Mean Expulsion Time Research Articles

Spanish Experience with Latero-Lateral Duodeno-Ileostomy + Sleeve Gastrectomy with Magnet Anastomosis System.

The partial diversion of intestinal contents facilitates achieving and maintaining weight loss and improving glycemic control in patients with obesity and with or without T2DM. The purpose of this study is to report our experience and 1-year follow-up with novel modification of SADI-S. This study is a part of a multicentric trial of patients that underwent primary side-to-side duodeno-ileostomy and sleeve gastrectomy (SG) with GT metabolic solutions magnetic anastomosis system. Feasibility, safety, and initial efficacy were evaluated. The mean age of the patients included was 48 ± 8.75years and the preoperative BMI was 43.32 ± 2.82kg/m2. The complications were present in 30% of patients. The anastomosis patency was confirmed by the passage of radiological contrast under fluoroscopy at a mean of 17days (17-29days), and the mean expulsion time was 42days (32-62). The mean diameter of the anastomosis after the magnet expulsion was 13.8 × 11.4mm. The percentage of total weight lost at 1year was 38.68 ± 8.48% (p < 0.001). The percentage of excess weight loss 82.5 ± 18.44% (p < 0.001) and improvements in glucose profiles were observed. Mean baseline HbA1c 5.77 ± 0.31% was reduced to 5.31 ± 0.26% (p < 0.024). Latero-lateral duodeno-ileostomy + SG with magnetic duodenal bipartition is afeasible and reasonably safe technique and induces weight loss in patients with obesity and improvement of glycemic control. This modification could be considered as an option to standard SADI-S or as a first step in two stages procedure. However, larger studies are needed. Clinicaltrials.gov Identifier: #NCT05322122.

Efficacy of sexual intercosurse in the spontaneous passage of distal or intramural ureteral stones: a randomsized controlled trial

Background: The role of sexual intercourse as an alternative treatment approach for ureteral stones (UTSs) is a recent area of investigation with only small sample-sized studies. This study aims to evaluate the role of sexual intercourse in the spontaneous passage of distal or intramural UTSs via a larger sample size. Materials and methods: The study population included cases that had either a distal ureteric or an intramural radiopaque stone. The patients were divided into two groups; group A was instructed to engage in sexual intercourse two to three times per week while also receiving symptomatic treatment for 4 weeks. Group B received symptomatic treatment alone and was instructed to abstain from sexual intercourse or masturbation for the same period. Results: A total of 160 male patients were enrolled in this study. The ages of the patients ranged from 21 to 58 years. The rate of stone expulsion after 2 weeks was 68.18% in group A and 53% in group B (P=0.053). The expulsion rate after 4 weeks was 80% in group A and 68.4% in group B (P=0.072). The mean expulsion time was 13.9±5.4 days for the experimental group and 15.2±6.7 days for the control group (P=0.179). The experimental group required fewer analgesic injections in comparison to the control group (P&lt;0.05). Conclusion: While the role of sexual intercourse in facilitating the passage of distal or intramural UTSs cannot be fully established, it may aid to some extent. However, it should not be relied upon as a standalone treatment modality.

A Novel Deformable Self-Assembled Magnetic Anastomosis Ring (DSAMAR) for Esophageal Stenosis Recanalization without Temporary Gastrostomy in Beagle Dogs

