Comparative Efficacy of Tamsulosin Versus Tamsulosin With Tadalafil in Combination With Prednisolone for the Medical Expulsive Therapy of Lower Ureteric Stones: A Randomized Trial

Abstract

PurposeTo compare the safety and efficacy of tamsulosin and tamsulosin with the phosphodiesterase-5 inhibitor tadalafil in combination with prednisolone as medical expulsive therapies for lower ureteric stones.Materials and MethodsBetween July 2011 and December 2012, 62 adult patients presenting with distal ureteric stones sized 5 to 10 mm were randomized equally to treatment with tamsulosin (group A) or tamsulosin with tadalafil (group B). Therapy was given for a maximum of 6 weeks. In addition, patients in groups A and B were given 5-mg prednisolone once daily (maximum 1 week). The stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up and endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done by using Student t-test and chi-square test.ResultsThere was a higher expulsion rate (83.9% in group B and 74.2% in group A) and a lower time to expulsion in both treatment groups than in historical controls used in earlier studies. However, these results were not statistically significant (p=0.349, p=0.074, respectively). Statistically significant differences were noted in hospitalization for colic and analgesic requirement, which were less in group B than in group A. There were no serious adverse events. Another important finding was improvement in erectile function in group B.ConclusionsMedical expulsive therapy for distal ureteric stones using tamsulosin and tadalafil with prednisolone is safe and efficacious. Also, the prescription of tadalafil in cases of erectile dysfunction with the development of lower ureteric stones may provide additional advantages.

The Role of Tadalafil and Tamsulosin Alone and in Combination Therapy in Lower Ureteric Stone Expulsion

“…7 We decided to use tadalafil on the basis of reports by Gratzke et al who demonstrated the role of phosphodiesterase inhibitors in relaxation of ureteric muscles in the rank order of vardenafil>sildenafil>tadalafil. Because tadalafil is more selective than sildenafil for PDE5 than PDE6 receptors, which are present in the retina, visual problems are less likely.…”

“…3,4 Currently, alpha-1 adrenergic receptor antagonists represent the treatment of choice for lower urinary tract symptoms as shown in many randomised controlled clinical trials. 5,6,7 Alpha-1 adrenergic receptors are present in ureteric smooth muscles and antagonists inhibit basal tone, peristaltic frequency, and ureteral contractions even in the intramural tract.…”

Update on medical expulsive therapy for distal ureteral stones: Beyond alpha-blockers

“…Improved erectile function was seen in 12.9% of patients receiving tadalafil. 25 The use of PDE5 inhibitors and its potential value in MET remain in its infancy. Future studies are required to assess the utility of PDE5 inhibitors in MET.…”

“…24 Kumar and colleagues examined the use of tadalafil in conjunction with tamsulosin and corticosteroid therapy. 25 The paper was based on the assumption that by combining drugs acting through different mechanisms, better ureteric relaxation and reduction in intramural pressure could be achieved. Patients were divided into 2 groups.…”

Üriner Sistem Taş Hastalığında Medikal Ekspulsif Tedavi: Kime, Nasıl, Ne Kadar?

“…'ları boyutu 5 ile 10 mm arası değişen distal üreter taşına sahip 62 hastaya tamsulosin (Grup A) ve tamsulosin + tadalafil (Grup B) vermişlerdir (18). Yazarlar, Grup A'da %74.2, Grup B'de ise %83.9'luk bir taş düşürme oranı bildirmişlerdir.…”