Passage Of Distal Ureteral Stones Research Articles

Effect of Silodosin in the Treatment of Distal Ureteral Stone

Background: Ureteral stones are a common type of urinary tract stones, accounting for 20% of all cases. The majority of these stones, approximately 70%, are located in the distal ureter. Recent studies have shown that α1- Adrenergic blockers can enhance the spontaneous passage of distal ureteral stones. Objectives: This study was done to compare the outcomes of treating distal ureteral stone with Silodosin, an α1- A adrenergic blocker, versus without Silodosin. Materials and Methods: A total of 70 patients aged between 18 and 50 years, diagnosed with distal ureteral stone, were enrolled in the study, which took place at the Department of Urology, Dhaka Medical College, from October 2017 to March 2019. The patients were divided into two groups: Group A and Group B. Group A consisted of 35 patients who were instructed to drink 3 litres of water daily, while Group B received the same instruction and also received Silodosin 8 mg/day. The treatment duration was four weeks, during which patients were monitored weekly through history, serum creatinine levels, X-ray KUB, and ultrasonogram of KUB. The number of stone expulsions, duration of spontaneous stone passage through the ureter, analgesic dosages, and adverse effects were recorded. Results: The higher expulsion rate in Group B (91.4%) compared to Group A (71.4%) (P=0.031). The mean expulsion duration was significantly shorter in Group B (8.94±3.58 days) compared to Group A (13.08±7.26 days) (P<0.00298). Additionally, Group B required significantly lower analgesic dosages (115.71±75.51 mg) compared to Group A (255.71±108.31 mg) (P=0.00001). No adverse effects were observed in Group A, while two patients in Group B experienced adverse effects (retrograde ejaculation and postural hypotension). Conclusion: These results indicate that 8 mg/day of silodosin facilitates the expulsion of distal ureteral stone of about 5 to 10 mm in diameter in the largest dimension and significantly reduces the number of analgesic dosages.

Ultrasound to facilitate passage of distal ureteral stones

Feasibility of ultrasonic propulsion and burst wave lithotripsy (BWL) to noninvasively reposition distal ureteral stones to facilitate passage and relieve pain was tested. Patients presenting to the clinic or emergency department were recruited. Thirteen subjects underwent ultrasonic propulsion (lower amplitude, longer duration pulses) alone, and 10 subjects also received intermittent BWL (higher amplitude, shorter duration pulses). All participants were awake and underwent a pain assessment pre- and post-procedure. For analysis, subjects were sub-categorized based on whether their stone was acute or chronic (present for ≤10 days or >10 days from their initial ED or symptomatic presentation, respectively). Seventeen subjects were enrolled in the acute study population and 6 subjects were enrolled in the chronic population. Overall, 94% of acute stones passed in an average of 3.4 days post-procedure relative to 54% in 7.5 days in the American Urological Association guidelines. 67% of chronic cases passed stones or fragments, and two surgeries were cancelled. Pain reduction was statistically significant ( p = 0.0215). Adverse events were limited to hematuria on initial urination post-procedure (BWL only, n = 3) and a mild sensation, akin to a pinprick, associated with fewer than 10 of 620 propulsion bursts ( n = 3). [Work supported by NIH-P01-DK04331.]

