduced peristalsis. The ureteral smooth muscle of DM mice was significantly thicker than that of normal mice in all ureteral tissues: proximal (p = 0.040), mid (p = 0.010), and distal (p = 0.028). The relative protein expression of P-ERK (p = 0.005) and P–JNK (p = 0.001) was higher in the diabetic group compared to the normal group. Additionally, protein expression of VEGF (p = 0.002) and PKC (p = 0.001) were remarkably up-regulated in DM mice. Conclusions: Hyperproliferation of ureteral smooth muscle was observed in DM mice, but not in normal mice. The pathways mediated by P–ERK, P–JNK, VEGF, and PKC may play an important role in pathological ureteral conditions.

MO060CYSTINURIA: DISEASE PRESENTATION, PROGNOSIS AND QUALITY OF LIFE ANALYSIS OF A WEB-BASED COHORT

Abstract Background and Aims Cystinuria is considered a rare condition as approximately 1% of adult and 6% of pediatric kidney stones are due to this defect. Prevalence varies by geographic region, with good representation in the Mediterranean area. Given the low prevalence and the lack of a defined clinical pathway for these patients, only partial data are available on the long-term course of the disease. A group of cystinuria patients has gathered on Facebook to exchange advice on symptom management and therapy. The use of this type of platform, in cases of low-prevalence diseases, is a good method of collecting patients who otherwise would be difficult to reach. We proposed an online survey to further analyze clinical, therapy, and quality of life of cystinuria patients. Method An online survey was proposed to an Italian social media group restricted to cystinuric patients with the agreement of the administrator. Before participating to the survey, patients provided documentation on their diagnosis and signed an informed consent. The survey was structured in four sections: a thorough medical history focused on kidney stone and cystinuria, the SF-36 questionnaire, the Fatigue Severity Scale, The Brief Pain Inventory. Data was managed and analyzed anonymously. Results Our survey was sent to 55 patients, but only 18 completed all questionnaires. Our cohort is composed of 5 men and 13 women, with a mean age of 39.5 years (SD 17.6), mean height 156.4 cm (SD 18.5), mean weight 60.8 kg (SD 17.9), mean BMI 24.1 (SD 4.5). About medical history, 15/18 patients have had at least 4 episodes of renal sstons in their lifetime, of these 10/15 reported stone expulsion in most episodes. The first episode occurred on average at 14.9 years (SD 9.3), while confirmed diagnosis of cystinuria arises at 20.1 years (SD 15.1). Most patients experienced bilateral stones (12/18). The diagnosis was confirmed generally by: stone composition analysis (39%), urinary cystine levels (24%), cystine crystals revealed at fresh urine exam (22%), genetic findings (7%), Brand test (2%), other (5%). About 33% of our cohort performed a genetic test. Almost 95% of patients are in follow-up with a clinic. Routine exams include: renal ultrasound (30%), nephrologist evaluation (27%), urine 24h evaluation (25%), urology visit (13%), abdominal CT (4%), kidney x-ray (2%). All the patients of our cohort received urological or surgical procedures for kidney stones: generally endoscopic procedures (32%), or lithotripsy (30%), or open surgery (23%). Four patients underwent a nephrectomy. Patienst reportes an average of 31 painful episodes of renal colic (min 0; max 200) in their history. Of these episodes almost 6 ended with a stone expulsion (min 0; max 50), while haematuria was reported by 12 patients (up to 20 episodes in a patient lifetime). A secondary stone composition in addition to cystine was reported by 5/18: calcium oxalate in 100% of these cases, even with struvite and calcium phosphate. Most of these patients (78%) received some nutritional recommendation: generally by nephrologist (50%), or dietician (23%), or urologist (18%). Indications were not easy to follow: a 0-100 visual scale about compliance showed a mean of 45 (SD 27). The 78% were currently on drug therapy: most used therapy included citrate (45%), tiopronin (40%), or bicarbonate (10%). Drugs compliance is very low (26/100 scale SD 23.3). Nobody in our cohort showed a GFR of less than 60 mL/min/1.73 m2. 4/18 reported a positive family history of cystinuria, while 7/18 relatives with renal stones without a diagnosis. Conclusion Patients affected by cystinuria show a very poor quality of life, with high levels of pain, fatigue, and emotional wellness. The diagnosis is delayed from the first event, and they are exhausted by an high frequency of pain stone passages. More attention to quality of life aspects is needed in patients with this rare but life-threatening condition.

