Comparative study between Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for lower ureteral stones
Abstract
Objective: To compare the efficacy of Tamsulosin, Silodosin and Tadalafil as a medical expulsive therapy for treatment of distal ureteral calculi.
Patients and methods: Over a period of 6 months (January 2022 to June 2022) this prospective randomized study was conducted on 170 patients with distal ureteric stone ≤ 10 mm. Patients were randomly divided into three groups. Patients in group A received Tamsulosin 0.4mg, in group B received Silodosin, and in group C receive Tadalafil 5 mg. Therapy was given for a maximum of 4 weeks. The rate and time of stone expulsion, the analgesic use, attacks of colic and hospital visits for pain, and adverse effects of drugs were recorded.
Results: Among 170 patients who were enrolled in study, 20 were lost to follow-up (7, 8, 5 in group A, B, And C respective-ly). There was a significant higher stone passage rate in group C than group A and B (90% vs. 70% and 76% respectively; p-value = 0.043) and shorter expulsion time in group C (8.7 ± 3.3 days) vs. group A (12.5 ± 5.2 days) and group B (11.3 ± 4.2 days) with (p-value = 0.001)(highly statistically significant with p-value < 0.001) and increased amount of analgesics required in group A (225 ± 115.7 mg) and group B (163 ± 77.5 mg) when compared with group C (120 ± 55.3 mg).
Conclusion: Tadalafil is more effective than Tamsulosin and Silodosin in treatment of patients with distal ureteric stones ≤ 10 mm as regard stone expulsion rate, expulsion time with decreased number of colicky episodes and side effects.
References
- Somani BK, Aboumarzouk O, Traxer O, et al. Medical expulsive therapy for ureteral stones: where do we go from here? Nat Rev Urol. 2016; 13:608-12. DOI: https://doi.org/10.1038/nrurol.2016.146
- Ibrahim AI, Shetty SD, Awad RM, Patel KP. Prognostic factors in the conservative treatment of ureteric stones. Br J Urol 1991; 67:358-61. DOI: https://doi.org/10.1111/j.1464-410X.1991.tb15161.x
- Yilmaz E, Batislam E, Basar MM, et al. The comparison and effi-cacy of 3 different a1-adrenergic blockers for distal ureteral stones. J Urol. 2005; 173:2010-2. DOI: https://doi.org/10.1097/01.ju.0000158453.60029.0a
- Campschroer T, Zhu Y, Duijvesz D, et al. Alpha-blockers as med-ical expulsive therapy for ureteral stones. Cochrane Database Syst Rev. 2014; (4):CD008509. DOI: https://doi.org/10.1002/14651858.CD008509.pub2
- Liu Z, Su J, Yuan D, et al. Efficacy and safety of PDE5-Is and a-1 blockers for treating distal ureteral calculi: a mixed treatment comparison network meta-analysis of randomized controlled clinical tri-als. Int J Clin Exp Med. 2019; 12:4623-37.
- Assimos D, Krambeck A, Miller NL, et al. Surgical management of stones: American urological association/endourological society guideline, Part I. J Urol. 2016; 196:1153-60. DOI: https://doi.org/10.1016/j.juro.2016.05.090
- Özsoy M, Liatsikos E, Scheffbuch N, Kallidonis P. Comparison of silodosin to tamsulosin for medical expulsive treatment of ureteral stones: a systematic review and meta-analysis. Urolithiasis. 2016; 44:491-7. DOI: https://doi.org/10.1007/s00240-016-0872-y
- Gnyawali D, Pradhan MM, Sigdel PR, et al. Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial. Adv Urol. 2020; 2020:4347598. DOI: https://doi.org/10.1155/2020/4347598
- Shokeir AA, Tharwat MA, Abolazm AE, Harraz A. Sildenafil citrate as a medical expulsive therapy for distal ureteric stones: A randomised double-blind placebo-controlled study. Arab J Urol. 2016; 14:1-6. DOI: https://doi.org/10.1016/j.aju.2015.12.001
- Hsu YP, Hsu CW, Bai CH, et al. Silodosin versus tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis. PLoS One. 2018; 13:e0203035. DOI: https://doi.org/10.1371/journal.pone.0203035
- Elgalaly H, Sakr A, Fawzi A, et al. Silodosin vs. tamsulosin in the management of distal ureteric stones: a prospective randomised study. Arab J Urol. 2016; 14:12-7. DOI: https://doi.org/10.1016/j.aju.2015.11.004
- Bai Y, Yang Y, Wang X, et al. Tadalafil facilitates the distal ureter-al stone expulsion: a meta-analysis. J Endourol. 2017; 31:557-63. DOI: https://doi.org/10.1089/end.2016.0837
- Bensalah K, Pearle M, Lotan Y. Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol. 2008; 53:411-9. DOI: https://doi.org/10.1016/j.eururo.2007.09.012
- Wolf JS Jr. Treatment selection and outcomes: ureteral calculi. Urol Clin North Am. 2007; 34:421-30. DOI: https://doi.org/10.1016/j.ucl.2007.04.010
- Puvvada S, Mylarappa P, Aggarwal K, et al. Comparative effi-cacy of tadalafil versus tamsulosin as the medical expulsive therapy in lower ureteric stone: a prospective randomized trial. Cent European J Urol. 2016; 69:178-82.