BackgroundTo assess the feasibility of a deformable self-assembled magnetic anastomosis ring (DSAMAR) in the treatment of esophageal stenosis in beagle dogs via transoral access without temporary gastrostomy. MethodsExperimental esophageal stenosis was created in 10 beagle dogs by partial cervical esophageal ligation. The DSAMAR was inserted into the distal esophagus via the narrow section of the esophagus using a gastroscope. A circular DSAMAR was placed in the proximal esophagus. The magnetic rings on both sides of the experimental stenosis automatically attracted each other. We then recorded the operation time, postoperative complications, anastomotic formation time, and magnetic ring discharge time. The dogs were euthanized 4 weeks postoperatively; subsequently, we obtained the esophageal anastomotic specimens and observed the anastomotic formation via the naked eye and by light microscopy. ResultsOur esophageal stenosis model produced reproducible stenoses in all dogs, which was confirmed via endoscopy and esophagography. DSAMAR was successfully implanted in all experimental animals under endoscopic and X-ray monitoring, and all linear DSAMARs were successfully transformed into rings. The magnets at both ends of the esophageal stenosis were automatically attracted. All animals survived until euthanasia. No complications, including esophageal perforation, bleeding, and gastrointestinal obstruction, were noted during the perioperative period. The mean operation time of endoscopic magnetic anastomosis was 15.6 ± 2.41 (range, 12–19) min. The mean esophageal anastomotic formation time was 8.8 ± 1.03 (range, 7–10) days, and the mean expulsion time of DSAMAR was 13.94 ± 2.88 (range, 10–19) days. Gastroscopy and esophagography were performed at 4 weeks postoperatively; the esophageal patency was good. Macroscopic observation of the esophageal anastomotic specimens revealed that the esophageal mucosal layer of the anastomosis had good continuity and the anastomosis was smooth. ConclusionDSAMAR is a feasible option for magnetic recanalization of esophageal stricture via transoral access without temporary gastrostomy.

Medical expulsive therapy in ureteric calculi: A prospective study

Ureteric calculus with a colicky pain is a common issue faced by surgeons and urologists in the ER and OPD with a major universal health and financial strain on the health care system. Different studies have shown promising outcomes for ureteric calculus with medical expulsive therapy (MET) in relation to the expulsion rate and mean duration of expulsion, decrease hospital stay and less requirements of analgesics. The aim of this study is to compare the efficacy and safety of Tamsulosin alone or in combination of Deflazacort in medical expulsive therapy of ureteric calculus of less than 10 mm (sub-centric).Effect was studied on two groups. Group-A patient received standard medical treatment plus Tamsulosin. Group-B patients received standard medical treatment and Tamsulosin plus Deflazacort.MET with Tamsulosin and Deflazacort has major advantages, with very mild, reasonable side effects and substantially lower healthcare system costs.Medical therapy with Tamsulosin is effective and have been found to increase and hasten the expulsion of ureteric calculus, but expulsion rate is more, mean expulsion time and duration of hospital stays, and the episodes of pain is less when tamsulosin is combined with Deflazacort.

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

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

Evaluation of the efficacy of sexual intercourse on distal ureteral stones in women: a prospective, randomized, controlled study.

To evaluate the efficacy of sexual intercourse in the expulsion of distal ureteric stones in women. A total of seventy woman patients with distal ureteral or intramural stone were randomly divided into two groups. Group 1 included 35 patients who were advised to do sexual intercourse 3-4times/week with the administration of symptomatic treatment, and group 2 (control group) included 35 patients receiving symptomatic treatment only and were instructed not to do sexual intercourse or masturbation during the study. After 4 weeks follow up; the expulsion rate, need for analgesic and ureterorenoscopic lithotripsy were compared for each group. The mean ages of the patients in groups 1 and 2 were 36.4 ± 10.8, 37.1 ± 12.4, respectively. The mean stone size was 7.01 ± 1.6 in group 1, 6.67 ± 1.4mm in group 2 (p: 0.3). Stone expulsion rate, in the first 2weeks for group 1 was 80% (28/35), while 51.4% (18/35) in group 2 (p < 0.001). In the 4th week, the expulsion rate for group 1 was 85.7%, but 60% in group 2 (p < 0.001). The mean expulsion time was shorter in group 1 (12 ± 4.2days) than group 2 (16.1 ± 6.4days) (p < 0.01). The analgesic needs in groups 1 and 2 were found to be 1.9 ± 0.7, 2.6 ± 0.8 times/a day respectively, and were significantly lower in group 1 (p < 0.001). At least three or four sexual intercourses per week seem to increase the spontaneous passage for distal or intramural ureteral stones in women. Furthermore, sexual intercourse reduces the need for analgesics.

