Tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones: A randomized controlled trial

Abstract

Objectives:To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones. Methods: Between January 2013 and December 2013, 244 patients presenting with distal ureteric stones (size 5-10 mm) were randomized equally to tamsulosin (group A) or tamsulosin plus tadalafil (group B). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow up, endoscopic treatment and adverse effects of drugs were recorded. Statistical analyses were carried out using Student's t-test and the χ 2 -test. Results: There was a statistically significant higher expulsion rate in group B compared with group A (83.6% vs 65.5%; P-value = 0.031) and a shorter time to expulsion (14.9 ± 4.4 days vs 16.7 ± 4.8 days; P-value = 0.003). Statistically significant differences were noted in terms of the number of hospital visits and analgesic requirement in favor of group B. There was no serious adverse event. An improvement in erectile function was noted in patients of group B compared with those of group A. Conclusions: Medical expulsive therapy for distal ureteric stones using tamsulosin plus tadalafil is safe, effective and well tolerated. Furthermore, tadalafil provides the additional advantage of improving erectile dysfunction when this condition coexists with a lower ureteric stone.

Role of Tamsulosin, Tadalafil, and Silodosin as the Medical Expulsive Therapy in Lower Ureteric Stone: A Randomized Trial (a Pilot Study)

“…It is important to note that drugs A and B act on a-1 adrenoceptor, whereas drug C acts through PDE, which are totally separate pathways in modulation of ureteric motility and thus opening the potential of combining these drugs to further aid the ureteric stone expulsion. Such combination as tamsulosin with tadalafil has already been successfully used by Jayant et al, 25 and this further opens up the potential for combining silodosin with tadalafil. 26 Colicky pain in ureteral stone occurs due to an increase in intraureteral pressure above the site of ureteral obstruction.…”

Efficacy and safety of phosphodiesterase type 5 inhibitors for the treatment of distal ureteral calculi of 5 to 10 mm in size: A systematic review and network meta‐analysis

“…In our initial research, we identified seven studies . Two of them were excluded when we went through the full text because they did not measure up the previous inclusion criteria (Figure ).…”

“…Over the past 10 years, the possibility in MET to use phosphodiesterase type 5 inhibitors (PDE5i) has been studied due to their direct influences on ureteral smooth muscle relaxation in animals and human models . Investigators have focused on how can the effective implementation with PED5i in clinical practice, and the results of these studies displayed that tadalafil prescription owns positive benefits …”

Re: Abdel-Kader MS. Evaluation of the efficacy of sexual intercourse in expulsion of distal ureteric stones. Int Urol Nephrol 2016 [Epub ahead of print]

“…On the basis of theory, many studies have shown that distal ureteral stones can be successfully treated with different PDE5Is. Jayant et al [3] conducted a randomized controlled trial to compare the efficacy of tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones (5-10 mm) and found the addition of tadalafil with tamsulosin able to facilitate the ureteric stone expulsion. Recently, Shokeir et al [4] found sildenafil…”