Management of lower ureteral stones using Tamsulosin - A prospective study

Introduction: It has been scientifically established that α1-adrenergic antagonists cause inhibition of the basal tone, peristaltic frequency, and contractions in the lower ureter. Earlier studies have shown promising results with Tamsulosin (α1-adrenergic antagonist) helping in spontaneous passage of Ureteral stones. Hence this prospective randomized double-blind placebo-controlled study is taken up to establish the real impact of Tamsulosin a specific alpha blocker (α1-adrenergic receptors) in expelling distal ureteral stones. This study aimed to include 80 patients with ureteral stones of less than 5 mm and more than 5 mm in size located in the distal ureter. Materials and methods: In the Present study, informed consent was obtained from all 80 patients and the study was conducted after institutional ethical committee approval. Patients are randomized to two groups to receive Tamsulosin and placebo along with analgesics whenever required. Patients were followed up for a period of one month to study the stone expulsion rate, drug side effects and pain episodes. Results: All 80 patients complied with prescribed treatment schedules except 4 patients in placebo group and 2 in study group who were lost to follow up. At the end of 4 weeks, stone expulsion was seen in 30 out of 38 (79% patients in study group and 20 patients out of 36 (56%) in placebo group. The stone expulsion time was shorter in the study group (6.2±3.2 days) and in 9.67±5.4 days for placebo group. No significant impact on the expulsion rate was seen in relation with age, gender and ureteric stones present either in right side or left side. The frequency of pain episodes was almost same and mild in both groups. Conclusion: Tamsulosin is safe and effective drug to enhance spontaneous passage of smaller stones present in distal ureter.