https://doi.org/10.4081/aiua.2023.10849
Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral stones
Submitted: September 7, 2022
Accepted: October 6, 2022
Published: February 22, 2023
Accepted: October 6, 2022
Abstract Views: 1751
PDF: 995
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Objective: To compare the efficacy of Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for treatment of distal ureteral calculi.
Patients and methods: Over a period of 6 months (January 2022 to June 2022) this prospective randomized study was conducted on 170 patients with distal ureteric stone ≤ 10 mm. Patients were randomly divided into three groups. Patients in group A received Tamsulosin 0.4mg, in group B received Silodosin, and in group C receive Tadalafil 5 mg. Therapy was given for a maximum of 4 weeks. The rate and time of stone expulsion, the analgesic use, attacks of colic and hospital visits for pain, and adverse effects of drugs were recorded.
Results: Among 170 patients who were enrolled in study, 20 were lost to follow-up (7, 8, 5 in group A, B, And C respective-ly). There was a significant higher stone passage rate in group C than group A and B (90% vs. 70% and 76% respectively; p-value = 0.043) and shorter expulsion time in group C (8.7 ± 3.3 days) vs. group A (12.5 ± 5.2 days) and group B (11.3 ± 4.2 days) with (p-value = 0.001)(highly statistically significant with p-value < 0.001) and increased amount of analgesics required in group A (225 ± 115.7 mg) and group B (163 ± 77.5 mg) when compared with group C (120 ± 55.3 mg).
Conclusion: Tadalafil is more effective than Tamsulosin and Silodosin in treatment of patients with distal ureteric stones ≤ 10 mm as regard stone expulsion rate, expulsion time with decreased number of colicky episodes and side effects.
Somani BK, Aboumarzouk O, Traxer O, et al. Medical expulsive therapy for ureteral stones: where do we go from here? Nat Rev Urol. 2016; 13:608-12.
DOI: https://doi.org/10.1038/nrurol.2016.146
Ibrahim AI, Shetty SD, Awad RM, Patel KP. Prognostic factors in the conservative treatment of ureteric stones. Br J Urol 1991; 67:358-61.
DOI: https://doi.org/10.1111/j.1464-410X.1991.tb15161.x
Yilmaz E, Batislam E, Basar MM, et al. The comparison and effi-cacy of 3 different a1-adrenergic blockers for distal ureteral stones. J Urol. 2005; 173:2010-2.
DOI: https://doi.org/10.1097/01.ju.0000158453.60029.0a
Campschroer T, Zhu Y, Duijvesz D, et al. Alpha-blockers as med-ical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2014; (4):CD008509.
DOI: https://doi.org/10.1002/14651858.CD008509.pub2
Liu Z, Su J, Yuan D, et al. Efficacy and safety of PDE5-Is and a-1 blockers for treating distal ureteral calculi: a mixed treatment comparison network meta-analysis of randomized controlled clinical tri-als. Int J Clin Exp Med. 2019; 12:4623-37.
Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American urological association/endourological society guideline, Part I. J Urol. 2016; 196:1153-60.
DOI: https://doi.org/10.1016/j.juro.2016.05.090
Özsoy M, Liatsikos E, Scheffbuch N, Kallidonis P. Comparison of silodosin to tamsulosin for medical expulsive treatment of ureteral stones: a systematic review and meta-analysis. Urolithiasis. 2016; 44:491-7.
DOI: https://doi.org/10.1007/s00240-016-0872-y
Gnyawali D, Pradhan MM, Sigdel PR, et al. Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial. Adv Urol. 2020; 2020:4347598.
DOI: https://doi.org/10.1155/2020/4347598
Shokeir AA, Tharwat MA, Abolazm AE, Harraz A. Sildenafil citrate as a medical expulsive therapy for distal ureteric stones: A randomised double-blind placebo-controlled study. Arab J Urol. 2016; 14:1-6.
DOI: https://doi.org/10.1016/j.aju.2015.12.001
Hsu YP, Hsu CW, Bai CH, et al. Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis. PLoS One. 2018; 13:e0203035.
DOI: https://doi.org/10.1371/journal.pone.0203035
Elgalaly H, Sakr A, Fawzi A, et al. Silodosin vs. tamsulosin in the management of distal ureteric stones: a prospective randomised study. Arab J Urol. 2016; 14:12-7.
DOI: https://doi.org/10.1016/j.aju.2015.11.004
Bai Y, Yang Y, Wang X, et al. Tadalafil facilitates the distal ureter-al stone expulsion: a meta-analysis. J Endourol. 2017; 31:557-63.
