Nifedipine versus tamsulosin for the management of lower ureteral stones

Università degli Studi di Torino, Torino, Piedmont, Italy
The Journal of Urology (Impact Factor: 3.75). 09/2004; 172(2):568-71. DOI: 10.1097/01.ju.0000132390.61756.ff
Source: PubMed

ABSTRACT We evaluate and compare the effectiveness of 2 different medical therapies during watchful waiting in patients with lower ureteral stones.
A total of 86 patients with stones less than 1 cm located in the lower ureter (juxtavesical or intramural tract) were enrolled in the study and were randomly divided into 3 groups. Group 1 (30) and 2 (28) patients received daily oral treatment of 30 mg deflazacort, (maximum 10 days). In addition group 1 patients received 30 mg nifedipine slow-release (maximum 28 days) and group 2 received 1 daily oral therapy of 0.4 mg tamsulosin (maximum 28 days), Group 3 patients (28) were used as controls. Statistical analyses were performed using Student's test, ANOVA test, chi-square test and Fisher's exact test.
The average stone size for groups 1 to 3 was 4.7, 5.42 and 5.35 mm, respectively, which was not statistically significant. Expulsion was observed in 24 of 30 patients in group 1 (80%), 24 of 28 in group 2 (85%) and 12 of 28 in group 3 (43%). The difference in groups 1 and 2 with respect to group 3 was significant. Average expulsion time for groups 1 to 3 was 9.3, 7.7 and 12 days, respectively. A statistically significant difference was noted between groups 2 and 3. Mean sodium diclofenac dosage per patient in groups 1 to 3 was 19.5, 26, and 105 mg, respectively. A statistical significant difference was observed between groups 1 and 2 with respect to group 3.
Medical treatments with nifedipine and tamsulosin proved to be safe and effective as demonstrated by the increased stone expulsion rate and reduced need for analgesic therapy. Moreover medical therapy, particularly in regard to tamsulosin, reduced expulsion time.