The effect of Panax ginseng on facilitating the expulsion of ureteral stones and improving of renal function: A hypothesis.

The effect of Panax ginseng on facilitating the expulsion of ureteral stones and improving of renal function: A hypothesis.

Current and emerging pharmacological targets for medical expulsive therapy.

The primary goals of medical expulsive therapy are to increase the rate of stone expulsion along the ureter to avoid ureteral obstruction and reduce ureteral colic and thus avoid the need for surgical and more invasive interventions. This review focussed on the findings from in vivo and in vitro animal and human studies that have investigated the pharmacological mechanisms controlling ureteral motility and their translation to current and potentially new clinically used drugs for increasing the rate of stone expulsion along the ureter. The complicated contractility profile of the ureter, which alters with age, tissue segment region, orientation and species contributes to the difficulty of interpreting studies on ureteral pharmacology, which translates to the complexity of discovering ideal drug targets for medical expulsive therapy. Nevertheless, the current drug classes clinically used for patients with stone lodgement include α1 -adrenoceptor antagonists, calcium channel blockers and NSAIDS, whilst there are promising targets for drug development that require further clinical investigations including the phosphodiesterase type 5 enzyme, β-adrenoceptors and 5-HT receptors.

MANAGEMENT OF URINARY CALCULUS WITH HERBAL PREPARATION (MORINGA OLEIFERA AND TRIBULUS TERRESTRIS)

Urinary stones are a common disease that remains a significant health problem. It carries significant morbidity and imposes tremendous financial burden on healthcare system. Urolithiasis affects up to 5% of the population, with a recurrence rate of 50 to 80%. Males are more frequently affected than the females. Management includes both medicinal and surgical treatment which depends on size, type and location of stone. Larger stones which fail to pass through urinary system, needs treated by surgical interventional such as Extracorporeal shock wave lithotripsy (ESWL), Ureteroscopy, and Percutaneous Nephrolithotomy etc. For prevention and recurrence of stone, many herbal medicines have been used traditionally which are believed to cause the disintegration, dissolution and dislodgement and expulsion of urinary stones. In Ayurveda, there are references and comprehensive description of various herbal drugs regarding their anti-lithaitic properties. Role of Moringa oleifera (Shigru mool) and Tribulus terrestris (Gokshura phala) has been highly mentioned. In the present study, a total of 30 patients of Urolithiasis (Mutrashmari) with stone size up to 12mm were selected and all patients were randomly assigned to receive the designed herbal treatment i.e., decoction of Moringa oleifera and Tribulus terrestris for a maximum of 60 days. The study concluded that the herbal formulation is found significant in improving the symptoms of Urolithiasis in all patients and stones in 11 patients were also expelled out.

Fragility index of urological literature regarding medical expulsive treatment.

The role of medical expulsive treatment (MET) is controversial. Fragility index is an additional metric to assess randomized controlled trials (RCTs) outcome validity and indicates how many patients would be required to convert a trial from being statistically significant, to not significant. The larger is the FI, the better the trial's data. The aim of this study is to assess FI of RCTs regarding MET for ureteral stones. A systematic literature search was performed. RCTs, reporting stone expulsion as a dichotomous outcome, showing statistical significance were eligible. FI (the number of patients needed to change from a non-event to event group, to lose statistical significance) and Fragility quotient (FI divided by total sample size), were calculated while Pearson's correlation and Mann-Whitney U test were used as appropriate. Thirty-six RCTs were eligible, with median FI = 3.5 and fragility quotient = 0.042, median sample size = 81, median journal impact factor = 1.73 and median reported p value = 0.008. In 33.3% of the studies, number of patients lost during follow-up was larger than FI, while in 13.89% of the studies, FI was 0, indicating use of inappropriate statistical method. Pearson's correlation showed significant positive association between FI and sample size (r = 0.981), number of events (r = 0.982) and impact factor (r = 0.731), while no association was found with p value or publication year. In this analysis, a calculated FI of 3.5 indicates that findings from RCTs on MET for ureteral stones are fragile and should be interpreted in combination with clinical thinking and expertise.

Comparison of efficacy of various drugs used for medical expulsive therapy for distal ureter stones: A systematic review and network meta-analysis.

