Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial

Abstract

Introduction. Urolithiasis is one of the common disorder with which about 1/5th is found in the ureter, of which 2/3rd is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug. Methods. This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded. Results. Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; P=0.025) and shorter expulsion time (1.66 vs. 2.32 weeks P=0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study. Conclusion. Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.

Gilaburu extract ( Viburnum opulus Linnaeus) is as effective as Tamsulosin in medical expulsive therapy of distal ureteral calculi

“…They concluded that combination treatment was better in stone clearance. Gnywali et al 28 used Tadalafil combined with Tamsulosin and Tamsulosin for MET in distal ureteral stones based on the fact that PDE5 inhibitor drugs cause the relaxation of smooth muscles, and published their results. They found that the stone expulsion times were shorter and the number of colic pain episodes was lower in Tadalafil combined with Tamsulosin.…”

Comparative study between Silodosin alone and Silodosin plus Tadalafil for the medical management of lower Ureteric Stone in South-Western part of the Bangladesh

“…There has been a steep rise of minimally invasive procedures for ureteric stones as well as renal stones management. 1,2,3 However, medical expulsive therapy is still regarded as an established treatment option for the management of distal ureteric stones (DUS). Stone location, size, number, ureteric spasm, mucosal edema or inflammation and ureteric anatomy are the key factors that influence the passage of ureteric stones.…”

Current and emerging pharmacological targets for medical expulsive therapy

“…In particular, the benefit of using these PDE drugs in combination with tamsulosin is controversial where it was reported that there is no significant difference in calculus expulsion rate between patients administered with tamsulosin alone and patients treated with combined tamsulosin and tadalafil 39 . However, other studies suggest that combination therapy is more effective, and stone expulsion time and colic episodes are reduced in patients who receive tamsulosin and tadalafil compared to those who received tamsulosin alone 40 . Further clinical investigations are required to assess the potential efficacy of PDE 5 inhibitors alone and in combination with other drugs or treatments like shockwave lithotripsy.…”