The Role of Tamsulosin in the Management Of Lower Ureteric Stones.
Iraqi Postgraduate Medical Journal,
2006, Volume 5, Issue 4, Pages 371-376
Recent Studies have reported outstanding results concerning medical expulsive therapy (MET) for distal ureterolithiasis in terms of stone expulsion and control of colic pain. While ureteral intracorporeal and extracorporeal shock wave lithotripsy are recognized to be effective, the role of MET has not yet been established for the treatment of this disease.
To evaluate the role of α1- adrenergic antagonist Tamsulosin in conservative therapy for patients with juxtavesical ureteral stones.
Sixty consecutive symptomatic patients with juxtavesical unilateral lower ureterolithiasis from the urologic consultation department in Baghdad Medical City were enrolled in this randomized prospective controlled study during the period from January 2005 to December 2006. Patients were randomly divided into two groups, group 1 (n=30) and group 2 (n=30). The two patient groups used oral diclofenac (25 mg orally twice daily) plus cotrimoxazole 2 times daily for 5 days and 75 mg diclofenac injected intramuscularly on demand. All patients were instructed to drink 2 L water daily. Group 1, served as the control group. Group 2 was given the α1 -blocker (tamsulosin) in addition to conservative treatment. Tamsulosin capsule (0.4 mg) was administered daily. The treatment duration was until stone expulsion or 28 days, whichever came first. During this period, all patients were evaluated weekly by urinary tract ultrasonography and serum createnine level, and were asked whether they experienced acute colic pain, to score the intensity of pain according to a visual analog scale (VAS), whether the calculus passed spontaneously, the day and time of stone expulsion, number of diclofenac injections, and finally any drug side effects. Statistical analyses were performed with Student’s t test, ANOVA, and Mann-Whitney U test as appropriate. Correlation analysis was done using Spearman's rank test. Cox proportional hazard regression module was used to determine the predictive factors for expulsion.
The stone expulsion rate was 70% for group 1 and 90% for group 2 (P=0.003). Mean stone size was 7.3 and 7.7 mm, respectively (P=0.24). Mean expulsion time, mean VAS of pain, mean attack of acute colic, and mean number of diclofenac injections were significantly less in patients used tamsulosin. Only therapy and stone size proved to be significantly predictive factors of stone expulsion (P<0.0001 and 0.001) respectively, while gender and age did not have any predictive value. Although side-effects, such as headache, abnormal ejaculation, and dizziness occurred more in patients who were given tamsulosin, no significant side-effects was detected so as to require exclusion of a patient from the study.
Medical Expulsive Therapy (MET) for lower ureterolithiasis with tamsulosin during conservative treatment period is safe and effective as demonstrated by the absence of serious side effects and increased stone expulsion rate with early time. Also MET with tamsulosin affords an outstanding control of pain for patients while waiting for stone expulsion.
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