Role of Medical Expulsive Therapy in Ureterolithiasis

Objective: Medical expulsive therapy (MET) for urolithiasis has gained increasing attention in the last few years. MET is an excellent treatment modality for ureteric stones in the appropriately selected patients. This study was carried out to study the role of MET in the treatment of upper/middle/lower ureteric and VUJ calculi to compare the safety and efficacy of tamsulosin and tamsulosin with Deflazacort as medical expulsive therapy for ureteric stones. Materials and methods: Between July 2013 to June 2014, 105 adult patients with ureteric stones sized 5mm to 10mm were randomized equally to treatment with tamsulosin or tamsulosin with deflazacort. Therapy was given for a maximum of 6 weeks. The stone expulsion rate, mean time to expulsion (days), site of stones passed, endoscopic treatment (URS) and adverse effects of the drugs were noted. Statistical analysis was done by using student’s t-test and chi-square test. Results: Total 105 patients were included in this study. Only Tamsulosin 0.4mg once daily was given to 53 patients in group A. Fifty two patients in group B were treated with Tamsulosin 0.4mg once daily plus Deflazacort 6mg twice daily.The stone expulsion rate was 84.9% (45/53) in group A and 96.1% (50/52) in group B. Mean expulsion time (days) was shorter in group B. It was 4.96 days in group B compared with group A (8.53 days) which was highly statistically significant. Conclusion: Medical expulsive therapy (MET) for ureteric stones using tamsulosin and tamsulosin with Deflazacort is safe and efficacious. Tamsulosin with Deflazacort is very effective in expelling stones present in all the levels of the ureter. Bangladesh Journal of Urology, Vol. 17, No. 2, July 2014 p.67-70

Medical Expulsive Therapy (MET) for Large Distal Ureteral Stones: A Prospective Study Comparing Three Drugs

Introduction: One of the most common disorders of the urinary tract is Urolithiasis. Twenty percent of lithiasis are located in the ureter of which 68% are seen in the distal ureter. The concept of medical expulsive therapy (MET) has been developed with enough knowledge of the ureter physiology in order to make easier the spontaneous expulsion of the stone. The aim of this study was to evaluate the efficacy and safety of three different drugs for the treatment of pelvic ureteral stones. Materiel and Methods: Between October 2017 and November 2018, 90 adult patients presenting with low or non-obstructive pelvic ureteral stones sized 8 to 10 mm were included. They were prospectively randomized, using computer-based randomization charts, into three equal groups: treatment with ketoprofen 100 mg once daily (Group I), silodosin 8 mg once daily (Group II) and tadalafil 5 mg once daily (Group III). The aim was to compare spontaneous expulsion of stone between those drugs Results: The mean expulsion time from the start of MET was 11.5 ± 3.27 days for ketoprofen group, 10.71 ± 3.98 days for silodosin group and 10.57 ± 3.40 days for tadalafil group. But these differences were also not significant (P = 0.79). The use of analgesics (grade II) was higher in groups II and III compared to group I, but without significant difference (23.33% in group I, 33.33% in group II and 40% in group III, p = 0.38). Discussion: The overall chance of spontaneous passage is low when the stone diameter is sized more than 7 mm. A wide range of spontaneous passage rates have been reported in the literature, varying from 71% to 98% for distal ureteral stones less than 5 mm and 25% - 53% for stone sized 5 to 10 mm with a mean expulsion time of more than 10 days. Conclusion: The three drugs have a low expulsion rate for 8, 9 and 10 mm pelvic ureteral stones with a higher adverse event rate for the NSAID group.

A comparative study of efficacy and safety of tamsulosin with nifedipine versus tamsulosin alone as medical expulsive therapy for lower ureteric stones

Background: Lower ureteric stones (LUS) comprises of 70% of ureteric stones. Spontaneous passage depends on stone size and location in ureter. Impacted calculi initiate smooth muscles contractions causing ureteric spasms. α-1 blockers like tamsulosin and calcium channel blocker like nifedipine relaxes ureteric smooth muscle, facilitating spontaneous expulsion. Pain and discomfort associated with urolithiasis, hospitalization and surgical cost can be minimized by medical expulsive therapy. Many studies had compared efficacy of tamsulosin with nifedipine, only few have explored the combination. This study compared efficacy of nifedipine and tamsulosin versus tamsulosin alone.Methods: 64 patients with LUS (5-10 mm) were assigned into 2 groups. Group 1 received tamsulosin and nifedipine and group 2 only tamsulosin. Rate of expulsion, time to expulsion, analgesic frequency and pain VAS score were analyzed. Chi-square or Fisher’s exact test to analyze categorical data, Mann Whitney U test or unpaired t test for differences between groups and Wilcoxon matched-pairs signed rank test for within group. A p&lt;0.05 was statistically significant.Results: Rate of expulsion was 87.5% in group 1 and 65.6% in group 2 (p&lt;0.05). Mean expulsion time was 6.68±1.89 days for group 1 and 8.52±2.62 in group 2 (p&lt;0.05). Analgesic requirement was similar. Adverse effects were headache, dizziness and postural hypotension.Conclusions: Combination therapy yielded better rate of expulsion and reduction in stone expulsion time than tamsulosin alone. Thus, combination therapy can be considered for effective treatment outcomes.

