PurposeThis study aimed to compare the safety and efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteral stones.Materials and MethodsThis prospective randomized study was conducted at the Department of Urology of Bir Hospital over a period of 12 months in 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 bedtime for 2 weeks. Stone expulsion rate, number of ureteric colic episodes and pain score, analgesic requirements, and adverse drug effects were noted in both groups. Statistical analyses were performed by using Student t-test and chi-square test.ResultsAltogether 85 patients, 41 in group A and 44 in group B, were enrolled in the study. The patients' average age was 31.72±12.63 years, and the male-to-female ratio was 1.5:1. Demographic profiles, stone size, and baseline investigations were comparable between the 2 groups. The stone expulsion rate was significantly higher in the tadalafil group than in the tamsulosin group (84.1% vs. 61.0%, p=0.017). Although the occurrence of side effects was higher with tadalafil, this difference was not significant (p=0.099). There were no serious adverse effects.ConclusionsTadalafil 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.
Introduction: Dilation of the track can be achieved by multiple incremental flexible Amplatz type, Alken metal telescoping dilators, or balloon in Percutaneous Nephrolithotomy (PCNL). Balloon dilator is the most expensive method. Both of the incremental dilation techniques are more time consuming with higher failure rates. Hence, a prospective randomized study was conducted to compare the safety and efficacy of “single shot” dilation of the nephrostomy tract by amplatz dilator with serial alken metallic telescopic dilation technique in PCNL. Methods: Of the 138 renal stone patients who underwent PCNL from January 2015 to December 2015, 100 patients were randomized into two groups. Serial tract dilation with alken metallic dilators was used in group A (n=50), and one shot dilation technique in Group B (n=50). The access tract dilation time, success rate, blood loss and complications were evaluated. Results: Both the groups were comparable in terms of mean age, location and size (largest diameter) of the stone (p>0.05). No difference was observed in the procedural success rate between groups A and B (96% v 94% respectively, p=0.64). Mean access time was similar in both groups (5.89+2.67 vs 4.98+2.0 mins, p=0.06). Complications between the groups were not significantly different. There were 6 patients with previous open stone surgery in both the groups. Previous open stone surgery did not impact procedural success rate, access time and complications in both groups. Conclusion: One-shot dilation technique is equally as effective, safe and well tolerated as metal telescopic dilation techniques even in patients with history of ipsilateral open stone surgery.
Introduction: Percutaneous nephrolithotomy (PCNL) is the most commonly done procedure for the treatment of large and complex renal calculi. Tubeless PCNL has been advocated in selected patients as it is thought to reduce the post-operative analgesia requirement and postoperative hospital stay. Methods: A retrospective comparative study was carried out in 100 patients who underwent PCNL between January 2019 to July 2020. Patients were divided into two groups; Group A (Tubeless PCNL) and Group B (Standard PCNL) and were compared in terms of stone-free rate, operative time, postoperative analgesic requirement, postoperative hospital stay, postoperative blood transfusion, and postoperative complication. Statistical analysis was done using SPSS software (version24). The Chi-square test and Student’s t-test were applied for the calculation of variables and a p-value of <0.05 was considered significant. Results: Stone clearance in Group A was higher than Group B (92% vs 88%, p= 0.51). The overall complication was significantly less in Group A (p=0.03). The mean drop in post-operative hemoglobin in Group A was 0.75 ± 0.26 mg/dl and in Group B was 0.90 ± 0.47g/dl (p=0.44). Post-operative blood transfusion was required in 6 patients in Group A and 14 patients with Group B (p=0.26). The mean operating time in minutes was less in Group A (47.10±5.67, p = 0.048). The requirement of post-operative analgesic (Tramadol) was higher in Group B (172.50 ± 40.75mg. vs 142.31 ± 34.44, (p=0.02). The mean duration of hospital stay for Group A was 3.54 ± 0.91 and Group B was 4.56 ± 0.91 days (p<0.001). Conclusion: Tubeless PCNL is a safe, effective, and feasible procedure for renal stones. It decreases the length of hospital stay, the requirement of blood transfusion, and the need for postoperative analgesia.
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