Stone Expulsion Rate Research Articles

Effect of Tamsulosin and Dichlozid on the Expected Treatment of Ureteral Calculi

Purpose: We evaluated the effect of tamsulosin and hydrochlorothiazide (Dichlozid) on the expulsion of ureteral stones. Materials and Methods: A total of 132 patients with a single ureteral calculi less than 10 mm in diameter were enrolled and divided into 3 groups: group 1 (n=40) received tamsulosin (0.2 mg/day), group 2 (n=35) received Dichlozid (25 mg/day) and tamsulosin (0.2 mg/day), and group 3 (n=57) was the control. Proximal and distal ureteral stones were evaluated separately. Efficacy was evaluated in terms of the rate and duration of expulsion according to stone size (<5 mm, ≥5 mm) for a maximum period of 4 weeks. Results: The mean stone diameters were 4.9±1.7 mm (group 1), 4.8±1.6 mm (group 2), and 5.3±1.8 mm (group 3). The overall expulsion rates were 70%, 74.3%, and 52.6%, respectively, and showed statistical significance. The mean durations of expulsion were 14.7±1.6, 12.8±1.5, and 18.0±2.0 days, respectively, and group 2 showed a significant decrease in the duration. There were no significant differences in the expulsion rate of proximal and distal ureteral stones in any group. Distal ureteral stones in groups 1 and 2 showed a significant reduction in the mean expulsion time (<5 mm: 13.6±0.5, 11.8±0.7, and 16.7±0.8 days in groups 1, 2, and 3, respectively; ≥5 mm: 15.0±1.4, 13.0±0.6, and 17.8±0.4 days in groups 1, 2, and 3, respectively). The mean expulsion time for smaller proximal stones (<5 mm) in groups 1 and 2 was reduced significantly (17±0.6, 15.2±0.8, and 19.3±0.6 days in groups 1, 2, and 3, respectively). Conclusions: Medical therapy with tamsulosin is time-saving and effective for treating ureteral calculi. In addition, adjunctive treatment with Dichlozid may reduce the duration of expulsion. (Korean J Urol 2009;50: 1213-1218) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Effectiveness of Low-dose and Standard-dose Tamsulosin in the Treatment of Distal Ureteric Stones: A Randomized Controlled Study

Low-dose (0.2 mg/day) and standard-dose (0.4 mg/day) tamsulosin were studied in a randomized controlled trial of 75 out-patients with distal ureteroliths in Thailand. Group 1 (n = 25; control) received oral sodium diclofenac 50 mg twice a day for 10 days; group 2 (n = 25) received oral sodium diclofenac 50 mg twice a day for 10 days, with oral tamsulosin 0.2 mg once a day up to 28 days; and group 3 (n = 25) received oral sodium diclofenac 50 mg twice a day for 10 days, with oral tamsulosin 0.4 mg once a day up to 28 days. For groups 1, 2 and 3, respectively, the expulsion rates were 4%, 40% and 68% (significantly different for group 1 vs group 2, and for group 1 vs group 3) and mean expulsion times were 23.00, 9.30 and 10.76 days. Both doses of tamsulosin increased stone expulsion rate and decreased expulsion time in comparison with the control, and have been shown to be safe and effective in Asian patients.

The Effect of Tamsulosin and Nifedipine on Expulsion of Ureteral Stones after Extracorporeal Shock Wave Lithotripsy

Purpose: We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room (ER) visits for pain control. Results: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1 (84.4%) compared with group 3 (60.6%) (p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate (94.1%) than those of group 3 (66.7%) (p=0.042). There was no difference in stone expulsion rates between group 2 (67.7%) and group 3 (60.6%). Conclusions: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones. (Korean J Urol 2008;49:150-154) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Efficacy of tamsulosin in medical expulsive therapy for distal ureteral calculi