Meta-analysis of the efficacy of sexual intercourse for distal ureteric stones.

ObjectiveThis meta-analysis was performed to evaluate the efficacy of sexual intercourse for treatment of distal ureteral stones.MethodsRandomized controlled trials (RCTs) of sexual intercourse for treatment of distal ureteral stones were searched using PubMed, EMBASE, and the Cochrane Controlled Trials Register.ResultsThree RCTs comprising 240 patients were included in the meta-analysis, which showed that sexual intercourse was effective in treating distal ureteral stones. The expulsion rate of distal ureteral stones at the second week (odds ratio [OR] = 6.61, 95% confidence interval [CI]: 3.66 to 11.94), expulsion rate of distal ureteral stones at the fourth week (OR = 4.00, 95% CI: 2.09 to 7.64), and number of analgesic injections (mean difference [MD] = −0.79, 95% CI: −1.51 to −0.08) indicated that sexual intercourse was more effective than placebo. However, the mean expulsion time of distal ureteral stones (MD = −3.98, 95% CI: −8.77 to 0.81) showed no difference between sexual intercourse and placebo.ConclusionsCompared with placebo, sexual intercourse exhibited greater efficacy for the treatment of distal ureteral stones, whilst potentially alleviating pain.

COMPARISON OF MEAN DURATION REQUIRED FOR COMPLETE EXPULSION WITH ISOSORBIDE MONONITRATE VERSUS MISOPROSTOL IN FIRST TRIMESTER MISSED MISCARRIAGE

Background: Medical management of first trimester miscarriage possess significant advantages over surgical management. Misoprostol has been previously tested in the management of miscarriage in different regimens and settings. Isosorbide mononitrate (IMN) is also an effective and safe drugs for early expulsion of conception material. But controversial results have been noticed from literature. So we conducted this study to confirm more effective drug.&#x0D; Objective: To compare the mean duration required for complete expulsion with isosorbide mononitrate versus misoprostol for first trimester missed miscarriage.&#x0D; Material &amp; Methods&#x0D; Study Design: Randomized Controlled Trial.&#x0D; Setting: unit I, Department of Obstetrics &amp; Gynaecology, Lahore General Hospital, PGMI, Lahore.&#x0D; Duration: Six months ( August, 2017 to January,2018)&#x0D; Data Collection Procedure: Females were randomly divided in two groups by using lottery method. Group A was given 800 µg misoprostol in posterior fornix of vagina 3 hourly maximum 2 doses. Group B was given 40mg IMN in posterior fornix of vagina 3 hourly maximum 2 doses. Patients were reassessed if vaginal bleeding or uterine contractions were noted otherwise repeat dose was given after 3 hours. Time till complete expulsion was noted. Complete expulsion was confirmed subsequently by ultrasonography when no products of conception are found in utero. All the data was entered and analyzed through SPSS version 21.&#x0D; Results: The mean age of females was 30.40±5.51years. In this study, 18 (25%) were para 1, 27 (37.5%) were para 2, 15 (20.83%) were para 3 and 12 (16.67%) were para 4. The mean gestational age of females was 9.51±1.11weeks. The mean BMI of females was 24.56±3.76kg/m2. The mean duration required for complete expulsion was 91.69±15.74min in misoprostol group and 122.58±16.55min in IMN group. There was significant difference in both groups (p&lt;0.05).&#x0D; Conclusion: Thus the mean expulsion time was significantly less for misoprostol than IMN. For future, we can recommend misoprostol for complete evacuation of conception material during first trimester missed miscarriage.