MP18-07 ULTRASOUND TO REPOSITION AND ACCELERATE PASSAGE OF DISTAL URETERAL STONES

You have accessJournal of UrologyStone Disease: Surgical Therapy II (MP18)1 Sep 2021MP18-07 ULTRASOUND TO REPOSITION AND ACCELERATE PASSAGE OF DISTAL URETERAL STONES M. Kennedy Hall, Jeff Thiel, Patrick C. Samson, Ross Kessler, Peter Sunaryo, Robert M. Sweet, Ian S. Metzler, Martin L. Gunn, Layla Anderson, Barbrina Dunmire, Christina Popchoi, Ravi Managuli, Bryan W. Cunitz, Barbara Burke, Adam D. Maxwell, Michael R. Bailey, Mathew D. Sorensen, Hunter Wessells, and Jonathan D. Harper M. Kennedy HallM. Kennedy Hall More articles by this author , Jeff ThielJeff Thiel More articles by this author , Patrick C. SamsonPatrick C. Samson More articles by this author , Ross KesslerRoss Kessler More articles by this author , Peter SunaryoPeter Sunaryo More articles by this author , Robert M. SweetRobert M. Sweet More articles by this author , Ian S. MetzlerIan S. Metzler More articles by this author , Martin L. GunnMartin L. Gunn More articles by this author , Layla AndersonLayla Anderson More articles by this author , Barbrina DunmireBarbrina Dunmire More articles by this author , Christina PopchoiChristina Popchoi More articles by this author , Ravi ManaguliRavi Managuli More articles by this author , Bryan W. CunitzBryan W. Cunitz More articles by this author , Barbara BurkeBarbara Burke More articles by this author , Adam D. MaxwellAdam D. Maxwell More articles by this author , Michael R. BaileyMichael R. Bailey More articles by this author , Mathew D. SorensenMathew D. Sorensen More articles by this author , Hunter WessellsHunter Wessells More articles by this author , and Jonathan D. HarperJonathan D. Harper More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002003.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The feasibility of ultrasonic propulsion and burst wave lithotripsy (BWL) to noninvasively reposition distal ureteral stones to facilitate passage and relieve pain was tested. METHODS: Patients presenting to the kidney stone clinic or emergency department (ED) with a distal ureteral stone were recruited after standard of care pain management. To attempt to move the stone, 10 subjects underwent ultrasonic propulsion (lower amplitude, longer duration bursts) alone, and 10 subjects also received intermittent BWL (higher amplitude, shorter duration bursts). All participants were awake without anesthesia and underwent:· a screening ultrasound to ensure the stone was visible· a pain assessment pre- and post-procedure · contact once a week for three weeks to assess for adverse events· follow-up imaging and chart review within 12 weeksSubjects were sub-categorized based on whether their stone was acute or chronic (≤10 days or >10 days from their ED visit, respectively). RESULTS: Demographic data and effectiveness outcomes are presented in Tables 1 and 2. Overall, 93% of acute stones passed in an average of 3.6 days post-procedure. There was no control group, but Table 2 includes published passage rates and times for potentially similar untreated groups as reference. Stone motion was observed in 16 of 20 cases, including a stone pushed into the bladder, ureteral jets were observed following propulsion bursts in 9 of 20 cases and fragmentation was observed in 3 of 10 BWL cases. Pain reduced post-procedure in 10 of 20 subjects, while pain increased in only one subject; although, the average score was low prior to treatment, and the average decrease was not statistically significant (p=0.13). Adverse events were limited to slight reddening of the skin (N=6), hematuria on only the initial urination post-procedure (BWL only, N=3), and a mild sensation, akin to a pinprick, on fewer than 10 of 620 propulsion bursts among 3 subjects. CONCLUSIONS: This feasibility study showed the potential for facilitating stone passage of distal ureteral stones and relieving pain with ultrasonic propulsion and BWL. Source of Funding: Work supported by NASA, NIH P01 DK043881, and NIH K01 DK104854 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e320-e320 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information M. Kennedy Hall More articles by this author Jeff Thiel More articles by this author Patrick C. Samson More articles by this author Ross Kessler More articles by this author Peter Sunaryo More articles by this author Robert M. Sweet More articles by this author Ian S. Metzler More articles by this author Martin L. Gunn More articles by this author Layla Anderson More articles by this author Barbrina Dunmire More articles by this author Christina Popchoi More articles by this author Ravi Managuli More articles by this author Bryan W. Cunitz More articles by this author Barbara Burke More articles by this author Adam D. Maxwell More articles by this author Michael R. Bailey More articles by this author Mathew D. Sorensen More articles by this author Hunter Wessells More articles by this author Jonathan D. Harper More articles by this author Expand All Advertisement Loading ...

Is Medical Therapy for Distal Ureteral Stones Efficient? Tamsulosin versus Deflazacort: A Prospective Randomised Trial.

