Medical expulsive therapy: a cost effective evidence-based definitive treatment for ureteric stones
Keywords:Lower ureter, Medical expulsive therapy, Stone size, Ureteric calculi, Urolithiasis
Background: The lifetime risk of kidney stones is between 5% and 10% and rates of recurrence are as high as 50%. Majority of the ureteric stones (70%) are found in the lower third of the ureter. Available setup, type, size of the stone, and expertise of the surgeon are the major factors affecting the treatment modality. Medical expulsive therapy has shown promising results in previous studies. Aim of the study was to assess the efficacy of tamsulosin and deflazacort combination therapy for stone expulsion in relation with site and size of stones.
Methods: A total of 97 patients with ureteric calculi of size 10 mm or less attending the urology out-patient department were included. Received medical expulsive therapy using tamsulosin (0.4 mg) and deflazacort (30 mg) for 7 days. Patients were evaluated for stone expulsion on 7th day by non-contrast computed tomography of kidney ureter bladder. Site, side and size of stones were noted.
Results: Ureteric calculi was more prevalent in the age group of 21-30 years 38 (39.2%). Male preponderance was observed (76.28%) with male female ratio being 3.2:1. Lower site 64 (65.97%) ureteric calculi were most common. The majority had a stone size of 4-6 mm (42%). Stones were expelled on 7th day in 69 (71.13%) patients. Expulsion rates were highest for the stone size of 2-4 mm (94.4%) followed by 4-6 mm (88.1%). The highest expulsion rates were observed for Lower ureteric stones (84.4%).
Conclusions: Medical expulsive therapy using tamsulosin and deflazacort is an effective treatment modality for the management of ureteric stones, especially those present in lower ureter and those ≤8 mm in size.
Wood KD, Gorbachinsky I, Gutierrez J. Medical expulsive therapy. Indian J Urol. 2014;30(1):60-4.
Tiselius HG. Epidemiology and medical management of stone disease. BJU Int. 2003;91:758-67.
Sofia NH, Walter TM. Prevalence and risk factors of kidney stone. Global J Res Ana. 2016;5(3):183-7.
Chauhan CK, Joshi MJ, Vaidya ADB. Growth inhibition of struvite crystals in the presence of herbal extract Commiphora wightii. J Materials Sci. 2008;20(1):85-92.
Smith RD, Shah M, Patel A. Recent advance in management of ureteral calculi. Med Rep. 2009;1:1-53.
Bos D, Kapoor A. Update on medical expulsive therapy for distal ureteral stones: Beyond alpha-blockers. Urol Assoc J. 2014;8(11-12):442-5.
Parsons JK, Hergan LA, Sakamoto K. Efficacy of α-blockers for the treatment of ureteral stones. J Urol. 2007;177:983-7.
Sinha AR, Siwach V. Evaluation of the efficacy of tamsulosin and deflazacort versus tamsulosin alone in expulsion of lower ureteric stones in a tertiary center. Int J Sci Stud. 2019;6(10):68-72.
Dellabella M, Milanese G, Muzzonigro G. Randomized trial of the efficacy of tamsulosin, nifedipine, and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol. 2005;174:167-72.
Morita T, Wada I, Suzuki T, Tsuchida S. Characterization of alpha-adrenoceptor subtypes involved in the regulation of ureteral fluid transport. Tohoku J Exp Med. 1987;152:111-8.
Malin JM, Deane RF, Boyarsky S. Characterisation of adrenergic receptors in human ureter. Br J Urol. 1970;42:171-4.
Seitz C, Liatsikos E, Porpiglia F. Medical therapy to facilitate the passage of stones: What is the evidence? Eur Urol. 2009;56:455-71.
Kaneko T, Matsushima H, Morimoto H. Efficacy of low dose tamsulosin in medical expulsive therapy for ureteral stones in Japanese male patients: A randomized controlled study. Int Urol. 2010;17:462-5.
Yilmaz E, Batislam E, Basar M. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol. 2005;173:2010-2.
Ramesh A, Karthick P, Kumar SR. Medical expulsion therapy for ureteric calculus – possible. Int Surg J. 2016;3:113-8.
Porpiglia F, Vaccino D, Billia M. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol. 2006;50:339-44.
Ibrahim AK, Mahmood IH, Mahmood NS. Efficacy and safety of tamsulosin vs alfuzosin as medical expulsive therapy for ureteric stones. Arab J Surg. 2013;11:142-7.
Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR. 2002;178:101-3.