Number Of Colic Episodes Research Articles

Role of low-dose deflazacort with tamsulosin versus tamsulosin alone for medical expulsive therapy of ureteric stone

Background: Urolithiasis is a common condition in daily urological practice. Medical Expulsive Therapy (MET) is non-invasive approach for removal of ureteric stone. In MET, alpha-blocker Tamsulosin is commonly used in treating urolithiasis but it does not address the pathology of inflammation presents in such condition. With addition of low dose Deflazacort as anti-inflammatory agent, there may have a potential to improve the pathology and outcome of the treatment. Aims and Objectives: This study aims to find the efficacy of low-dose deflazacort combined with tamsulosin in the MET for distal ureterolithiasis. Materials and Methods: This prospective randomized controlled trial was conducted from December 2022 to December 2023 in Rampurhat Government Medical College and Hospital. A total of 130 patients with ureteric stone ≤10 mm were randomized into two groups. Tamsulosin group received tamsulosin (0.4 mg once daily for 28 days). Deflazacort group received tamsulosin (0.4 mg once daily for 28 days) with deflazacort (12 mg once daily for 10 days). All subjects were reviewed on 14 days and 28 days. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic episodes, and hospitalization were recorded. Adverse effects of drugs were noted. Results: Among 130 patients randomized, 4 patients were lost to follow-up and 8 patients required early intervention. Deflazacort group had similar rate of stone expulsion (88% vs. 80%, P=0.548). There were significantly shorter expulsion time (10.15 days vs. 14.28 days, P<0.001) and less number of colic episodes (33 episodes vs. 21 episodes, P=0.026) and less analgesic requirements (65% vs. 82.5%, P=0.022) in deflazacort group. No significant side effects were noted during the study. Conclusion: Low-dose deflazacort added to tamsulosin provides a significant advantage in ureteric stone expulsion without any extra side effects. With a comparable rate of stone passage, there are more rapid stone expulsion, low analgesic requirement, and less colic episodes when low-dose deflazacort is added to tamsulosin for ureteric stone ≤10 mm.

Comparative Study between Tadalafil versus Tamsulosin versus Halphabarol with Terpenes Mixture as a Medical Expulsive Therapy for Lower Ureteric Stones

Abstract Background urolithiasis is a health problem of worldwide importance. Urolithiasis is the third most common urological disease affecting the urinary tract after urinary tract infections and prostatic diseases. Ureteral stones account for 20% of urolithiasis, and 70% of ureteral stones are located in the lower third of the ureter. Ureteric stones have great bearing on the health as well as quality of life of the patient. Aim of the Study to compare the efficacy of tadalafil (a phosphodiesterase-5 inhibitor), tamsulosin (an alpha-1blocker) and halphabarol (Proximol) with terpenes mixture (Rowatinex) as a medical expulsive therapy for lower ureteric stones. Patients and Methods this was a prospective randomized comparative study conducted on 60 patients between the ages of 20 and 40 years and complaining of unilateral single lower ureteric stone less than or equal to 8 mm presented through the outpatient clinics of Urology in Ain Shams University Hospitals and Damanhour Medical National Institute over a period of 10 months (from November 2017 to August 2018). The patients were randomly divided into 3 equal groups: Group A (20 patients were treated by tadalafil 5 mg once daily), Group B (20 patients were treated by tamsulosin 0.4 mg once daily) and Group C (20 patients were treated by Proximol with Rowatinex three times daily). Therapy was given for a maximum of 3 weeks. The patients were followed-up until stone passage or the end of the study period. Results the results of this study indicate that the stone expulsion rate was significantly higher in tadalafil group and tamsulosin group than Proximol with Rowatinex group (75% vs. 75% vs. 40%, P value = 0.030). Also, the mean stone expulsion time was significantly shorter in tadalafil group and tamsulosin group than Proximol with Rowatinex group (10.20 ± 3.91 days vs. 10.80 ± 3.64 days vs. 14.25 ± 3.28 days, P value = 0.046). The number of patients who experienced renal colic episodes, the number of colic episodes and the number of injectable analgesic uses were significantly lower in tadalafil group and tamsulosin group than Proximol with Rowatinex group (P value < 0.05). The number of follow up ureteroscopic procedures was significantly lower in tadalafil group and tamsulosin group than Proximol with Rowatinex group (25% vs. 25% vs. 60%, P value = 0.030). Also, the drugs are safe with mild few side effects. Conclusion PDE5 inhibitors (tadalafil) are equally efficacious to alpha-1 adrenergic antagonists (tamsulosin) in expulsion of lower ureteric stones less than or equal to 8 mm without any serious side effects. Comparing to Proximol with Rowatinex, both tadalafil and tamsulosin increase significantly the stone expulsion rate, decrease significantly the stone expulsion time and provide significant control of renal colicky pain, significantly less analgesic requirements and significantly lower follow up ureteroscopic procedures.

Comparative efficacy of tamsulosin versus tadalafil as medical expulsive therapy for distal ureteric stones.