To evaluate the efficacy of tamsulosin and deflazacort in the spontaneous expulsion of distal ureteral stones when applied in an independent or combined manner. 134 patients with distal ureteral stones (4 - 10 mm) were included in tothe study. All patients were randomized into four groups: group 1 (n = 37) patients receiving tamsulosin (0.4 mg/day); group 2 (n = 26) patients receiving deflazacort (30 mg/day); group 3 (n = 37) patients receiving combined treatment (tamsulosin and deflazacort) with the same dosages; and group 4, control group cases (n = 34), receiving paracetamol on demand. Although deflazacort treatment was limited to 10 days due to the possible associated side effects, α-blocker and paracetamol lasted up to four weeks. Patients were followed up on a weekly basis and at the end of four weeks all groups were compared primarily with respect to the stone expulsion rates. No statistically significant difference was noted between all groups regarding the age, sex, or stone burden (p > 0.05). Spontaneous stone expulsion rates after 4 weeks were 64.8 %, 69.2 %, 75.7 %, and 26.4 % in group 1, 2, 3, and 4 respectively. Spontaneous passage rates were statistically higher in all treatment groups when compared with the control group. Despite the highest spontaneous stone expulsion rate noted in group 3; this difference was not statistically significant when compared with the group 1 and 2. No major side effect related to the medications was observed. Tamsulosin facilitated the spontaneous passage of distal ureteral stones < 10 mm in size in an effective manner particularly when applied in combination with an oral corticosteroid.

PD23-07 PELVIC DIGITAL TOMOSYNTHESIS FOR THE EVALUATION OF DISTAL URETERAL CALCULI: ORGAN SPECIFIC DOSES AND EFFECTIVE DOSE COMPARED WITH NON-CONTRAST COMPUTED TOMOGRAPHY

INTRODUCTION AND OBJECTIVES:Follow-up imaging to confirm passage of distal ureteral stones represents a dilemma in the outpatient setting. We have previously published on the substantial radiation ...

Medical Expulsive Therapy

Medical expulsive therapy (MET) for ureteral stones involves the administration of pharmaceutical agents to facilitate passage of stones by ideally increasing the rate of passage and reducing time for expulsion. Several medications have been studied for this use. The most commonly studied off-label medications include α1-antagonists and calcium channel blockers. This article reviews the data available for the use of MET and controversies in the use of medications to aid stone passage based on more recent randomized controlled trials and meta-analyses. Based on the latest guidelines, α-blockers have been the most studied medication type and may have some benefit in the passage of distal ureteral stones greater than 4 mm in size. This review contains 2 figures and 34 references. Keywords: α1-antagonists, α-blockers, calcium channel blockers, medical expulsion therapy, phosphodiesterase inhibitors, ureteral stones

Silodosin: An Update on Efficacy, Safety and Clinical Indications in Urology.

Silodosin determines smooth muscle relaxation in bladder and prostate tissues, increases bladder blood flow in conditions of chronic bladder ischemia and regulates the activity of transcriptional factors responsible for stromal growth and prostate hyperplasia. Phase III trials have already demonstrated the efficacy and safety of silodosin in the treatment of patients bothered by lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). We aimed to describe the rationality for the use of silodosin and to summarize the current literature on the use of Silodosin for the treatment of LUTS. PubMed and Web of Science were queried with the terms: 'silodosin' in combination (AND) with the terms 'lower urinary tract symptoms', 'LUTS', 'pathophysiology', 'symptoms' OR 'therapy'. Studies published in the last 10years (2007-2017) in adults and core clinical journals in English were included. Silodosin 8mg once-daily was superior to placebo in improving IPSS total score, voiding subscore, storage subscore and QoL score, and at least as effective as tamsulosin 0.4mg once-daily in all the efficacy analyses. In addition, studies assessing the effect on urodynamic parameters showed that silodosin determined a higher improvement in the bladder outlet obstruction index compared to other alpha1 adrenergic receptor antagonists. Concerning the safety profile, long-term data (after 9months of treatment) confirmed the limited effect of silodosin on the cardiovascular and gastrointestinal systems. Although ejaculatory disorders represented the main complaint of patients taking silodosin, the discontinuation rate due to this condition remained low even in a long-term follow-up study (7.5%). Encouraging findings showed that silodosin may be administered as a medical expulsive therapy for promoting spontaneous stone passage of distal ureteral stones < 10mm, to relieve LUTS in patients who underwent prostate cancer brachytherapy and to increase the likelihood of successful trials without a catheter in patients experiencing acute urinary retention. Silodosin is one of the drugs approved for the treatment of BPH, being highly effective in improving not only LUTS but also urodynamic parameter impairments secondary to BPH. Moreover, it has shown efficacy as medical expulsive therapy for distal ureteral stones in previous prospective randomized trials. Sponsorship for this study and article processing charges were funded by Recordati.