Medical expulsive therapy has been found to be effective for distal ureteric stones; however, which drug is most efficacious in terms of stone expulsion rate (SER) and stone expulsion time (SET) is not known. With this review we aimed to compare the efficacy of various drug treatments for distal ureter stones used as medical expulsive therapy in terms of SER and SET. Systematic literature search was conducted to include all the randomised study comparing various drug interventions for lower ureter stones. Standard preferred reporting items for systematic review and meta-analysis for network meta-analysis (PRISMA-NMA) were pursued. In this review, 50 randomised studies with 12,382 patients were included. For stone expulsion rate (SER), compared with placebo all the treatment groups were more effective except nifedipine and sildenafil. According to the SUCRA values obtained, naftopidil plus steroid was the highest rank and nifedipine lowest. For stone expulsion time (SET), compared with placebo only tadalafil plus silodosin, nifedipine plus steroid, alfuzosin, silodosin, tadalafil and tamsulosin were more effective. SUCRA values were highest for tadalafil plus silodosin and least for naftopidil plus steroid. From subgroup analysis with individual drugs for SER, SUCRA values were highest for naftopidil followed by silodosin and SET was highest for silodosin and least for naftopidil. For lower ureter stone, tadalafil plus silodosin is the best combination and silodosin best individual drug considering the SET and SER. Nifedipine as monotherapy is no more effective than control group.

Percutaneous transcystic removal of gallbladder and common bile duct stones: a narrative review.

The incidence of gallstone-related complications is rising, thus leading to increases in waiting list times for elective laparoscopic cholecystectomy (LC). Percutaneous cholecystostomy (PC) provides immediate biliary drainage and may be used as an emergency option in a critically unwell patient as a bridge to surgery, or as the management option of a patient who is not fit for surgery. However, a significant number of these patients may be readmitted after PC with recurrent acute cholecystitis or pancreatitis, leading to significant morbidity and mortality. The aim of the present review was to analyze the available literature surrounding the use of the transcystic approach, including the extraction and balloon expulsion method, in the management of patients with gallbladder stones and/or common bile duct (CBD) stones. The full text of 18 articles were reviewed, of which four were included in this review. Results showed an overall success rate of CBD stone extraction in 118 of 139 patients (84.9%), gallbladder stone extraction in 97 of 114 (85.0%), and CBD stone expulsion in 27 of 29 (93.1%). Percutaneous CBD and gallbladder stone extraction may be a safe management option for elderly or co-morbid patients who are not appropriate for surgical intervention. However, the evidence base surrounding this is very limited; therefore, further research is required in order to evaluate this in more detail.

EVALUATION OF EFFICACY OF SILODOSIN VERSUS SILODOSIN WITH DEFLAZACORT IN EXPULSION OF LOWER URETERIC CALCULI

Objectives: To compare the efcacy of silodosin versus silodosin with deazacort in expulsion of lower end ureteric calculi, in terms of episodes of pain,stone expulsion rate,stone expulsion time ,analgesic requirements and side effects Introduction: Ureteric calculi represent 20% of urinary stones. Ureteroscopy and Shock wave lithotripsy proven the method of treatments for lower ureteric stones; however, they are expensive and not risk free. Aconservative approach is becoming more popular as a result of advances in pharmacological therapy which reduces the symptoms and helps in stone expulsion. We performed a randomized controlled prospective study to evaluate the efcacy of Deazacort in combination with alpha blocker silodosin in medical management of symptomatic lower Ureteric stones of ≤8 mm size. Material and methods: A prospective randomised controlled study was conducted on 60 patients, age ≥ 18 , who had unilateral lower ureteric stone of ≤ 8 mm. Patients were divided into three groups. Group 1 received silodosin 8 mg for 14 days,Group 2 received silodosin 8 mg plus deazacort 30mg daily for 14 days and Group 3 (control) received diclofenac potassium (75 mg ) when required. The patients were followed-up by ultrasonography ,plain radiograph KUB and computed tomography (in some cases). Results: There was a higher stone expulsion rate of 95% in Group 2 as compared to Group 1(85%) and Group 3(35%) . Group 2 showed a signicant advantage for stone expulsion time ,decreased pain episodes and analgesic use. Two patients, one in group 1 and group 2, reported retrograde ejaculation. Conclusion: The results showed that silodosin with deazacort , increases the stone expulsion rate, decrease the stone expulsion time, decreases the mean number of pain episodes and decreases the mean analgesic dosage requirement. But larger study is required to establish its efcacy for expulsion rate which will be statistically signicant.

