Objectives: To assess the spontaneous passage rate for patients being treated with alfuzosin 10 mg daily after presenting with an acute ureteral stone compared with a control group, and to assess the respective pain control status. Methods: This was a prospective randomized controlled trial. Patients presenting with an acute ureteral stone (size 5-10 mm) were enrolled and randomized into a medical expulsive therapy (MET) group or control group. The MET group received alfuzosin slow release (SR) 10 mg daily for 4 weeks and dologesic (paracetamol + dextropropoxyphene, four tablets daily on demand) for 2 weeks. The control group received the same analgesics for 2 weeks only. Diclofenac sodium SR 100 mg daily for 2 weeks was added in case of suboptimal pain control. All the patients were assessed through phone interview at week 2 and with kidney-ureter-bladder X-ray at week 5 to check for any evidence of stone passage. Results: A total of 67 patients were included in the analysis. The overall spontaneous passage rate was increased by 31.8% with MET (P = 0.006). For an upper ureteral stone, the rate was increased by 51.3% (P = 0.01). The MET group used significantly less dicolofenac sodium (1.5 tablets vs 6.7 tablets, P = 0.031). Conclusions: MET using alfuzosin SR 10 mg daily is effective to enhance the ureteral stone spontaneous passage rate, particularly for upper ureteral stones. Fewer analgesic drugs are consumed and more patients can avoid ureteroscopic lithotripsy and/or extracorporeal shock wave lithotripsy.

Renal cell carcinoma is well known for its varied presentation and its potential of metastasizing to virtually any organs. Metastasis to the ureter or bladder is extremely rare. To date only 52 cases of metastatic renal cell carcinoma to ureter have been reported. We report a case of metachronous solitary metastasis of renal cell carcinoma to the ipsilateral ureteric stump one year after radical nephrectomy of the primary tumour. Completion ureterectomy and partial cystectomy was performed and pathology confirmed metastatic renal cell carcinoma. Six months later the patient was found to have bladder recurrence again. Contrast computed tomography scan of abdomen showed multiple liver metastases. The disease progressed despite use of target therapy. He finally succumbed 29 months after the initial nephrectomy.

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