Can Ureteral Jet Flow Measurement Predict Spontaneous Passage of Distal Ureteral Stones?

Objectives: The study aimed to investigate the relationship between the spontaneous passage of distal ureteral stones and ureteral jet flow measurement. Methods: The study included 74 patients with acute renal colic between June 2015 and June 2016, and distal ureteral stones of 10 mm or less in a non-contrast CT were comprised in a prospective study. The ureteral jet was measured by Doppler ultrasonography. At the fourth week follow-up, kidney-ureter-bladder radiography was taken and the patients who no longer had a stone were considered to have spontaneously passed it. Results: The average stone size of the patients was 5.6 ± 2.0 mm. After 4 weeks of follow-up, 55 patients (74.3%) had passed the stone spontaneously whereas 19 (25.6%) had not. The patients in the former group were found to have a higher peak flow velocity of ureteral jet on the stone side than those in the latter group. In regression analysis ureteral jet on the stone side was independently associated with spontaneous passage (p = 0.027). For the spontaneous passage, a ureteral jet flow peak velocity above 15.25 cm/s had an 85.4% sensitivity and 63.1% specificity. Conclusions: Measurement of the ureteral jet flow peak velocity can be beneficial in predicting the potential spontaneous passage of distal ureteral stones.

Efficacy and Safety of Tamsulosin in Medical Expulsive Therapy for Distal Ureteral Stones with Renal Colic: A Multicenter, Randomized, Double-blind, Placebo-controlled Trial

BackgroundRecent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones. ObjectiveTo evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo. Design, setting, and participantsWe conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin. InterventionParticipants were randomly assigned (1:1) into tamsulosin (0.4mg) or placebo groups for 4 wk. Outcome measurements and statistical analysisThe primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events. Results and limitationsAmong 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; p<0.001) for distal ureteral stones. Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones (>5mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (p<0.001), required lower use of analgesics compared with placebo (p<0.001), and significantly relieved renal colic (p<0.001). No differences in the incidence of adverse events were identified between the two groups. ConclusionsOur data suggest that tamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5mm, but no effect for stones ≤5mm. Patient summaryIn this report, we looked at the efficacy and safety of tamsulosin for the treatment of distal ureteral stones. We find that tamsulosin significantly facilitates the passage of distal ureteral stones and relieves renal colic.

Editorial Comment

The prevalence of urolithiasis in the United States has steadily increased over the past several years. 1 Scales Jr., C.D. Smith A.C. Hanley J.M. et al. Prevalence of kidney stones in the United States. Eur Urol. 2012; 62: 160 Abstract Full Text Full Text PDF PubMed Scopus (1468) Google Scholar The morbidity caused by stone disease is similarly significant, as 30% of patients diagnosed with stone disease report loss of work associated with the diagnosis. 2 Pearle M.S. Calhoun E.A. Curhan G.C. et al. Urologic diseases in America project: urolithiasis. J Urol. 2005; 173: 848 Abstract Full Text Full Text PDF PubMed Scopus (627) Google Scholar Furthermore, when medical expulsive therapy is unsuccessful, procedural intervention often presents a significant financial burden to both the patient and practice. 3 Tosoian J.J. Ludwig W. Sopko N. et al. The effect of repair costs on the profitability of a ureteroscopy program. J Endourol. 2015; 29: 406-409 Crossref PubMed Scopus (31) Google Scholar As such, and in light of health care reform with greater focus on financial responsibility, the potential therapeutic effect of lifestyle modifications such as diet and exercise remains an important consideration. 4 Hyams E.S. Matlaga B.R. Cost-effectiveness treatment strategies for stone disease for the practicing urologist. Urol Clin North Am. 2013; 40: 129 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar In the accompanying article, Doluoglu et al 5 Doluoglu O.G. Demirbas A. Kilinc M.F. et al. Can sexual intercourse be an alternative therapy for distal ureteral stones? A prospective, randomized, controlled study. Urology. 2015; 86: 19-24 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar hypothesize that sexual intercourse may facilitate the passage of distal ureteral stones via a nitric oxide–mediated pathway. Specifically, the authors propose that nitric oxide released in high concentrations in cavernous tissue during erection and intercourse may be released in the distal ureter as well, triggering relaxation of ureteral muscle. Indeed, previous studies have identified nitrergic fibers in the distal ureter and demonstrated a relaxant effect of NO on ureteral smooth muscle. 6 Yucel S. Baskin L.S. Neuroanatomy of the ureterovesical junction: clinical implications. J Urol. 2003; 170: 945 Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar , 7 Iselin C.E. Ny L. Larsson B. et al. The nitric oxide synthase/nitric oxide and heme oxygenase/carbon monoxide pathways in the human ureter. Eur Urol. 1998; 33: 214 Crossref PubMed Scopus (26) Google Scholar Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled StudyUrologyVol. 86Issue 1PreviewTo investigate the effect of sexual intercourse on spontaneous passage of distal ureteral stones. Full-Text PDF

