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. 2013 Dec;11(4):405-10.
doi: 10.1016/j.aju.2013.08.008. Epub 2013 Sep 14.

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

Himesh R Gandhi  1 , Chandrasekhar Agrawal  2
Affiliations

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

Himesh R Gandhi et al. Arab J Urol. 2013 Dec.

Abstract

Objectives: To assess and compare, in a randomised clinical trial, the efficacy of tamsulosin and nifedipine as medical expulsive therapy for distal ureterolithiasis.

Patients and methods: In 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 30 mg/day, and group 2 (64 patients) receiving tamsulosin 0.4 mg/day. Both groups received oral prednisolone 30 mg/day for 10 days and diclofenac 75 mg intramuscularly on demand. Patients were assessed by weekly ultrasonography with or with no abdominal computed tomography, during a follow-up of 4 weeks. The stone passage rate and time, analgesic use, hospitalisation and endoscopic interventions were evaluated. The results were analysed statistically using appropriate tests.

Results: The stone expulsion rate was 55% for group 1 and 80% for group 2 (P = 0.004). The mean stone size was 8.59 and 8.85 mm in groups 1 and 2, respectively. The mean expulsion time was 23 days for group 1 and 9 days 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).

Conclusions: Medical 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.

Keywords: JVT, juxtavesical tract; MET, medical expulsive therapy; Nifedipine; Pain; Renal colic; Tamsulosin; US, ultrasonography; Ureteric calculi; VUJ, vesico-ureteric junction.

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Figures

Figure 1
Figure 1
A flow diagram of the total population of the study.
Figure 2
Figure 2
The Kaplan–Meier analysis of the stone expulsion rate vs. stone expulsion time in both groups.
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