A prospective study on medical expulsive therapy for distal Ureteral stones

Urolithiasis is one of the most common diseases of the urinary tract. Ureteral stones account for 20% of the calculi in urolithiasis and about 70% of ureteral stones are present in the distal third of the ureter at the time of presentation. A conservative approach through medical expulsive therapy has now become an established treatment modality that employs various drugs acting on the ureter by different mechanisms. Aim of the study: To compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones Materials and Methods: This prospective study was conducted at the Institute of Urology, Rajiv Gandhi government General hospital, Chennai, over a period of 12 months, from October 2016 to September2017 in 100 patients with distal ureteral stones sized 5 to 10 mm. Patients were randomly divided into 2 groups: group A received tamsulosin 0.4 mg and group B received tadalafil 10 mg at night for 10 days. Stone expulsion rate, age group, sex ratio, number of ureteric colic episodes, analgesic requirements, and adverse drug effects were noted in both groups. Observations and results: Altogether 100 patients, 50 in group A and 50 in group B, were enrolled in the study. The patients' average age was 46.5 years, and the male-to-female ratio was 3.3:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. Although the stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (53% vs. 47%), this difference was not statistically significant. There were no serious adverse effects. Conclusion: Tadalafil has a significantly higher stone expulsion rate than tamsulosin when used as a medical expulsive therapy for distal ureteral stones sized 5–10 mm. Both drugs are safe, effective, and well tolerated with minor side effects.