To evaluate the potential role of tamsulosin in the medical treatment of distal ureteral stones. Ninety patients with symptomatic distal ureteral calculi were enrolled. They were randomly divided into two groups: Group A (n=45) received diclofenac 100 mg on demand for 4 weeks plus levofloxacin 250 mg daily for the first week and were well hydrated; and Group B (n=45) received the same therapy plus tamsulosin 0.4 mg/daily for 4 weeks. Abdominal ultrasound scans and KUB X-rays were performed weekly. Stone expulsion rates, time to expulsion, pain episodes and analgesic usage were determined. Intervention by means of shock-wave lithotripsy (SWL) or ureteroscopy was evaluated. The stone expulsion rate was 51.1% for Group A, compared to 88.9% for Group B (p=0.001). The average time to expulsion was 12.53+/-2.12 days for Group A and 7.32+/-0.78 days for Group B (p=0.04). The number of pain episodes was significantly lower in Group B and mean use of analgesics was lower for Group B (0.14+/-0.5 vials) than Group A (2.78+/-2.7 vials). Twenty-two patients in Group A failed to pass their stones after 4 weeks but only five in Group B. Of the patients who were not stone-free, 19 were treated with SWL and eight underwent ureteroscopy. Our study reveals the efficacy of tamsulosin for the treatment of distal ureteral stones. Tamsulosin should be added to the standard medical approach for treating these stones.

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.

MP-03.12: Tamsulosin effect on the peristalsis of completely and partially obstructed ureter in the anesthetized dog

Tamsulosin (T) proved clinically useful for increased ureteric stone expulsion rate, reduced expulsion time and reduced need for analgesic therapy. In dogs duodenal administration of T results in peak effect on urethral pressure after 90 minutes. We set out to study the effect of T on ureteric pressure in the anesthetized dog to elucidate the mechanism by which T facilitates stone expulsion.

A Systematic Review of Medical Therapy to Facilitate Passage of Ureteral Calculi

Acute renal colic is a common presenting complaint to the emergency department. Recently, medical expulsive therapy using alpha-antagonists or calcium channel blockers has been shown to augment stone passage rates of moderately sized, distal, ureteral stones. Herein is a systematic evaluation of the use of medical expulsive therapy to facilitate ureteral stone expulsion. We searched the databases of MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. Additional sources included key urologic journals and bibliographies of selected articles. We included studies that incorporated a randomized or controlled clinical trial design, patients older than 18 years, treatment in which an alpha-antagonist or calcium channel blocker was compared to a standard therapy group, and studies that reported stone expulsion rates. A random effects model was used to obtain summary risk ratios (RRs) and 95% confidence intervals (CIs) for stone expulsion rate. A pooled analysis of 16 studies using an alpha-antagonist and 9 studies using a calcium channel blocker suggested that the addition of these agents compared to standard therapy significantly improved spontaneous stone expulsion (alpha-antagonist RR 1.59; 95% CI 1.44 to 1.75; number needed to treat 3.3 [95% CI 2.1 to 4.5]; calcium channel blocker RR 1.50; 95% CI 1.34 to 1.68; number needed to treat 3.9 [95% CI 3.2 to 4.6]) in patients with distal ureteral stones. Subgroup analysis of trials using concomitant medications (ie, low-dose steroids, antibiotics, and elimination of trials using an anticholinergic agent) yielded a similar improvement in stone expulsion rate. Adverse effects were noted in 4% of patients receiving alpha-antagonist and in 15.2% of patients receiving calcium channel blockers. Our results suggest that "medical expulsive therapy," using either alpha-antagonists or calcium channel blockers, augments the stone expulsion rate compared to standard therapy for moderately sized distal ureteral stones.

Comparative Evaluation of Efficacy of Use of Tamsulosin and/or Tolterodine for Medical Treatment of Distal Ureteral Stones

To evaluate the activity of the therapeutic agents (tamsulosin and/or tolterodine) used to accelerate the expulsion of stones and to reduce the probable complications during observation of the medical treatment of distal ureteral stones to allow spontaneous passage. A total of 120 patients with distal ureteral stones were included in the study. Patients with stones less than 10 mm and allowing urinary flow were included in the study. The patients were studied in four randomly divided groups. Group 1 patients received tamsulosin 0.4 mg/day, group 2 patients received tamsulosin 0.4 mg/day plus tolterodine 2 mg (twice a day), group 3 patients received tolterodine 2 mg (twice a day), and group 4 patients did not receive any medical treatment (control group). Differences among the four groups in patient age and stone dimension were not statistically significant (P >0.05). The stone expulsion rates were greater (P <0.05) in groups 1 and 2 than in groups 3 and 4. A significant variation (P <0.05) regarding the time to stone expulsion was observed in groups 1 and 2. In our study, the use of tamsulosin for the expulsion of distal ureteral stones was effective; however, the use of tolterodine provided no additional advantages.