EFFICACY OF SELECTIVE ALPHA-1 RECEPTOR BLOCKERS (TAMSULOSIN) IN FACILITATING THE PASSAGE OF RENAL STONES AFTER EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY

BACKGROUND & OBJECTIVE: Urinary system stone disease is a common entity. Small renal stones are preferably treated using Extracarporeal Shock Wave Lithotripsy (ESWL) technique. Passage of stone fragments result in pain, hematuria and urinary tract obstruction. This can be avoided by the use selective α-1 receptor antagonists like Tamsulosin. However, their efficacy remains a matter of debate. In this study the role of selective α-1 blocker was evaluated in facilitating spontaneous expulsion of renal stone fragments after ESWL. The objective of our study was to find out the Efficacy of Tamsulosin (Selective α-1 blocker) in facilitating the transit of stone fragments (4-7mm) after ESWL. Follow up X-ray KUB was used to confirm the stone clearance. Efficacy was measured in terms of stone expulsion rate.
 METHODOLOGY: It was randomized controlled trial including 150 patients coming to outpatient department of Urology Lahore General Hospital, Lahore from January 25, 2010­ to July 25, 2010. Total 150 patients with renal stones broken down into fragments (4-7mm) after ESWL were enrolled using non-probability purposive sampling technique. Patients were categorized into group A and B. Patients of group A received cap. Tamsulosin 0.4mg along with Tab. Diclofenac sodium 50mg. Whereas, patients belonging to group B received only diclofenac sodium 50 mg twice daily. Patients underwent ESWL every three weeks, in case of non-fragmentation, to the maximum of 4 sessions. All the patients were followed with X Ray KUB for stone clearance. The data of all patients was incorporated into pre designed Performa. Statistical evaluation of clinical variables done in terms of efficacy i.e. stone clearance.
 RESULTS: Stone clearance rate of patients in group A was 86.6% as compared to only 76% in group B. Usage of selective α-1 blockers in group A enhanced the stone clearance rate as compared to group B. However this difference was statistically insignificant (p-value-0.094).
 CONCLUSION: There was increased stone clearance in alpha one blocker group but not statistically significant. Further studies with larger sample size are required to evaluate the role of Selective α-1 blockers (Tamsulosin) after ESWL.

Silodosin versus Tamsulosin as Medical Expulsive Therapy for Children with Lower-Third Ureteric Stones: Prospective Randomized Placebo-Controlled Study

Aim: To compare the efficacy and safety of silodosin versus tamsulosin as medical expulsive therapy for stones of lower-third ureter in children. Patients and Methods: This prospective single-blind placebo-controlled randomized study included 167 pediatric patients who presented with distal ureteric stone (DUS) less than 1 cm. Patients were randomized into 3 groups; group I received silodosin 4 mg once daily, and group II received tamsulosin 0.4 mg while those in group III had placebo. The side effects of the used drugs, both rate and time of stone expulsion, and number of pain episodes were compared among the study groups for a maximum of 4 weeks. Results: Follow-up data of our patients after treatment revealed that the stone expulsion rate was significantly higher and the time to stone expulsion was significantly shorter in group I (89.3%, 12.4 ± 2.3 days) and group II (74.5%, 16.2 ± 4.2 days) compared to group III (51.8%, 21.2 ± 5.6). However, a statistically significant difference between silodosin and tamsulosin groups in favor of the former one was reported regarding the 2 studied items. Meanwhile, pain episodes requiring analgesia were statistically fewer in group I and II in contrast to placebo group. Adverse events were comparable among all groups. Conclusion: Silodosin provides significantly better stone expulsion rate and shorter expulsion time than tamsulosin for treatment of DUS. Both medications showed good safety profiles in children. However, further studies are required on a larger scale to confirm our results. Assessment of drug safety on younger age-group is still needed.

Correlation between Expulsion of Distal Ureteric Calculus with CRP Level, WBC Count and Neutrophil Percentage among the Patients attending on Manipal Teaching Hospital, Pokhara (Retrospective Study)