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    • ". In medical expulsive treatments in cases of distal ureteral stones with median sizes of 4.7–6.7 mm, 80% passage rate has been reported [7] [8]. Recommended period to wait for stones to pass under observation or medical expulsive treatment is 2 to 6 weeks [9]. "
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    ABSTRACT: Seventy percent of ureteral stones are located at distal ureter. Effective and safe passage of distal ureter stones is mediated by observation or medical expulsive treatment. Most of stones located at distal ureter pass spontaneously under observation; however, some are complicated with urinary tract infection, hydronephrosis, and renal function disturbances. Spontaneous perforation of the upper ureter is a rare condition that poses diagnostic and therapeutic problems. This case is reported, because the patient developed an unexpected spontaneous renal pelvis rupture (SRPR), while she was under observation and expected to pass her right ureteral stone spontaneously through hydration and analgesic treatment.
    10/2013; 2013:932529. DOI:10.1155/2013/932529
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    • "The patient, the attending urologist, and the investigators were not aware of study arm assignments until the final assessment of outcome. Sample-size calculation was performed based on previous reports of spontaneous stone expulsion and assumed a clinically relevant difference in expulsion rate of 25% [13] [16] [17] [20]. The stone expulsion rate was estimated to be 90% and 65% for patients with and without tamsulosin medication, respectively. "
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    ABSTRACT: Numerous randomised trials have confirmed the efficacy of medical expulsive therapy with tamsulosin in patients with distal ureteral stones; however, to date, no randomised, double-blind, placebo-controlled trials have been performed. The objective of this trial was to evaluate the efficacy of medical expulsive therapy with tamsulosin in a randomised, double-blind, placebo-controlled setting. Patients presenting with single distal ureteral stones < or = 7 mm were included in this trial. Patients were randomised in a double-blind fashion to receive either tamsulosin or placebo for 21 d. The medication was discontinued after either stone expulsion or intervention. Abdominal computed tomography was performed to assess the initial and final stone status. MEASUREMENTS AND LIMITATIONS: The primary end point was the stone expulsion rate. Secondary end points were time to stone passage, the amount of analgesic required, the maximum daily pain score, safety of the therapy, and the intervention rate. Ten of 100 randomised patients were excluded from the analysis. No statistically significant differences in patient characteristics and stone size (median: 4.1 mm [tamsulosin arm] vs 3.8 mm [placebo arm], p=0.3) were found between the two treatment arms. The stone expulsion rate was not significantly different between the tamsulosin arm (86.7%) and the placebo arm (88.9%; p=1.0). Median time to stone passage was 7 d in the tamsulosin arm and 10 d in the placebo arm (log-rank test, p=0.36). Patients in the tamsulosin arm required significantly fewer analgesics than patients in the placebo arm (median: 3 vs 7, p=0.011). A caveat is that the exact time of stone passage was missing for 29 patients. Tamsulosin treatment does not improve the stone expulsion rate in patients with distal ureteral stones < or = 7 mm. Nevertheless, patients may benefit from a supportive analgesic effect. CLINICALTRIALS.GOV: NCT00831701.
    European Urology 04/2009; 56(3):407-12. DOI:10.1016/j.eururo.2009.03.076 · 12.48 Impact Factor
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    ABSTRACT: OBJECTIVES To study the efficacy of alfuzosin compared with tamsulosin in the management of lower ureteral stones. METHODS A total of 102 patients with stones 1 cm size and located in the lower ureter were enrolled in the present study and randomized into 3 equal groups. Group 1 patients (n 34) received 0.4 mg tamsulosin daily, group 2 patients (n 34) received 10 mg alfuzosin daily, and group 3 patients (n 34) received placebo (control group). The patients were given 75 mg diclofenac injection intramuscularly on demand and were followed up for 4 weeks. RESULTS The average stone size for groups 1, 2, and 3 was comparable (6.17, 6.70, and 6.35 mm, respectively). Stone expulsion was observed in 28 of 34 patients (82.3%) in group 1, 24 of 34 patients (70.5%) in group 2, and 12 of 34 patients (35.2%) in group 3. The average expulsion time for groups 1, 2, and 3 was 12.3, 14.5, and 24.5 days, respectively. The results of both study groups (groups 1 and 2) were superior to those in the placebo group (P .003 and P .001, respectively), but the study failed to show any statistically significant differences between tamsulosin and alfuzosin (P .25). Alfuzosin was associated with fewer side effects than tamsulosin, especially in terms of retrograde ejaculation. CONCLUSIONS Medical treatment of lower ureteral calculi with tamsulosin and alfuzosin resulted in a signifi-cantly increased stone expulsion rate, decreased expulsion time, and a reduced need for analgesic therapy. UROLOGY 73: 706 –709, 2009. © 2009 Elsevier Inc. S ymptomatic ureterolithiasis represents the most common condition observed by urologists in an emergency setting. 1 Of all ureteral stones, 70% are found in the lower third of ureter at presentation. Al-though a watchful waiting approach can be used success-fully for a large number of patients, 2,3 it can also result in complications such as urinary tract infection, hydrone-phrosis, and renal function deterioration. The use of the watchful waiting approach has been extended with the use of pharmacologic therapy in the form of -adrenergic blockers to provide relief from colic pain and facilitate stone expulsion. 4-6 Studies have revealed the presence of 1 -adrenergic receptors in the ureter. The density of 1 -adrenergic receptors in ureteral smooth muscle cells is significantly greater than other adrenergic receptors. 1 -Adrenergic antagonists have been proved to inhibit basal tone, peri-staltic frequency, and ureteral contractions in the intra-mural part of ureter. 6 Several clinical trials have shown good results with the use of selective -blockers in the treatment of lower ureteral stones. 7-9 Most of these trials have studied the efficacy of tamsulosin on lower ureteral stones. We performed a pro-spective randomized study comparing alfuzosin and tamsu-losin for the relief of ureteral colic and in facilitating the spontaneous expulsion of distal ureteral stones.
    Urology 04/2009; · 2.13 Impact Factor
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