Can Sexual Intercourse Be an Alternative Therapy for Distal Ureteral Stones? A Prospective, Randomized, Controlled Study

To investigate the effect of sexual intercourse on spontaneous passage of distal ureteral stones. The patients were randomly divided into 3 groups with random number table envelope method. Patients in group 1 were asked to have sexual intercourse at least 3-4 times a week. Patients in group 2 were administered tamsulosin 0.4 mg/d. Patients in group 3 received standard medical therapy alone and acted as the controls. The expulsion rate was controlled after 2 and 4 weeks. Differences in the expulsion rate between groups were compared with the chi-square test for 3 × 2 tables. P <.05 was considered as statistically significant. The mean stone size was 4.7 ± 0.8 mm in group 1, 5 ± 1 mm group 2, and 4.9 ± 0.8 mm group 3 (P = .4). Two weeks later, 26 of 31 patients (83.9%) in the sexual intercourse group, and 10 of 21 patients (47.6%) in tamsulosin group passed their stones, whereas 8 of 23 patients (34.8%) in the control group passed their stones (P = .001). The mean stone expulsion time was 10 ± 5.8 days in group 1, 16.6 ± 8.5 days in group 2, and 18 ± 5.5 days in group 3 (P = .0001). Our results have indicated that patients who have distal ureteral stones ≤6 mm and a sexual partner may be advised to have sexual intercourse 3-4 times a week to increase the probability of spontaneous passage of the stones.

389 The efficacy of tamsulosin (tams) alone vs corticosteroids alone vs tamsulosin + corticosteroids in determining the spontaneous passage of distal ureteral stones: Results of a prospective study

389 The efficacy of tamsulosin (tams) alone vs corticosteroids alone vs tamsulosin + corticosteroids in determining the spontaneous passage of distal ureteral stones: Results of a prospective study

Silodosin to Facilitate Passage of Ureteral Stones: A Multi-institutional, Randomized, Double-blinded, Placebo-controlled Trial

BackgroundUsing a selective α-blocker for medical expulsive therapy (MET) is a cost-effective treatment approach widely used for ureteral stones. ObjectiveTo evaluate the efficacy of silodosin, a selective α-1a receptor antagonist, in this setting. Design, setting, and participantsThis was a multicenter, phase 2 study conducted in adult patients with a unilateral ureteral calculus of 4–10mm. Of 239 patients in the safety population, six discontinued due to adverse events. InterventionPatients were randomized 1:1 to receive silodosin 8mg or placebo for up to 4 wk. Outcome measurements and statistical analysisThe primary outcome was spontaneous stone passage, analyzed using logistic regression. Secondary outcomes included time to stone passage, emergency room (ER) visits, hospital admissions, analgesic use, and incidence and severity of pain. Results and limitationsNo significant differences between the silodosin and placebo groups were observed for passage rate of all stones (52% vs 44%, respectively; p=0.2). However, silodosin achieved a significantly greater rate of distal ureter stone passage than placebo (p=0.01). Significant differences were not observed for ER visits, hospital admission, or use of analgesics. The number of patients in the intent-to-treat population was slightly below the calculated sample size (232 vs 240) and sample sizes were not calculated for subgroup analyses. ConclusionsThis is among the first prospective, randomized, multi-institutional trials to examine the efficacy of a selective α-1a antagonist as MET in patients with ureteral calculi and did not demonstrate a benefit to the entire ureter. However, silodosin was found to be well tolerated and beneficial in facilitating the passage of distal ureteral stones, warranting additional future studies on distal stone elimination. Patient summaryIn this report, we looked at the efficacy of silodosin for the treatment of ureteral stones. We found that silodosin increased passage of distal ureteral stones.

