Current Issue Current Issue (abstract) UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.05
Medical Treatment for Small Stones in the Lower Ureter
INTRODUCTION: There are a variety of treatment options available for management of lower ureteral stones. Recent studies have shown the efficacy of some types of drug therapy. The present investigation was a prospective study with randomized patient groups. The purpose was to compare the efficacy of tamsulosin and nifedipine, two commonly prescribed drugs used in medical expulsive therapy for distal ureteric stones.
METHODS: A total of 171 patients with distal ureteral stones < 1 cm in diameter were randomly divided into 3 groups and given medications for a period of 30 days. Patients in all 3 groups received: (1) prophylactic ciprofloxacin (500 mg) 2 times/day for 1 week; (2) Rowatinex capsules (100 mg) 3 times/day until the stone was expelled; (3) EPIMAG magnesium citrate effervescent sachets (2.125 g) dissolved in water 3 times/day until the stone was expelled; (4) diclofenac sodium tablets (50 mg) 2 times/day for 1 week. In addition to the fixed medications described above, patients in group 1 (n = 58) were treated with tamsulosin (0.4 mg) 1 time/day for a maximum of 30 days; patients in group 2 (n = 57) took slow-release nifedipine (30 mg) 1 time/day for a maximum of 30 days. Patients in group 3 (n = 56) were not given tamsulosin or nifedipine. The variables measured were stone expulsion rate, time of expulsion, and number and severity of pain attacks. ANOVA and chi-square tests were used for statistical analysis.
RESULTS: There were no statistically significant differences between the 3 groups on characteristics of sex, age, stone size, or stone laterality. Results showed that 89.6% of the patients taking tamsulosin (group 1) expelled their stones within 30 days, compared with 66.6% of the patients taking nifedipine (group 2) and 57.1% of patients taking only analgesics (group 3). The difference between group 1 and the other groups was statistically significant. Patients taking tamsulosin expelled the stones in a significantly shorter amount of time than patients in the other 2 groups. They also had significantly fewer pain attacks and needed fewer analgesics. Patients taking nifedipine did not have any significant benefits over patients in the other 2 groups.
CONCLUSION: Medical expulsion therapy for lower ureteric stones is a successful procedure. Adding an α-1 adrenergic blocker such as tamsulosin to the treatment regimen is recommended before undertaking any more invasive intervention.
KEYWORDS: Ureter; Stones; Tamsulosin; Nifedipine
CORRESPONDENCE: Dr. Tarek Salem, Rehab City, Modern Cairo, Group 94, Building 4, Flat 11, Cairo, Egypt (tareksalem61@hotmail.com).
CITATION: UroToday Int J. 2009 Oct;2(5). doi:10.3834/uij.1944-5784.2009.10.05
|
UroToday, 1802 Fifth Street, Berkeley CA 94710 Privacy Policy | © 2009 UroToday ® All Rights Reserved |