Efficacy of α-Blockers for the Treatment of Ureteral Stones

We determined if alpha-blocker therapy promotes expulsion of ureteral stones. Meta-analysis was performed of randomized clinical trials of alpha-blockers for the treatment of ureteral stones. The primary outcome was overall stone expulsion rate. Risk ratios and risk differences were estimated using DerSimonian and Laird random effects models. Eleven trials (911 participants) met inclusion criteria for this study. Pooled analysis demonstrated significantly increased rates of stone expulsion with alpha-blocker therapy. Compared to patients receiving conservative therapy only, patients receiving conservative therapy plus alpha-blockers were 44% more likely to spontaneously expel the stones (RR 1.44, 95% CI 1.31 to 1.59, p<0.001), and stone expulsion incidence increased significantly (RD 0.28, 95% CI 0.22 to 0.34, p<0.001). Sensitivity and subgroup analyses categorized by specific alpha-blocker, prior use of shock wave lithotripsy and stone size produced similar effect estimates, but were generally less precise due to smaller sample sizes. The largest subgroup of trials (664 participants) studied tamsulosin without prior shock wave lithotripsy (RR 1.44, 95% CI 1.32 to 1.58; RD 0.29, 95% CI 0.23 to 0.35). alpha-Blocker therapy is associated with significantly increased rates of distal ureteral stone expulsion.

Additive Expulsion Effect of Tamsulosin after Shock Wave Lithotripsy for Upper Ureteral Stones

Purpose: We evaluates if the administration of tamsulosin increases the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the patients with upper ureteral stones and if this decreased the use of analgesic drugs after the procedure. Materials and Methods: A total of 45 patients with stones 6-12mm in size that were located in the upper ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=23) received 3 times a day oral treatment of 20mg caroverine (a spasmolytic drug). Group 2 (n=22) received one time a day oral therapy of 0.2mg tamsulosin. All the patients received oral treatment for 14 days. Both groups of patients were allowed to use 30mg ketorolac trimethamine intramuscular injections on demand. The endpoint of the study was the stone expulsion rate, the use of analgesics and the drug adverse effects during treatment. Results: The average stone size was 7.9±2.79mm for group 1 and 8.2± 3.14mm for group 2. No statistical difference between the two groups was found for the stone size, age and gender distribution. The expulsion rate was significantly higher in group 2 (90.9%) compared with group 1 (65.2%) (p=0.038). The average number of pain control injections was 0.78 for group 1 and 0.23 for group 2, and there was a statistically significant difference between the two groups (p=0.042). Conclusions: The use of tamsulosin proved to be effective and safe, as demonstrated by the increased stone expulsion rate and the lesser need for pain control than that when using just a spasmolytic drug for ESWL of upper ureter stones. (Korean J Urol 2006;47:813-817) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Effect of Tamsulosin on the Expectant Treatment of Lower Ureteral Stones

Purpose: We evaluated the effectiveness of tamsulosin on the expectant treatment for the patients suffering with lower ureteral stones. Materials and Methods: A total of 67 patients with stones less than 5mm that were located in the lower ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=32) received 20mg caroverine (a spasmolytic drug) orally three time a day. Group 2 (n=35) received 0.2mg tamsulosin orally one time a day. The treatment was continued until expulsion of stone or to a maximum of 28 days. All patients were allowed 30mg ketorolac trimethamine intramuscular injections on demand. We compared the two groups for stone size, the expulsion rate, the time to expulsion and use of analgesics. Results: The average stone size was 4.3±0.61mm for group 1 and 4.4± 0.51mm for group 2. No statistical difference between two groups was found for stone size, age and sexual distribution. The expulsion rate was significantly higher in group 2 (82.8%), compared with group 1 (53.1%) (p=0.002). The mean expulsion time was 8.3 days for group 1 and 4.6 days for group 2 (p<0.0001). The average number of intramuscular analgesic injections was 3.9 for group 1 and 1.1 for group 2 (p<0.0001). Conclusions: Tamsulosin was proved to be effective and safe, as demonstrated by the increased stone expulsion rate, the decreased expulsion time and the reduced use of pain control in the expectant treatment of the lower ureter stones. (Korean J Urol 2006;47:708-711) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand?

