Outcome of uncomplicated ureteric calculi managed with medical expulsive therapy in the outpatient clinic of a urology unit in Sri Lanka

Abstract

ObjectiveAlthough medical expulsive therapy (MET) is shown to be effective for ureteric calculi, the optimum duration and the stone size suitable for MET are not well established yet. The objectives of the study were to determine the optimum duration and maximum stone size suitable for MET.ResultsAll patients with radiologically confirmed uncomplicated ureteric calculi treated with MET using tamsulosin over a period of 6 months in the outpatient setting were followed up. There were 213 patients. 165 were men. Mean age was 42 years. At presentation 42 stones were in upper ureter (19.7%), 51 in mid ureter (23.9%), 120 in lower ureter (56.3%). The majority (82.7%) of stones were less than 10 mm. Seven stones (3.3%) were over 15 mm. Ninety-two (43.2%) patients had spontaneous passage of stones within 6-weeks of MET. Another 38.9% passed the stone within the next 6-weeks. Thirty-eight patients (17.8%) required surgery. Uncomplicated ureteric stones up to 10 mm can be given a trial of MET using tamsulosin which can be extended up to 12-weeks with a success rate over 92%. This may have substantial clinical and fiscal benefits by reducing the number of interventional procedures especially in resource-poor settings.Electronic supplementary materialThe online version of this article (10.1186/s13104-017-2974-1) contains supplementary material, which is available to authorized users.

Outcome of ureteric stone treatment with tamsulocin

“…Higher expulsion rate in our study was noted when tamsulocin was given for longer duration. Jayawardene et al, in a report from Srilanka, revealed that all patients in their study (n=67) with stones less than 5 mm passed out with MET over 12 weeks duration of tamsulocin therapy [17].…”

“…Jayawardene et al revealed that the success of MET significantly improved when the distance to travel along the ureter for the stone was less. Expulsion rate with MET was 47.6%, 82.3% and 94.1% for upper, mid and lower ureteric stones respectively [17].…”

“…The difference was more pronounced for smaller stones, and narrows as the size of stone increased. Jayawardene et al reported 98 (90%) percent stone expulsion after 12 weeks of MET for stones  5 mm [17].…”

“…A most plausible explanation for this differential effect of tamsulocin is that highest concentration of 1-adrenergic receptors is found in the distal ureter, therefore having the largest potential for tamsulocin in the lower ureteric stones [19]. However the role of 1-blocker in the expulsion of upper ureteric stone seems to be less obvious [17]. This might be the reason for the low expulsion rate of the upper ureteric stone.…”

Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial

“…is can cause inflammatory reaction with mucosal edema which could further worsen the ureteric obstruction, increasing the risk of impaction and retention [8]. However, selective alpha-1 blockers, such as tamsulosin and silodosin, have been the treatment of choice, with proven efficacy in multiple clinical trials [8][9][10].…”