A Prospective Study Comparing Tamsulosin and Silodosin in Medical Expulsive Therapy for Lower Ureteric Stones

Abstract

The urinary stone disease is one of the most common afflictions of the modern society and it has been described since antiquity with the westernization of global culture. The efficacy of mini-invasive therapies, such as Extracorporeal Shock Wave Lithotripsy [ESWL] and ureteroscopy are not risk free, are problematic and are quite expensive. Recently, the use of watchful waiting approach has been extended by using Pharmacotherapy. This can reduce symptoms and facilitate stone expulsion. MATERIALS AND METHODSThis prospective randomised study was conducted between September 2015 and May 2016 at Rajarajeshwari Medical College and Hospital, Bangalore. The cohort comprised 100 adult patients (54 men and 46 women) who presented with a symptomatic, unilateral, single, uncomplicated lower ureteric stone of ≤ 10 mm. Patients were randomized into two equal groups, 50 (50%) patients received a daily single dose of tamsulosin 0.4 mg for 28 days and 50 (50%) patients received a daily single dose of silodosin 8 mg for 28 days. Both groups were compared in terms of patient's demographics, socioeconomic status, stone size and side, type of MET, stone expulsion rate, stone expulsion time, number of pain episodes, need for analgesics use and incidence of side effects. Subgroup analysis was performed according to stone size ≤ or > 5 mm. RESULTSNo significant differences among the two groups for patient's age, gender, stone side and stone size. Spontaneous stone expulsion rate within 28 days was observed in 44 (88%) patients in the tamsulosin group and in 45 (90%) patients in the silodosin group without statistically significant differences. There were no statistically significant differences observed in terms of mean expulsion time, mean number of pain episodes and need for analgesics. Retrograde ejaculation was significantly higher in the silodosin arm, while the incidence of side effects related to peripheral vasodilation were higher in the tamsulosin arm, but it was statistically insignificant. CONCLUSIONTamsulosin and silodosin are equally effective as MET for distal ureteric stones sized 10 mm or smaller. MET with silodosin is associated with a lower incidence of side effects related to peripheral vasodilation, but a higher incidence of retrograde ejaculation when compared to tamsulosin. However, a multicentre study on a larger scale is needed to evaluate the current medicines. KEYWORDSTamsulosin, Silodosin, Stone Expulsion Rate, Medical Expulsion Therapy (MET). Financial or Other, Competing Interest: None. Submission 18-06-2016, Peer Review 13-07-2016, Acceptance 18-07-2016, Published 25-07-2016. Corresponding Author: Dr. Sreedhar Reddy, Professor and HOD, Department of Urology Raja Rajeshwari Medical College and Hospital, Bangalore. E-mail: urologyreddy@yahoo.com DOI: 10.14260/jemds/2016 Nevertheless these techniques are not risk free, are problematic and are quite expensive. (4) Recently, the use of watchful waiting approach has been extended by using Pharmacotherapy. This can reduce symptoms and facilitat...

Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis

“…One study [ 28 ] had a high risk of attrition bias (incomplete outcome data). Seven studies [ 21 , 22 , 27 – 29 , 31 , 32 ] were rated as having a high risk of bias due to no prespecified sample size calculation. Three observational studies [ 33 – 35 ] were identified, and the quality of these studies was high (NOS score: 9).…”

“…A subgroup analysis showed that the expulsion rate changed with stone size and study design and was not influenced by the follow-up time (1, 2, 3, or 4 weeks) or stone location (only DUSs or not only DUSs) ( Table 3 ). For stone sizes, silodosin had a significantly higher expulsion rate than tamsulosin in patients with stone sizes of 5~10 mm (five studies [ 18 , 26 , 29 , 31 , 34 ], n = 410, pooled RD: 0.14, 95% CI: 0.06 to 0.22, I 2 = 0%). However, silodosin had no superior effect over tamsulosin for stone sizes of <5 mm (three studies [ 26 , 31 , 34 ], n = 150, pooled RD: 0.03, 95% CI: -0.06 to 0.11, I 2 = 0%).…”

“…For stone sizes, silodosin had a significantly higher expulsion rate than tamsulosin in patients with stone sizes of 5~10 mm (five studies [ 18 , 26 , 29 , 31 , 34 ], n = 410, pooled RD: 0.14, 95% CI: 0.06 to 0.22, I 2 = 0%). However, silodosin had no superior effect over tamsulosin for stone sizes of <5 mm (three studies [ 26 , 31 , 34 ], n = 150, pooled RD: 0.03, 95% CI: -0.06 to 0.11, I 2 = 0%). For the study design, silodosin had a significantly higher expulsion rate than tamsulosin in RCTs (13 studies [ 18 , 21 – 32 ], n = 1313, pooled RD: 0.16, 95% CI: 0.11 to 0.21, I 2 = 16%).…”

“…Four studies [ 18 , 24 , 31 , 34 ] ( n = 483, three RCTs and one observational study) evaluated the requirement for analgesics ( Fig 7 ). The pooled SMD indicated no significant difference favoring silodosin compared to tamsulosin (pooled SMD: -0.71, 95% CI: -1.81 to 0.40, I 2 = 97%).…”

Efficacy and safety comparison between silodosin and tamsulosin as medical expulsive therapy for distal ureteral stones

“…However, the incidence of retrograde ejaculation was considerably higher in the silodosin group. [11][12][13][14][15][16][17][18][19][20][21][22][23][24] Alpha-adrenergic receptors are observed throughout the human ureter, predominantly in the distal ureter. 25 Stimulation of these receptors increases the force of contraction of the ureter and the ureteral peristaltic frequency.…”