Introduction: Urolithiasis is a common medical diagnosis that doctor encounters in the outpatients and emergency departments. The prevalence of renal stone disease has increased steadily over the past decades. There are different modalities of treatment of ureteric calculus. However, most of the distal ureteric calculus passes spontaneously thus the application of invasive procedure at the early stage can be considered overtreatment.Methods: The 68 patients of the surgical department, Manipal teaching hospital, Pokhara, with distal ureteric calculus of ≤ 8mm, who were under the treatment Tamsulosin Hydrochloride 0.4mg once daily for 2 weeks or till the expulsion of stone from 1st October 2017 to 30th September 2018 (one year period) were retrospectively evaluated for the spontaneous stone expulsion rate and its association with serum CRP level, WBC count and Neutrophil percentage. The patients were divided into 2 groups i.e. spontaneously ureteric stone expelled group and non expelled group. Furthermore, for statistical analysis, each group were subdivided according to normal and elevated serum CRP level, white blood cell count and neutrophil percentage. The associations between these factors and ureteral stone passage were then examined.Results: Most of the cases were in the age group of 21-40 years with the mean age of 40.09 ± 16.11, where 57.4% of patients were male. Among all mean duration of symptoms was 6 days. The ratio of left to right stone was 1.26:1. Out of 68 patients, 80.9% of the patient’s distal ureteric stone was passed out spontaneously with medical expulsion therapy. There were statistically significant (p<0.001) association between normal serum CRP level, White cell counts and neutrophil percentage with the expulsion of distal ureteric calculus with size ≤ 8mm.Conclusion: There is a higher expulsion rate of distal ureteric calculus of size ≤ 8mm with the patient of the normal level of serum CRP level, White cell counts and neutrophil percentage than that of abnormal level.

Comparison of the efficacy of silodosin and a terpene combination in the medical expulsive therapy of distal ureteral stones.

We aimed to compare the efficacy of silodosin and a terpene combination in the treatment of distal ureteral stones. The data of the patients admitted to the urology policlinic with renal colic, diagnosed with distal ureteral stones, and followed up with medical expulsive therapy between December 2017 and June 2018 were retrospectively reviewed. The patients were divided into two groups: Group 1 comprised 72 patients that received 8mg/day silodosin and Group 2 consisted of 51 patients that were given three capsules of a terpene combination daily. The groups were compared in terms of the patients' demographic characteristics, medical history, localisation of the present stone, renal collecting system status, daily fluid intake, number of emergency service visits, number of additional analgesic applications needed, number of pain attacks, number of days off work, stone expulsion rate and time to stone expulsion. Of the total 123 patients, 98 (79.7%) were stone-free. The stone-free rate was 75.0% in Group 1 and 86.3% in Group 2, with no statistical difference between the two groups. However, the number of visits to the emergency service because of pain, number of additional analgesic applications required, number of days off work, and time to stone expulsion were statistically significantly lower in Group 2 than in Group 1. The treatment of distal ureteral stones with silodosin is as effective as the terpene combination. However, the terpene combination is more effective than silodosin in managing pain and accelerating stone expulsion.

Can the Hounsfield unit predict the success of medical expulsive therapy using silodosin in 4- to 10-mm distal ureteral stones?

We aimed to investigate the predictive ability of the Hounsfield unit (HU) on non-contrast computed tomography (NCCT) for the success of medical expulsive therapy (MET) using silodosin in distal ureteric stones of 4-10mm. The data of patients who underwent MET were retrospectively screened. The patients were divided into two groups as Groups 1 and 2 depending on the presence or absence of stone expulsion, respectively. In addition to HU calculated using the NCCT images, state of the collecting systems, daily fluid intake, number of emergency department visits, and number of pain attacks were compared. A total of 88 patients were included in the study. Sixty-four patients (72.7%) expelled the stone after MET while the treatment was not successful in 24 patients (27.3%). The stone area was significantly larger in Group 2 (28.4±15.7mm2 vs 46.8±16.1mm2 ; P<.001). NCCT-HU was calculated as 542.5±256.8 for Group 1 and 873.1±335.2 for Group 2, indicating a significant difference (P<.001). The mean number of pain attacks was 1.5±1.2 in Group 1 and 2.2±1.4 in Group 2 (P=.048). The number of visits to the emergency department significantly differed between Groups 1 and 2 (1.1±1.0 and 1.8±1.3, respectively; P=.010). In this study, HU and stone area values calculated on NCCT were found to be effective factors in predicting the treatment success for MET. Therefore, we consider that it would be useful to consider these parameters in the selection of an appropriate treatment for distal ureteric stones.

