NEW YORK (Reuters Health) - Instead of immediately performing cystoscopy or lithotripsy, new research suggests that patients with distal ureteral stones should be given a trial of medical expulsive therapy (MET). In particular, tamsulosin is very effective in achieving stone expulsion, obviating the need for hospitalization.

Using tamsulosin for MET "produced stone expulsion in almost all cases in a short time, allowing complete home patient treatment," note lead author Dr. Marco Dellabella and colleagues, from the Polytechnic University of the Marche Region in Ancona, Italy.

The findings, which appear in the July issue of The Journal of Urology, stem from a study of 210 patients with distal ureteral calculi who were randomized to receive home treatment with tamsulosin, phloroglucinol, or nifedipine. In all cases, the calculi were visualized with ultrasound or standard X-ray and were at least 4 mm in diameter.

In addition to the assigned expulsive agent, all of the subjects were treated with an oral corticosteroid and received antibiotic prophylaxis. Injectable diclofenac was given on an as-needed basis. Lastly, the patients were encouraged to drink 2 L of water daily.

All of the agents achieved stone expulsion in the majority of cases but tamsulosin was more effective than the others. The expulsion rate for tamsulosin was 97.1%, whereas phloroglucinol and nifedipine had rates of 64.3% and 77.1%, respectively (p < 0.0001).

Patients treated with tamsulosin achieved stone passage in a shorter period of time and were less likely to be hospitalized than patients treated with the other agents. Moreover, control of renal colic pain was superior in the tamsulosin group, resulting in fewer missed workdays.

Of the two less effective agents, nifedipine appeared to be the better choice for MET, resulting in lower analgesic use and fewer missed workdays than phloroglucinol.

Side effects were comparable for the three agents and none led to treatment discontinuation, the investigators point out.

If confirmed in multicenter trials, the results suggest that MET with tamsulosin "can be the first-line approach for the urologist and family physician in home management of the patient with a diagnosis of distal ureteral stone," Dr. Dellabella's team concludes.

J Urol 2005;174:167-172

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