It has recently been demonstrated that specific adrenoceptors subtypes (alpha(1A)/alpha(1D)) are prevalent in the distal part of the ureter, a finding supporting the interesting results obtained by different groups with the use of tamsulosin in the treatment of distal ureteral calculi. We performed a prospective randomized study to evaluate the effects of the addition of tamsulosin on our standard pharmacological therapy for the treatment of selected ureteral stones. A total of 64 patients referred to our department for the management of symptomatic ureteral calculi were considered. Patients were randomly divided into two treatment groups: group A (n=32) who received diclofenac (100 mg/daily) plus aescin (80 mg/daily) and group B (n=32) who received the same therapy plus tamsulosin (0.4 mg/daily) for a maximum of 2 weeks. No significant differences were found between the groups for age, gender distribution and mean stone size measured in the single largest dimension at presentation. The stone expulsion rate was 60% (19/32 patients) for group A and 88% for (28/32) for group B with a mean expulsion time of 7.4+/-2.2 (range 3.5-12) and 4.8+/-2.7 days (range 1.8-10.5), respectively. Group B showed a significant advantage in terms of both expulsion rate (P=0.01) and expulsion time (P=0.005). Different analgesics from those used in the standard treatment regimen were required in ten patients in group A (31%) but only three patients in group B (9%). This difference was significant (P=0.003). Hospitalization for recurrent colic was needed in 21% of patients in group A (7/32) and in 9% in group B (3/32) (P=0.01). Only two patients in each group (6%) experienced minor side effects associated with the expulsive therapy. Our data confirm the efficacy of tamsulosin in the treatment of distal ureteral stones up to 1 cm. This selective alpha-blocker should therefore be included in the pharmacological regimen of patients when a conservative approach is considered in the treatment of ureteral lithiasis.

Medical-expulsive therapy for distal ureterolithiasis: Randomized prospective study on role of corticosteroids used in combination with tamsulosin—simplified treatment regimen and health-related quality of life

Objectives To assess the clinical efficacy of the addition of a corticosteroid drug to tamsulosin in the medical-expulsive therapy of distal ureterolithiasis. Methods Sixty consecutive patients with a symptomatic distal ureteral stone were included in our study and randomized to one of two home treatment groups. Group 1 patients (n = 30) received tamsulosin (0.4 mg daily), and group 2 patients (n = 30) were treated with a corticosteroid drug (deflazacort, 30 mg daily) plus tamsulosin. The treatment duration was until stone expulsion or 28 days, whichever came first. The primary endpoint of the study was the stone expulsion rate. The secondary endpoints were the expulsion time; use of analgesics; number of emergency room admissions, hospitalizations, and workdays lost; drug side effects; and quality of life of the patients (EuroQol questionnaire, EQ-5D) during treatment. Results The two groups had a similar expulsion rate (90% for group 1 and 96.7% for group 2; P = 0.612), but the expulsion time was significantly reduced in group 2 patients ( P = 0.036). During the treatment period, we did not observe significant differences between the two groups in the number of emergency room visits or hospitalizations, analgesic use, number of workdays lost, or incidence of drug side effects. The quality of life of the patients during therapy, as determined using the EQ-5D, was similar in both groups. Conclusions The use of a corticosteroid drug in association with tamsulosin seemed to induce more rapid stone expulsion. In addition, tamsulosin alone as medical-expulsive therapy for distal ureteral calculi had excellent expulsive effectiveness.

NIFEDIPINE VERSUS TAMSULOSIN FOR THE MANAGEMENT OF LOWER URETERAL STONES

We evaluate and compare the effectiveness of 2 different medical therapies during watchful waiting in patients with lower ureteral stones. A total of 86 patients with stones less than 1 cm located in the lower ureter (juxtavesical or intramural tract) were enrolled in the study and were randomly divided into 3 groups. Group 1 (30) and 2 (28) patients received daily oral treatment of 30 mg deflazacort, (maximum 10 days). In addition group 1 patients received 30 mg nifedipine slow-release (maximum 28 days) and group 2 received 1 daily oral therapy of 0.4 mg tamsulosin (maximum 28 days), Group 3 patients (28) were used as controls. Statistical analyses were performed using Student's test, ANOVA test, chi-square test and Fisher's exact test. The average stone size for groups 1 to 3 was 4.7, 5.42 and 5.35 mm, respectively, which was not statistically significant. Expulsion was observed in 24 of 30 patients in group 1 (80%), 24 of 28 in group 2 (85%) and 12 of 28 in group 3 (43%). The difference in groups 1 and 2 with respect to group 3 was significant. Average expulsion time for groups 1 to 3 was 9.3, 7.7 and 12 days, respectively. A statistically significant difference was noted between groups 2 and 3. Mean sodium diclofenac dosage per patient in groups 1 to 3 was 19.5, 26, and 105 mg, respectively. A statistical significant difference was observed between groups 1 and 2 with respect to group 3. Medical treatments with nifedipine and tamsulosin proved to be safe and effective as demonstrated by the increased stone expulsion rate and reduced need for analgesic therapy. Moreover medical therapy, particularly in regard to tamsulosin, reduced expulsion time.