Objective:The objective of this study was to compare the relative efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteric stones.Patients and Methods:This was a prospective study performed between December 2014 and February 2016. A total of 123 adult patients (>18 years of age) presenting with distal ureteric stones sized 6–10 mm were randomized to treatment with tamsulosin 0.4 mg once daily (Group A) or tadalafil10 mg once daily (Group B). Therapy was given for a maximum of 4 weeks. The stone expulsion rate was the primary endpoint. Time to stone expulsion, number of colic episodes, analgesic use, number of hospital visits for pain, endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done using Fisher's exact test and Chi-square test.Results:A total of 61 patients were included in tamsulosin group and 62 patients in tadalafil group. A statistically insignificant difference was found for stone clearance rate between both groups as a whole (Group A-73.77%, Group B-69.35%, P = 0.690) as well as when we considered both subgroups (A1-78.05%, B1-75.0%, P = 0.802; A2-65.0%, B2-55.6%, P = 0.741). All the primary and secondary outcome measures were more in favour of stones ≤8 mm size than stones >8 mm size. No statistical difference was found for adverse drug effects except for retrograde ejaculation, which was significantly high in tamsulosin group (P < 0.001).Conclusion:This study showed that although tamsulosin is more effective for stone clearance than tadalafil, but this difference was not significant (P = 0.690).

The effect of tamsulosin, an alpha-1 receptor antagonist as a medical expelling agent in success rate of ureteroscopic lithotripsy.

Background:Tamsulosin is an α-1A-specific blocker which induces selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen and facilitates stone expelling.Objectives:In this study we aimed to assess the efficacy of tamsulosin for improving the success rate of ureteroscopic lithotripsy (URS) for lower ureteral stones.Patients and Methods:In a prospective study by a randomized controlled clinical trial, which was performed from June 2008 to December 2010, we enrolled one hundred and forty-two subjects and eventually 102 patients completed the clinical trial. All the patients underwent ureteroscopic lithotripsy with the pneumatic wolf lithotripsy. The patients were randomly divided into 2 groups: the study group including 52 patients, received tamsulosin with our traditional treatment (hydration and analgesic when required), and the control group with 50 patients who received placebo with traditional treatment. The number of colic episodes, lower urinary tract symptoms, analgesic dosage, and days of spontaneous passage of the stones through the ureter were recorded in a diary after lithotripsy.Results:The results showed that tamsulosin treatment group had low expulsion time (P = 0.011), low urinary tract symptoms, least analgesic needs and low adverse effects, all with statistically significant differences comparable with the control group (P < 0.05).Conclusions:Administration of α-1A-specific blocker reduced analgesic dosage and colic episodes and rate of adverse effects after ureteroscopic lithotripsy of lower ureteral stones and decreased gravel expulsion time after URSL.

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.

Effectiveness of doxazosin in the management of lower ureteral stones in male and female patients

To evaluate the effectiveness of doxazosin on the rate of spontaneous passage of distal ureteral stones in female patients. A total of 80 patients with stones sized 10 mm or smaller, located in the distal part of the ureter, were included. They were divided into two groups, according to the gender. Patients were followed-up until passage of the stone or for a maximum of 3 weeks. The number of pain episodes, stone expulsion rate and time, and possible side effects of medications were recorded and compared in both groups. All patients completed the study. No statistically significant difference was observed regarding patient age, stone size, and stone location between the groups (P > 0.05). Stone expulsion occurred in 29 patients (72.5%) in group 1 and in 28 patients (70%) in group 2 (P = 0.35). Mean time to expulsion was 6.5 days (range 3-15 days) in the male arm and 7.5 days (range 4-17 days) in the female arm (P = 0.97). There were no differences between the groups in the number of colic episodes and analgesic use. Medical treatment of distal ureteral stones with doxazosin has similar stone passage rate, expulsion time, and safety in women compared with men.

A second cycle of tamsulosin in patients with distal ureteric stones: a prospective randomized trial

To evaluate, in a prospective randomized pilot study, the effectiveness and safety of tamsulosin, administered in patients with distal ureteric stones and who have already undergone an unsuccessful first cycle of medical expulsive therapy (MET). We evaluated the effectiveness and safety of tamsulosin, administered as a further therapy, in patients previously unsuccessfully treated with combined expulsive 10-day therapy (tamsulosin + deflazacort) for distal ureteric stones. Ninety-one patients were enrolled and randomized into two groups, each receiving a different therapy for 10 days. Group A (46 patients) received a further cycle of tamsulosin (0.4 mg daily), and group B (45) did not. Age, gender, stone size, time to expulsion, number of acute episodes of colic during treatment and analgesic consumption were recorded. Patients who were not stone-free after the study period had ureteroscopy. The results were compared statistically using Student's t-, chi-square test and Fisher's exact test. The groups were comparable in age, gender and stone size (5.93 mm for group A and 6.03 mm for group B). The expulsion rate was significantly higher in group A (80%) than in group B (49%) (P < 0.01), whilst there were no differences between the groups in the number of colic episodes and analgesic use. There were no reported side-effects of medical therapy. A second cycle of 10 days of MET with tamsulosin in nonresponders to a 10-day first cycle of MET with tamsulosin and deflazacort is safe and effective, and therefore should be considered as an option in the management of uncomplicated distal ureteric stones.