The effect of smoking on spontaneous passage of distal ureteral stones

BackgroundAnimal studies have shown that nicotine affects the peristalsis of the ureter. The aim of the study is to analyze the effect of smoking on spontaneous passage of distal ureteral stones.Methods88 patients in whom distal ureteral stone below 10 mm diameter diagnosed with helical computerized tomography enhanced images were reviewed. Patients were grouped as either smokers (n:33) or non smokers (n:50). Follow-up for spontaneous passage of stones was limited with 4 weeks. Patients did not receive any additional medical treatment other than non-steroid anti inflamatory drugs only during painful renal colic episodes.Two groups were compared with the chi-square test in terms of passing the stone or not. Stone passage was confirmed with either the patient collecting the stone during urination or by helical CT.ResultsSmoking habits was present in 30(34%) patients and the frequency in both groups were similar (smokers: 23(76%) vs non-smokers: 46(79%)). Spontaneous passage of the stone was observed in 69(78%) patients. The two groups were comparable in terms of patien age, male to female ratio and stone size. Stone passage decreased as stone diameter increased. Total stone passage rates were similar in both groups (smokers: 76% vs. non-smokers: 79%) (p > 0.05). Passage of stones > 4 mm was observed in 46% and 67% of smokers and non-smokers respectively. However passage of stones with a diameter ≤ 4 mm were similar in both groups (smokers: 100% vs non-smokers: 92%) (p > 0.05).ConclusionSmoking has neither a favorable nor un-favorable effect on spontaneous passage of distal ureteral stones. However, spontaneous passage rates in patients with a stone diameter > 4 mm was lower in smokers. These results should be further confirmed with studies including larger numbers of patients.

Comparing efficacy of α1D-receptor antagonist naftopidil and α1A/D-receptor antagonist tamsulosin in management of distal ureteral stones

To compare the efficacy of α(1)D-receptor antagonist Naftopidil and α(1)A/D-receptor antagonist Tamsulosin in management of distal ureteral stones. A total of 131 patients with distal ureteral stones were included in the study from December 2008 to September 2010. The patients were randomized to 3 groups: group 1 (43 patients), those receiving 10 mg naftopidil once daily; group 2 (45 patients), those receiving 0.4 mg tamsulosin once daily; and group 3 (43 patients) were given a watchful waiting and served as control group. All patients were followed up for 2 weeks. Ultrasonography and kidney-ureters-bladder (KUB) were performed on day 7 and 14. At the end of the follow-up period, patients who failed to expel the stone were scheduled to undergo ESWL or ureteroscopy. Stone expulsion was observed in 31 patients in group 1 (72.1%), 37 patients in group 2 (82.2%), and 13 patients in group 3 (30.2%). A statistically significant difference was noted with Chi-square testing between groups 1 and 3, and groups 2 and 3 (P = 0.000 and P = 0.000, respectively). Average time to expulsion was 7.6 ± 2.26 days (range 1-12 days) in group 1, 7.7 ± 1.94 days (range 2-11 days) in group 2, and 9.4 ± 2.48 days (range 6-14 days) in group 3. A statistically significant difference was observed in time to expulsion between groups 1 and 3, and groups 2 and 3 (P = 0.000, P = 0.001, respectively) by ANOVA testing. The side effects encountered in the study groups were generally mild and did not require cessation of therapy in any patient. Naftopidil could significantly increase spontaneous passage of distal ureteral stones with low side effects. The stone expulsion rate is similar for the tamsulosin.