Efficacy of Tamsulosin in the Medical Management of Juxtavesical Ureteral Stones

We evaluated the efficacy of the alpha1-adrenergic antagonist tamsulosin for conservative expulsive therapy in patients with ureteral colic due to juxtavesical stones. A total of 60 consecutive symptomatic patients with stones located in the juxtavesical tract of the ureter were randomly divided into group 1--30 who received oral floroglucine-trimetossibenzene 3 times daily and group 2--30 who received 0.4 mg tamsulosin daily. The 2 groups received 30 mg deflazacort daily for 10 days plus cotrimoxazole 2 times daily for 8 days and 75 mg diclofenac injected intramuscularly on demand. Ultrasound followup and medical visits were performed weekly for 4 weeks. Stone passage rate and time, analgesic use, hospitalization and endoscopical intervention were evaluated. Statistical analysis was performed using the Student t test. The stone expulsion rate was 70% for group 1 and 100% for group 2. Mean stone size was 5.8 and 6.7 mm, respectively (p = 0.001). Mean expulsion time was 111.1 hours for group 1 and 65.7 hours for group 2 (p = 0.020). The mean number of diclofenac injections was 2.83 for group 1 and 0.13 for group 2 (p <0.0001). Ten group 1 patients were hospitalized, of whom 9 underwent ureteroscopy, compared with none in group 2 (p <0.0001 and 0.001, respectively). Tamsulosin used as a spasmolytic drug during renal colic due to juxtavesical calculi increased the stone expulsion rate and decreased expulsion time, the need for hospitalization and endoscopic procedures, and provided particularly good control of colic pain.

Effectiveness of nifedipine and deflazacort in the management of distal ureter stones

Objectives. To evaluate the effectiveness of medical therapy during watchful waiting in patients with distal ureter stones. Methods. Ninety-six patients with radiopaque stones located in the distal tract of the ureter and with stone sizes of 1 cm or smaller were involved in the study. The patients were randomly divided into two groups. Group A (n = 48) received oral treatment with 30 mg of deflazacort daily (maximum 10 days) plus 30 mg of slow-release nifedipine daily (maximum 4 weeks). Group B (n = 48) underwent a wait-and-watch approach. Both groups of patients were allowed to use diclofenac on demand. Statistical analyses were carried out using Student’s t test, the chi-square test, and Fisher’s exact test. Results. The average stone size was 5.8 ± 1.8 mm for group A and 5.5 ± 1.4 mm for group B. No statistically significant difference was found in stone size. Stone expulsion was observed in 38 (79%) of 48 patients in group A and in 17 (35%) of 48 patients in group B. The average expulsion time was 7 days (range 2 to 10) for group A and 20 days (range 10 to 28) for group B. A statistically significant difference was observed in both the expulsion rate and the expulsion time ( P <0.05). The mean amount of sodium diclofenac used was 15 mg per patient for group A and 105 mg per patient for group B ( P <0.05). Conclusions. The medical treatment proved to be effective and safe, as demonstrated by the increased stone expulsion rate, decreased expulsion time, and reduced need for analgesic therapy.

Oral Diclofenac in the Prophylactic Treatment of Recurrent Renal Colic

We have conducted a double-blind, randomized, placebo-controlled trial with oral diclofenac to study the prophylactic effect on renal colic recurrence and spontaneous stone expulsion rate. Forty-one patients were given 50 mg oral diclofenac 3 times a day for 7 days after being discharged for a colic episode from Oslo Emergency Hospital (< 24 h stay) and 39 patients were given matching placebo tablets. The number of new renal colic episodes per accumulated patient treatment days was 64/287 in the diclofenac group and 119/273 in the placebo group (p < 0.01). This difference was greatest during the first 4 treatment days. A similar trend was found for pain intensity (0-10 cm VAS) with the greatest difference on day 1 (4.3 vs. 2.8, p = 0.05). Side effects, mainly gastrointestinal, were reported for 14% of the treatment days in both treatment groups. Stone expulsion rate was almost identical (28 vs. 29 days), regardless of stone size. Readmission rate to Oslo Emergency Hospital/other hospitals were 10 and 67% (p < 0.001). In conclusion, oral treatment with diclofenac was effective as short-term prophylaxis of new colic episodes, especially during the first 4 days, and reduces the number of hospital readmissions significantly. The stone passage rate appears not to be affected.