Role of tamsulosin in the management of lower ureteric stone at tertiary care hospital in Western Rajasthan, India

Background: Many minimally invasive interventional techniques as well as expectant treatments exist for the management of lower ureteric calculi.Methods: 100 patients [group A (50 patients) patients given capsule tamsulosin 0.4mg, 1 daily up to 4 weeks while group B (50 patients) patients given regularly practiced treatment without Tamsulosin] with distal ureteric stone included in the study. Study duration was 6 months and study performed at S.P. Medical College. Bikaner, Rajasthan, India.Results: Group A showed a statistically significant advantage in terms of the stone expulsion rate. 41 patients (82%) in group A and 30 patients (60%) in group B expelled stones. Overall patients in group A had mean expulsion time of 7.86 days, whereas in group B mean expulsion time was 18.64 days. In group A stone expulsion rate was higher as compared to group B. In group A only 12 (24%) patients experienced pain relapses whereas in group B 32 (64%) patients reported pain relapses. The diclofenac dosage required in group A was observed to be 1.62 tablets whereas in group B it was 2.6 tablets.Conclusions: It is concluded that tamsulosin should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage.

Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones.

To evaluate the efficacy of sexual intercourse in expulsion of distal ureteric stones. The study included 56 patients with distal ureteric or intramural stone. The stones size ranged from 5 to 10mm and were detected by US, plain X-ray film, and non-enhanced CT. The patients were divided randomly into group A included 28 patients who were advised to do sexual intercourse 3-4 times/week with administration of symptomatic treatment, and group B included 28 patients receiving symptomatic treatment only (control group) and were instructed not to do sexual intercourse or masturbation during the study. Follow-up (4weeks) was done by plain X-ray, US, and urine analysis every week and by asking the patients about stone passage, time of expulsion, number of colicky attacks, and analgesic injections. Group A patients mean age was 36.5±10.7years and group B 37.3±12.5years. Stone expulsion rate, in the first 2weeks for group A, was 82% (23/28), while in group B 53% (16/28), (P=0.006). At the fourth week, expulsion rate for group A reached to 89%, but in group B 71.4%. The mean expulsion time was shorter in group A (11.9±4.4days) than group B (16.2±6.7days). The number of colicky attacks and analgesics for group A was less than group B. Practicing sexual intercourse for 3-4 times/week for married male patients with distal ureteric stone (5-10mm) increases the expulsion rate and decreases the frequency of renal colic and the needs for analgesic.

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

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.

English

INTRODUCTION: Urolithiasis is a common condition that affects approximately 5% to 10% of the population and the incidence of Urolithiasis is rising. Ureteric stones account for 20% of urinary tract stones and about 70% of them are found in the lower third of the ureter at presentation. Recent literatures show the efficacy of various drugs and minimally invasive procedures for the management of lower third ureteral stones. We performed a randomized, prospective study to assess and compare the efficacy of tamsulosin and silodosin as medical expulsive therapy for lower third ureteral stones. SETTING AND DURATION: Department of Surgery, Hassan Institute of Medical Sciences/ Teaching Hospital, Hassan. from August 2013 to August 2014. MATERIALS AND METHODS: The prospective data of 60 symptomatic patients with unilateral, lower third ureteral calculi of less than ≤10 mm were randomly allocated for out- patient treatment with tamsulosin and silodosin groups Patients aged ≥ 18 years with a single, unilateral, symptomatic, radio-opaque ureteric stone of 10 mm or smaller in the largest dimension located between the lower border of the sacroiliac joint and vesico-ureteric junction were included. For Group I tamsulosin a daily single dose of 0.4 mg for 28days and for Group II a daily single dose of silodosin 8mg was given. Nonsteroidal anti-inflammatory drugs were used on demand for both the groups. All the patients were told to observe passage of stone by filtering urine stream. The primary end point was the expulsion of the stone and the secondary end points were expulsion time, analgesic use, socioeconomic status, need for hospitalization, endoscopic treatment and drug side effects were documented. RESULTS: The stone expulsion rates in patients treated with tamsulosin and silodosin were 83.3% and 86.6% respectively. Mean stone expulsion times in tamsulosin group and silodosin group were 6.8 and 6.2 days respectively. Mean number of pain episodes were 1.5 and 1.4 in the tamsulosin and silodosin group respectively. The mean number of analgesic requirement was 1.0 and 0.8 for the tamsulosin and silodosin group, respectively with no significant difference. Overall, incidence of side effects was similar in both groups. Patients taking silodosin experienced a higher incidence of retrograde ejaculation but a lower incidence of side effects related to peripheral vasodilation when compared to patients taking tamsulosin. Sub-group analysis shows, higher expulsion rates but lower mean expulsion time and pain episodes for stones ≤ 5 mm with both tamsulosin and silodosin groups. The total number of patients from lower socioeconomic status was more than 50% in this study and expulsion rates were better than with patients of higher socio-economic status with tamsulosin is 89 % and silodosin is 94%. There was higher expulsion rates in patients with stones ≤ 5 mm and this was true for both patients treated with tamsulosin 13(92.8%) and silodosin 14(93.3%). However the difference was not statistically significant. Most trials on MET for lower ureteric stones with tamsulosin demonstrated significant lower mean number of pain episodes with respect to placebo (1, 9, 21-23). Results from the present study in terms of mean number of pain episodes and need for

Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion

We evaluated the efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) in patients with distal ureteral stone. In addition, we tried to determine the predictive value of Hounsfield Unit (HU) of the stone in the success of MET. A total of 75 patients with a distal ureteral stone of 5–10 mm diameter were randomly divided into three groups. Group 1 (n = 25) received tamsulosin 0.4 mg/d; group 2 (n = 25) received nifedipine 10 mg/day p.o and group 3 (n = 25) received diclofenac sodium 50 mg p.o. when required. At the beginning of each treatment, the HU of the stone was also measured using a non-contrast computerized tomography in all the patients. The results were evaluated at week four. The mean age of the patients was 36.8 (range, 16–68) years. Stone expulsion was observed in 19 (76%) patients in group 1, 16 (64%) patients in group 2 and 9 (36%) patients in group 3 (pgroup1-3 = 0.004, pgroup2-3 = 0.048 and pgroup1-2 = 0.355). The mean expulsion time was 9, 9.1 and 10.3 d, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.619). The mean diclofenac sodium dose per patient was 544, 602 and 1408 mg in groups 1, 2 and 3, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.977). The mean HU of the stone in patients with and without a successful MET was 363 and 389, respectively (p = 0.462). Our results showed that MET with both nifedipine and tamsulosin provided a similar increase in the expulsion rate for distal ureteral stones. HU does not seem to be a predictive parameter for stone expulsion.

The efficacy of tamsulosin vs. nifedipine for the medical expulsive therapy of distal ureteric stones: A randomised clinical trial

ObjectivesTo assess and compare, in a randomised clinical trial, the efficacy of tamsulosin and nifedipine as medical expulsive therapy for distal ureterolithiasis. Patients and methodsIn all, 128 symptomatic patients with stones in the juxtavesical tract of the ureter were randomly divided into group 1 (64 patients) receiving oral nifedipine sustained-release 30mg/day, and group 2 (64 patients) receiving tamsulosin 0.4mg/day. Both groups received oral prednisolone 30mg/day for 10days and diclofenac 75mg intramuscularly on demand. Patients were assessed by weekly ultrasonography with or with no abdominal computed tomography, during a follow-up of 4weeks. The stone passage rate and time, analgesic use, hospitalisation and endoscopic interventions were evaluated. The results were analysed statistically using appropriate tests. ResultsThe stone expulsion rate was 55% for group 1 and 80% for group 2 (P=0.004). The mean stone size was 8.59 and 8.85mm in groups 1 and 2, respectively. The mean expulsion time was 23days for group 1 and 9days for group 2 (P<0.001). The mean number of diclofenac injections was 1.19 for group 1 and 0.42 for group 2 (P<0.001). Eleven patients in group 1 vs. two in group 2 were hospitalised (P=0.001). Twenty-six patients in group 1 and 13 in group 2 underwent ureteroscopy (P<0.001). ConclusionsMedical expulsive therapy with tamsulosin should be considered as a first-line treatment for index cases of distal ureterolithiasis with no complications. The use of tamsulosin provides better stone expulsion than does nifedipine.