Comparative study between Silodosin alone and Silodosin plus Tadalafil for the medical management of lower Ureteric Stone in South-Western part of the Bangladesh

Objective: To compare the treatment outcome of Silodosin alone and Silodosin plusTadalafil as a medical expulsive therapy (MET) of lower ureteric stone in south-westernpart of Bangladesh. Methodology: The study was conducted in a tertiary hospital in Khulna, over a periodof 12 months (January 2019 to December 2019). Out of 108 patients, 100 meet theinclusion criteria who were purposively assigned into 2 groups. 48 patients included inSilodosin alone group and 52 in Silodosin plus Tadalafil group. Result: There was a significant higher stone expulsion rate in Silodosin plus Tadalafilthan Silodosin alone which was 88.46% vs75% respectively (P value 0.02). The meanstone expulsion time of Silodosin alone was14.33 (±3.1) days and Silodosin plus Tadalafilwas 11.48(±2.3) days (P value 0.001). The episodes of pain in Silodosin alone were0.7(±0.06) and 0.6(±0.2) in Silodosin plus Tadalafil group that was statisticallysignificant. Conclusion: The present study concludes that Silodosin plus tadalafil combinationtherapy significantly increases ureteric stone expulsion rate and decreases the expulsiontime and pain episodes than treatment with silodosin alone. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.67-71

Extracorporeal Shockwave Lithotripsy with Tamsulosin in Clearance of Upper Ureteral Calculi- A Randomized Control Clinical Trial

Background of the study: Urolithiasis has an incidence in the world of about 5% and the probability of a recurrence within 5–7 years is 50% (Parmar, 2004). Exact data about its prevalence is not known in Bangladesh but it is quite common as seen in outpatient department. It is more common in northern part of the country, male suffer more than female (M:F: 3:1) (Salam, 2002). Symptomatic ureteral calculi represent the most common condition encountered by an urologist in an emergency setting (Pak, 1998). Intervention is recommended for individuals with larger stones, especially greater than 5 mm (Kupeli et al., 1998). The treatment of this pathology was revolutionized with the introduction, in the late 1980s, of extracorporeal shock wave lithotripsy (ESWL), a non-invasive technology that has become one of the primary treatments for urinary stones. Its success rates vary depending on stone size and location and by the type of lithotripter employed. Medical expulsion therapy (MET) can play a key role in support of ESWL: specifically, expulsion is done by diuretics, calcium antagonists, anti-edema agents, and alpha-blockers. A few studies have reported their effectiveness (Borghi et al., 1994, Cervenakov et al., 2002, Porpiglia et al., 2002,Dellabella et al., 2003). Objective: This study is carried out to find out the role of Tamsulos in stone clearance in patientswith upper ureteral stone after extracorporeal shock wave lithotripsy (ESWL). Methods &amp; Material: This randomized control clinical trialwas performed in Department of Urology, National Institute of Kidney Diseases and Urology, Sher-EBangla Nagar, Dhaka during the period from July 2015 to June 2017. A total of 70 cases with upper ureteric stone were included during the study period. Patients were selected randomly in every alternate sequence, odd numbers for experimental group, Tamsulosin+ ESWL, group A &amp; even numbers for control group, only ESWL, group B. Stone clearance rate, number of ESWL session and stone expulsion time were evaluated. Results: In this study showed complete stone clearance one month after ESWL in Group A was 16(89%) and Group B was 16(84.21%) for stone size 6 to 10 mm. Comparison of clearance rate between two groups in stone size 6 to 10 mm was not statistically significant (p value &gt;.05). Complete stone clearance one month after ESWL in Group A was 13(76%) and Group B was 07(43.75%) for stone size 11 to 15 mm. Comparison of clearance rate between two groups in stone size 11 to 15 mm was statistically significant (p value &lt;.05). In this study requirement of number of ESWL sessions according to the stone size showed, in case of 6 to 10 mm stone size, average ESWL sessions 1.28±0.5 in Group A and 1.53±0.7 in Group B and in case of 11to 15 mm stone size, average ESWL sessions 1.29±0.5 in Group A and 1.62±0.7 in Group B. Comparison of ESWL sessions between two groups were statistically significant (p value &lt;.05). In this study mean expulsion time of stone in Group A was 22.34±12.23 days and in Group B was 32.34±21.96 days. Comparison of stone expulsion time between two groups were statistically significant (p value &lt;.05). Conclusion: Tamsulosin results in increased stone-free rates and in lower percentages of patients requiring re-treatment. Tamsulosin can be self-administered and can play a key role in the choice between tamsulosin after ESWL and only ESWL for upper ureteric stone disease treatment. Use of tamsulosin makes the expulsive medical therapy suitable for improving overall outcomes of ESWL treatment for upper ureteral stones. Tamsulosin helps in clearance of upper ureteral stones after ESWL. Bangladesh Journal of Urology, Vol. 23, No. 1, January 2020 p.36-42

Efficacy and Safety of External Physical Vibration Lithecbole After Extracorporeal Shock Wave Lithotripsy or Retrograde Intrarenal Surgery for Urinary Stone: A Systematic Review and Meta-analysis.