DOI: https://doi.org/10.1089/end.2016.0837
Bensalah K, Pearle M, Lotan Y. Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol. 2008; 53:411-9.
DOI: https://doi.org/10.1016/j.eururo.2007.09.012
Wolf JS Jr. Treatment selection and outcomes: ureteral calculi. Urol Clin North Am. 2007; 34:421-30.
DOI: https://doi.org/10.1016/j.ucl.2007.04.010
Puvvada S, Mylarappa P, Aggarwal K, et al. Comparative effi-cacy of tadalafil versus tamsulosin as the medical expulsive therapy in lower ureteric stone: a prospective randomized trial. Cent European J Urol. 2016; 69:178-82.
Laddha A, Mishra S, Ganpule A, et al. Comparison of tadalafil and tamsulosin in medical expulsive therapy for ureteric calculus: prospec-tive, randomized, placebo controlled study. Indian J Urol. 2015; 9:294.
Kc HB, Shrestha A, Acharya GB, et al. Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study. Investig Clin Urol. 2016; 57:351-6.
DOI: https://doi.org/10.4111/icu.2016.57.5.351
Parikh C, Gurjar V, Shah S. Tamsulosin versus tadalafil as med-ical expulsive therapy of distal ureteric stones: a comparative study. Int Surg J. 2019; 6:982-8.
DOI: https://doi.org/10.18203/2349-2902.isj20190835
Kumar S, Jayant K, Agrawal MM, et al. Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study). Urology. 2015; 85:59-63.
DOI: https://doi.org/10.1016/j.urology.2014.09.022
Goyal SK, Singh V, Pandey H, et al. Comparative efficacy of tamsulosin versus tadalafil as medical expulsive therapy for distal ureteric stones. Urol Ann. 2018; 10:82.
DOI: https://doi.org/10.4103/UA.UA_36_17
Hollingsworth JM, Rogers MA, Kaufman SR, et al. Medical ther-apy to facilitate urinary stone passage: a meta-analysis. Lancet. 2006; 368:1171-9.
DOI: https://doi.org/10.1016/S0140-6736(06)69474-9
Preminger GM, Tiselius HG, Assimos DG, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007; 178:2418-34.
DOI: https://doi.org/10.1016/j.juro.2007.09.107
Tamm EP, Silverman PM, Shuman WP. Evaluation of the patient with flank pain and possible ureteral calculus. Radiology. 2003; 228:319-29.
DOI: https://doi.org/10.1148/radiol.2282011726
Wang CJ, Huang SW, Chang CH. Efficacy of an a1 blocker in expulsive therapy of lower ureteral stones. J Endourol. 2008; 22:41-6.
DOI: https://doi.org/10.1089/end.2007.0133
Jayant K, Agrawal R, Agrawal S. Tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones: a randomized controlled trial. Int J Urol. 2014; 21:1012-5.
DOI: https://doi.org/10.1111/iju.12496
Hasan HF, Jaffal WN, Al-Hossona HA. The role of tadalafil in lower ureteric stone expulsion. Iraqi Postgrad Med J. 2011; 10:24-32.
Kinnman E, Nygårds EB, Hansson P. Peripheral a-adrenorecep-tors are involved in the development of capsaicin induced ongoing and stimulus evoked pain in humans. Pain. 1997; 69:79-85.
DOI: https://doi.org/10.1016/S0304-3959(96)03257-5
Li JK, Qiu S, Jin K, et al. Efficacy and safety of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi of 5 to 10 mm in size: A systematic review and network meta-analysis. Kaohsiung J Med Sci. 2019; 35:257-264.
DOI: https://doi.org/10.1002/kjm2.12048
Kumar S, Jayant K, Agrawal S, Singh SK. Comparative efficacy of tamsulosin versus tamsulosin with tadalafil in combination with prednisolone for the medical expulsive therapy of lower ureteric stones: a randomized trial. Korean J Urol. 2014; 55:196-200.
DOI: https://doi.org/10.4111/kju.2014.55.3.196
Rahman MJ, Faridi MS, Mibang N, Singh RS. Comparing tam-sulosin, silodosin versus silodosin plus tadalafil as medical expulsive therapy for lower ureteric stones: A randomised trial. Arab J Urol. 2018; 16:245-9.
DOI: https://doi.org/10.1016/j.aju.2017.11.012
How to Cite
Abdelaal, M. A., & El-Dydamony, E. M. (2023). Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral stones. Archivio Italiano Di Urologia E Andrologia, 95(1). https://doi.org/10.4081/aiua.2023.10849
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.