Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion

Abstract

We evaluated the efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) in patients with distal ureteral stone. In addition, we tried to determine the predictive value of Hounsfield Unit (HU) of the stone in the success of MET. A total of 75 patients with a distal ureteral stone of 5-10 mm diameter were randomly divided into three groups. Group 1 (n ¼ 25) received tamsulosin 0.4 mg/d; group 2 (n ¼ 25) received nifedipine 10 mg/day p.o and group 3 (n ¼ 25) received diclofenac sodium 50 mg p.o. when required. At the beginning of each treatment, the HU of the stone was also measured using a non-contrast computerized tomography in all the patients. The results were evaluated at week four. The mean age of the patients was 36.8 (range, 16-68) years. Stone expulsion was observed in 19 (76%) patients in group 1, 16 (64%) patients in group 2 and 9 (36%) patients in group 3 (p group1-3 ¼ 0.004, p group2-3 ¼ 0.048 and p group1-2 ¼ 0.355). The mean expulsion time was 9, 9.1 and 10.3 d, respectively (p group1-3 50.001, p group2-3 50.001 and p group1-2 ¼ 0.619). The mean diclofenac sodium dose per patient was 544, 602 and 1408 mg in groups 1, 2 and 3, respectively (p group1-3 50.001, p group2-3 50.001 and p group1-2 ¼ 0.977). The mean HU of the stone in patients with and without a successful MET was 363 and 389, respectively (p ¼ 0.462). Our results showed that MET with both nifedipine and tamsulosin provided a similar increase in the expulsion rate for distal ureteral stones. HU does not seem to be a predictive parameter for stone expulsion.

Computed tomography findings predicting the success of silodosin for medical expulsive therapy of ureteral stones

“…In a study related to MET, NCCT findings were compared with nifedipine and tamsulosin success rates and there was no significant difference found between success and failure groups in the study. The final report of the study was that HU is not a predictive parameter for stone expulsion [19]. In another study showing that stone size and localization, hydronephrosis grade, proximal ureteral diameter and ureteral wall thickness were highly associated with MET success rates, stone density was not shown to be associated with MET success [20].…”

Alpha blockers in the management of ureteric lithiasis: A meta-analysis

“…Results of quality assessment using the Cochrane Risk of Bias tool can be found in Figure 7. Overall, a high degree of bias was seen with only nine studies judged to be at low risk while 41 were judged to be intermediate risk and 17 high risk . The most common cause for bias was blinding of both participants and personnel and outcomes assessment.…”

α‐blockers as medical expulsive therapy for ureteric stones: a Cochrane systematic review

“…In total, 67 studies were included in our review (Appendix S2). Most studies (52 of 67) compared α‐blockers with standard therapy (i.e.…”

“…Most studies (52 of 67) compared α‐blockers with standard therapy (i.e. NSAIDs, corticosteroids, or antispasmodics) , and the other studies (15 of 67) compared α‐blockers with placebo . The sample size varied from 30 to 3 440, the mean or median age varied from 32 to 56 years, and the duration of follow‐up varied from 1 to 8 weeks.…”