Introduction: The current study evaluated the efficacy and safety of external physical vibration lithecbole (EPVL) after extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for urolithiasis. Methods: Publicized literature was systematically searched from EMBASE, Cochrane Library, PubMed, ScienceDirect, ClinicalTrials.gov, and Web of Science up to February 2020. Fixed-effects or random-effects model was chosen in risk ratio (RR) calculation according to heterogeneity. Quality of evidence was estimated under the guidance of Cochrane handbook. Stone expulsion rate, stone-free rates (SFRs), and complication rates were set as end points. Results: Six randomized controlled trials, including 853 patients, were eligible for analysis. EPVL significantly increased SFR within 3 weeks (RR = 1.17, 95% CI: 1.06-1.29, P = 0.001) and above 3 weeks (RR = 1.19, 95% CI: 1.03-1.37, P = 0.02) after SWL. EPVL also improved SFR within 3 weeks (RR = 1.84, 95% CI: 1.35-2.49, P < 0.0001) and above 3 weeks (RR = 1.53, 95% CI: 1.33-1.77, P < 0.00001) after RIRS. Besides, EPVL can significantly increase SFRs for stones in renal pelvis, lower calix, and multiple locations (all P-value <0.05). Although the overall complication rate was not significantly higher in EPVL + RIRS group, it was found to be 1.38 times higher in EPVL+SWL group (RR = 1.38, 95% CI: 1.06-1.79, P = 0.02), especially the incidence of flank pain (RR = 3.11, 95% CI: 1.02-9.46, P = 0.05). Conclusions: EPVL is effective and safe with high SFRs (especially in renal pelvis, lower calix, and multiple locations) after SWL or RIRS and lower overall complication rate after RIRS in patients with urolithiasis. However, the overall complication rate (especially the incidence of flank pain) was higher after EPVL + SWL.

Effect of Tamsulosin on Treatment of Lower Ureteric Calculi

Introduction: Medical expulsive therapy (MET) is one of the treatment modality for ureteric calculi. Recent studies have reported excellent results with MET for lower ureteral calculi. The aim of study to evaluate the effect of tamsulosin on treatment of lower ureteric calculi. Materials and Methods: A prospective study was conducted at outpatient department of Urology, Prime Medical College Hospital, Rangpur, Bangladesh during February 2018 to February 2019. A total of 100 patients with lower ureteric calculi included in this study. Cases were selected by inclusion and exclusion criteria and randomly allocated in two groups. Tamsulosin group (50 patients) were given capsule tamsulosin 0.4 mg, at bed time while observation group (50 patients) were given standard therapy without tamsulosin. The patients were prescribed diclofenac (50 mg) on demand for pain relief and were followed-up by X ray and ultrasonography of kidney, ureter and urinary bladder region for 28 days. The stone expulsion rate, expulsion time, and analgesic requirements were also recorded. Data were analyzed and compared by statistical tests. Results: Tamsulosin group showed a statistically significant advantage in terms of the stone expulsion rate. A stone expulsion rate of 78% (39 out of 50 patients) in tamsulosin group and 54% (27 out of 50 patients) was observed for observation group (p=0.011). In tamsulosin group, mean expulsion time was 7.26 ±3.35 days whereas in observation group mean expulsion time of 8.93 ±3.56 days (p=0.017). Tamsulosin group stone expulsion time was lower as compared to observation group. Overall the number of doses of analgesic (diclofenac) required in tamsulosin group, it was 3.78 ± 2.82 whereas in observation group was observed to be 5.93± 1.76. The variation between number of doses of analgesic required by patients in both groups was found to statistically significant (p=0.001). Conclusions: The effectiveness of tamsulosin as a medical expulsive therapy in patients with lower ureteric calculi was higher as compared to observation group. Tamsulosin has been found to increase stone expulsion rates, reduces mean days to stone expulsion and decreases number of doses of analgesic requirement. Bangladesh Journal of Urology, Vol. 22, No. 2, July 2019 p.155-159