Corticosteroids and Tamsulosin in the Medical Expulsive Therapy for Symptomatic Distal Ureter Stones: Single Drug or Association?

Uso de alfuzosina para la expulsión de cálculos del tercio distal del uréter

“…Varios factores tienen una fuerte influencia en el paso espontáneo de los cálculos ureterales, tales como su tamaño, configuración y localización, espasmo muscular, edema submucoso y anatomía ureteral, así como la historia de expulsión espontánea [1][2][3][4][5] . Basados en la literatura científica, la expulsión de los cálculos con manejo conservador se reporta entre el 25 y el 54%, con un tiempo medio de expulsión de 10 días y un uso considerado de analgésico en cálculos > 4 mm [6][7][8] . Otro estudio reporta expulsión espontánea en 1,6 semanas para cálculos < 4 mm, 2,8 semanas para aquellos entre 4-6 mm y no reporta expulsión espontánea en los > 6 mm 5 .…”

Update on medical expulsive therapy for distal ureteral stones: Beyond alpha-blockers

“…Nifedipine is the only calcium channel blocker that has shown some benefit in stone expulsion. 8,[16][17] Studies have indicated that nifedipine can be effective in reducing renal colic, while improvement in stone expulsion rate has been minimal. Alpha-blockers have been described to be significantly better than nifedipine in facilitating stone passage and relieving renal colic.…”

“…The only side effects described were 2 episodes of hypotension in the alpha-blocker alone group. 16 Further, a study by Dellabella and colleagues evaluated the additional benefit of corticosteroids to alpha-blockers in the treatment of distal ureteral stones. 17 Patients were randomly assigned to 2 treatment regimens: group 1 with alpha-blocker alone (0.4 mg tamsulosin) and group 2 with alpha-blocker plus corticosteroid (0.4 mg tamsulosin, deflazacort 30 mg).…”

“…16 This study was the first to effectively assess the efficacy of corticosteroids as a monotherapy in stone expulsion. A total of 111 patients were included in the study.…”

“…2 However, it may be safely used in conjunction with alpha-blockers in the appropriate patient population as side effects have been found to be insignificant. [16][17][21][22] A systematic review by Seitz and colleagues assessed the effectiveness of calcium channel blocker therapy. 8 A total of 9 studies were reviewed, that included 686 patients.…”