- Laddha A, Mishra S, Ganpule A, et al. Comparison of tadalafil and tamsulosin in medical expulsive therapy for ureteric calculus: prospec-tive, randomized, placebo controlled study. Indian J Urol. 2015; 9:294.
- Kc HB, Shrestha A, Acharya GB, et al. Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study. Investig Clin Urol. 2016; 57:351-6. DOI: https://doi.org/10.4111/icu.2016.57.5.351
- Parikh C, Gurjar V, Shah S. Tamsulosin versus tadalafil as med-ical expulsive therapy of distal ureteric stones: a comparative study. Int Surg J. 2019; 6:982-8. DOI: https://doi.org/10.18203/2349-2902.isj20190835
- Kumar S, Jayant K, Agrawal MM, et al. Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study). Urology. 2015; 85:59-63. DOI: https://doi.org/10.1016/j.urology.2014.09.022
- Goyal SK, Singh V, Pandey H, et al. Comparative efficacy of tamsulosin versus tadalafil as medical expulsive therapy for distal ureteric stones. Urol Ann. 2018; 10:82. DOI: https://doi.org/10.4103/UA.UA_36_17
- Hollingsworth JM, Rogers MA, Kaufman SR, et al. Medical ther-apy to facilitate urinary stone passage: a meta-analysis. Lancet. 2006; 368:1171-9. DOI: https://doi.org/10.1016/S0140-6736(06)69474-9
- Preminger GM, Tiselius HG, Assimos DG, et al. 2007 guideline for the management of ureteral calculi. J Urol. 2007; 178:2418-34. DOI: https://doi.org/10.1016/j.juro.2007.09.107
- Tamm EP, Silverman PM, Shuman WP. Evaluation of the patient with flank pain and possible ureteral calculus. Radiology. 2003; 228:319-29. DOI: https://doi.org/10.1148/radiol.2282011726
- Wang CJ, Huang SW, Chang CH. Efficacy of an a1 blocker in expulsive therapy of lower ureteral stones. J Endourol. 2008; 22:41-6. DOI: https://doi.org/10.1089/end.2007.0133
- Jayant K, Agrawal R, Agrawal S. Tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones: a randomized controlled trial. Int J Urol. 2014; 21:1012-5. DOI: https://doi.org/10.1111/iju.12496
- Hasan HF, Jaffal WN, Al-Hossona HA. The role of tadalafil in lower ureteric stone expulsion. Iraqi Postgrad Med J. 2011; 10:24-32.
- Kinnman E, Nygårds EB, Hansson P. Peripheral a-adrenorecep-tors are involved in the development of capsaicin induced ongoing and stimulus evoked pain in humans. Pain. 1997; 69:79-85. DOI: https://doi.org/10.1016/S0304-3959(96)03257-5
- Li JK, Qiu S, Jin K, et al. 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. Kaohsiung J Med Sci. 2019; 35:257-264. DOI: https://doi.org/10.1002/kjm2.12048
- Kumar S, Jayant K, Agrawal S, Singh SK. Comparative efficacy of tamsulosin versus tamsulosin with tadalafil in combination with prednisolone for the medical expulsive therapy of lower ureteric stones: a randomized trial. Korean J Urol. 2014; 55:196-200. DOI: https://doi.org/10.4111/kju.2014.55.3.196
- Rahman MJ, Faridi MS, Mibang N, Singh RS. Comparing tam-sulosin, silodosin versus silodosin plus tadalafil as medical expulsive therapy for lower ureteric stones: A randomised trial. Arab J Urol. 2018; 16:245-9. DOI: https://doi.org/10.1016/j.aju.2017.11.012
Metrics
Citations and online attention from Dimensions, Altmetric and PlumX.
License
Copyright (c) 2023 the Author(s)

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.