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.

Efficacy of Tamsulosin in the Management of Lower Ureteral Stones: A Randomized Double-blind Placebo-controlled Study of 100 Patients

To study the impact of tamsulosin on the rate of spontaneous passage of distal ureteral stones. A total of 100 patients with stones sized 10 mm or smaller, located in the distal part of the ureter were included. Patients were randomly assigned to 2 equal groups. Group 1 received 0.4 mg tamsulosin once daily and group 2 received placebo. The investigators and the patients were masked to the type of treatment. Patients were followed-up until passage of the stone, or for a maximum of 4 weeks. The number of pain episodes, need for analgesia, stone expulsion rate and time, and possible side effects of medications were observed in both groups. Apart from 4 patients in the placebo group who were lost to follow-up, all patients complied with the prescribed medications and continued the study. Stone expulsion occurred in 41 of 50 patients (82%) in group 1 and in 28 of 46 patients (61%) in group 2 (P = .02). The chance of stone expulsion was 3 times higher in the tamsulosin group (relative risk [RR] = 2.93; 95% CI, 1.152-7.45). In group 1, patients with stones sized < or = 5 mm showed a significantly higher expulsion rate compared to those with larger stones (> 5 mm). Age, gender, and stone laterality had no significant impact on the expulsion rate. The expulsion time was significantly shorter in the tamsulosin group (6.4 +/- 2.77 days vs 9.87 +/- 5.4 days for groups 1 and 2, respectively). Moreover, the frequency of pain episodes, the need for diclofenac, and its total dosage were significantly lower in the tamsulosin group. Side effects observed in both groups were comparable and mild, and no patient withdrew because of them. Tamsulosin is a safe and effective drug that enhances spontaneous passage of distal ureteral stones sized 10 mm or smaller.

Journal Club: Outcome Measures, Interim Analyses, and Bayesian Approaches to Randomized Trials

Editor's Capsule Summary for Ferre et al(1) WHAT IS ALREADY KNOWN ON THIS TOPIC: Patients with ureteral calculi are often prescribed adjunctive treatment with an alpha-blocking agent to enhance spontaneous stone passage. This practice has not been validated in emergency department (ED) patients. WHAT QUESTION THIS STUDY ADDRESSED: Does the addition of a 10-day course of tamsulosin to standard therapy after discharge from the ED increase the rate of passage of distal ureteral stones? WHAT THIS STUDY ADDS TO OUR KNOWLEDGE: In this randomized trial of 80 patients, most of whom had stones of 4 mm or less, time to stone passage was similar in tamsulosin and control patients. HOW THIS MIGHT CHANGE CLINICAL PRACTICE: This study does not support the routine use of tamsulosin in ED patients, though it is possible that it would be beneficial in patients with larger stones.

Efficacy of Selective α1D-Blocker Naftopidil as Medical Expulsive Therapy for Distal Ureteral Stones

Naftopidil is a specific alpha1D-adrenergic receptor antagonist. We performed the current randomized, controlled study to determine the expulsive role of naftopidil for distal ureteral stones. From March 2006 to January 2007, 60 patients with distal ureteral stones were randomly divided into groups 1 and 2. Group 1 served as the control and underwent watchful waiting, while group 2 received 50 mg naftopidil daily in the morning. All patients were instructed to drink a minimum of 2 l water daily. The stone expulsion rate and time, potential side effects of naftopidil, number of pain episodes and requirements for pain medication were documented during the 14-day followup. All patients in groups 1 and 2 completed the study. There was no difference between the groups in patient age, sex and stone size. The stone expulsion rate was significantly higher in group 2 than in group 1 (90.0% vs 26.7%, p <0.01). No significant difference in expulsion time was noted between the groups. No patients experienced obvious naftopidil side effects or ureteral colic. Multivariate analysis using a Cox proportional hazards model indicated that the probability of expulsion was increased 5.263 times (95% CI 2.304-12.024) in group 2 compared with that in group 1 (p <0.001). The selective alpha1D-blocker naftopidil can significantly facilitate spontaneous passage of distal ureteral stones with few side effects, providing a new choice for medical expulsive therapy.