A SECOND CYCLE OF TAMSULOSIN IN PATIENTS WITH DISTAL URETERIC STONES: A PROSPECTIVE RANDOMIZED TRIAL

BJU InternationalVolume 103, Issue 12 p. 1738-1738 A SECOND CYCLE OF TAMSULOSIN IN PATIENTS WITH DISTAL URETERIC STONES: A PROSPECTIVE RANDOMIZED TRIAL Gianluca Giannarini, Gianluca Giannarini Departments of Urology, University of Pisa, Pisa, and Second University of Naples, Naples, ItalySearch for more papers by this authorRiccardo Autorino, Riccardo Autorino Departments of Urology, University of Pisa, Pisa, and Second University of Naples, Naples, ItalySearch for more papers by this author Gianluca Giannarini, Gianluca Giannarini Departments of Urology, University of Pisa, Pisa, and Second University of Naples, Naples, ItalySearch for more papers by this authorRiccardo Autorino, Riccardo Autorino Departments of Urology, University of Pisa, Pisa, and Second University of Naples, Naples, ItalySearch for more papers by this author First published: 27 May 2009 https://doi.org/10.1111/j.1464-410X.2009.08641_1.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume103, Issue12June 2009Pages 1738-1738 RelatedInformation

Adjunctive Medical Therapy with an α-1A-Specific Blocker after Shock Wave Lithotripsy of Lower Ureteral Stones

Introduction: We assessed the efficacy of using an α-1A-specific blocker for improving the success rate in shock wave lithotripsy (SWL) for lower ureteral stones. Materials and Methods: This prospective study was conducted from June 2005 to December 2006 and involved 107 patients. All the patients underwent SWL with the PCK Stonelith. The patients were randomly divided into 3 groups: group 1 (34 patients) received tamsulosin, group 2 (35 patients) received terazosin, and group 3 (38 patients) received placebo. All patients were diagnosed by kidney-ureter-bladder X-ray, abdominal ultrasonography and intravenous urography. The number of colic episodes, lower urinary tract symptoms, analgesic dosage and days for spontaneous passage of the stones through the ureter were recorded by diary. Statistical analyses were performed using ANOVA, the χ² test, Fisher’s exact test and the non-parametric Wilcoxon 2-sample t test. Results: There were no differences between the groups regarding age, stone size, expulsion time and expulsion rate. The number of colic episodes and the analgesic dosage were significantly lower in group 1 compared with groups 2 and 3. A statistically significant difference was observed in lower urinary tract symptoms: lower urinary tract symptoms were observed in 4 of 34 patients in group 1 (12%), in 8 of 35 in group 2 (23%), and in 13 of 38 in group 3 (34%). Adverse effects were noted in 5 of 32 patients in group 2 (16%), which was significantly different in comparison with group 3. Conclusions: Administration of an α-1A-specific blocker reduced analgesic dosage and colic episodes after SWL of lower ureteral stones. There was no benefit with regard to increasing stone expulsion rate or decreasing expulsion time.

Efficacy of an α1 Blocker in Expulsive Therapy of Lower Ureteral Stones

To evaluate the clinical role of an alpha(1a-1d)-specific blocker in the medical expulsive therapy of symptomatic lower ureteral stones. This prospective study was carried out from May 2005 to December 2006 and involved 95 patients. All patients, who had symptomatic lower ureteral stones <10 mm diameter, were enrolled in this prospective study, and were randomly divided into three groups using the statistical software programs Plus 1.0 and Plus 2.10. Group 1 (32 patients) received tamsulosin (0.4 mg daily), group 2 (32 patients) received terazosin (2 mg daily), group 3 (31 patients) acted as controls. All patients were diagnosed with x-rays of the kidneys, ureters, and bladder, urinary ultrasonography, and intravenous urography. All patients received the same analgesic regimen and sublingual buprenorphine on demand. The number of colic episodes, lower urinary tract symptoms, analgesic dosages, and the number of days required for spontaneous passage of the stones were all recorded in a diary. Expulsion was observed in 26 of 32 patients in group 1 (81%), 25 of 32 in group 2 (78%), and 17 of 31 in group 3 (55%). The average expulsion time for groups 1, 2, and 3 were 6.3, 6.3, and 10.1 days, respectively. Mean analgesic dosage per patient in groups 1, 2, and 3 were 231, 256, and 347 mg, respectively. A statistically significant difference was observed between groups 1 and 2 with respect to group 3 for all three of these parameters. Adverse effects were also seen in 5 of 32 patients in group 2 (16%), a statistically significant difference with regard to groups 1 and 3. Medical treatment with alpha(1a-1d)-blocker proved to be safe and effective as demonstrated by the increased stone expulsion rate and reduced expulsion time, as well as the need for analgesics.