Medical Expulsive Therapy for Lower Ureteric Stones: A Comparative Study

Ali Muter, Samir

	Medical Expulsive Therapy for Lower Ureteric Stones: A Comparative Study
Mustansiriya Medical Journal
Article 1, Volume 9, Issue 1, 2010, Pages 47-51
Author
Samir Ali Muter
Abstract
Background Lower ureteric stones and accompanying ureteric colics represent one of the most common medical problems faced by urologist, the treatment usually starts with conservative therapy, however, if the stone fails to pass within 4-6 weeks, a prompts action should be taken to save the kidney, this usually involves one of the minimally invasive therapy options like shock wave lithotripsy (ESWL), of ureteroscopy. However this is not free of risk, and cost, for these reasons, urologists now concentrate on what's called medical expulsive therapy, which means using drugs to enhance stone passage. Objective In this study we evaluated and compared three of the most commonly used drugs, nifedipine, tamsulosin, and sildenafil citrate, for their expulsive role in lower ureteric stones. Methods Through out the period from Feb. 2008 until Nov. 2009, 98 patients with lower ureteric stones were enrolled in this study, they were thoroughly examined and investigated, then randomized into 4 groups, the first group patients received nifedipine, the second group patients received tamsulosin, the third group patients received sildenafil citrate, and the forth group patients served as control. Patients followed up for one month and monitored for stone passage, time of stone passage and number of ureteric colics experienced while on treatment. Data collected and analyzed statistically. Results Only patients on tamsulosin therapy showed a statistically significant improvement in stone passage rate (81.4%), compared to those on nifedipine(69.6%), sildenafil citrate (57.6%), and control (54.5%). Both nifedipine and tamsulosin significantly shortened the time needed for stone passage and reduced the number of ureteric colics, while sildenafil citrate failed to show any beneficial effect compared to control. Conclusions Tamsulosin may have a significant role in enhancing lower ureteric stone passage within shorter time and with less pain, and it is superior to nifedipine, and sildenafil citrate in this regard.
Keywords
nifedipine; Tamsulosin; sildenafil citrate; expulsive therapy; ureteric stones

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