Combined oral and vaginal misoprostol use in therapeutic terminations at 14 to 28 weeks of gestation

This study involved an investigation of the effectiveness and complications of oral and vaginal misoprostol use on the termination of second trimester pregnancies. A total of 103 cases were recruited from the medical records of the Gynecology and Obstetrics Clinic of Taksim Research and Training Hospital and AžA±rnak A°dil State Hospital. Women underwent therapeutic termination of pregnancy between the 14 to 28th week of gestation using the defined combined misoprostol regimen. After the women were admitted, 200 μg vaginal (100 μg intracervical, 100 μg into the posterior fornix), 200 μg oral doses and 200 μg of sequential doses were administered in the 2nd and 4th hour. Subjects were excluded from the study if they were out of the defined gestational weeks using additional drugs with misoprostol; their data has not been recorded in detail. Of the 103 cases, 86 had an abortion within 24 h and the mean expulsion time was calculated as 15.42 ± 7.14 h (min 6.39 to max 20.03) in this group. The success rate for the 24 h was found to be 83.4%. Six more cases had an abortion when the second dose was given. The mean expulsion time was found to be 9.31 ± 3.26 h (min 6.45 to max 13.21) for the second 24 h. The success rate over 48 h rose to 89.3%. The total expulsion time was 18.30 ± 8.74 h. There was a history of previous caesarean sections in 2 out of 11 cases that did not have an abortion and one of these cases underwent a hysterotomy. The pregnancy was terminated by evacuation and curettage, as abortion did not occur despite 3 different high dose misoprostol regimens as in the other cases. Pregnancies of the remaining 9 cases were terminated with different misoprostol doses, oxytocin infusion and the evacuation and curettage method. When complication rates were evaluated, analgesic requiring pain (18.4%) was the leading complication, followed by nausea (11.6%), fever (7.7%), headaches and dizziness (5.8%), transfusion-requiring haemorrhage (3.8%) and diarrhea (1.9%). Uterine rupture or death did not occur. A combined misoprostol regimen is relatively safe with acceptable side effects when used carefully for the termination of second trimester pregnancies. Keyword: Misoprostol, Pregnancy Trimester. Second, Termination of Pregnancy, Mean Expulsion Time, Medical Termination, Vacuum Curettage, Side Effects

Tamsulosin and doxazosin as adjunctive therapy following shock-wave lithotripsy of renal calculi: randomized controlled trial

Alpha-blockers have been established as medical expulsive therapy for urolithiasis. We aimed to assess the effect of tamsulosin and doxazosin as adjunctive therapy following SWL for renal calculi. We prospectively included 150 patients who underwent up to four SWL sessions for renal stones from June 2008 to 2009. Patients were randomized into three groups of 50 patients each, group A (phloroglucinol 240 mg daily), group B (tamsulosin 0.4 mg once daily plus phloroglucinol), and group C (doxazosin 4 mg plus phloroglucinol). The treatment continued up to maximum 12 weeks. Patients were evaluated for stone expulsion, colic attacks, amount of analgesics and side-effects of alpha-blockers. There were no significant differences between the groups regarding stone expulsion rates (84; 92 and 90%, respectively). The mean expulsion time of tamsulosin was significantly shorter than both control group (p = 0.002) and doxazosin (p = 0.026). Both number of colic episodes and analgesic dosage were significantly lower with tamsulosin as compared to control and doxazosin. Steinstrasse was encountered in 10 (6.7%) patients with no significant difference between the groups. 16 patients on tamsulosin and 21 on doxazosin experienced adverse effects related to postural hypotension. Moreover, 2 (4%) patients in the tamsulosin group reported ejaculatory complaints. In conclusion, adjunction of tamsulosin or doxazosin after SWL for renal calculi decreases the time for stone expulsion, amount of the analgesics and number colic episodes. There was no benefit regarding the overall stone expulsion rate. The side-effects of these agents are common and should be weighted against the benefits of their usage.