ROLE OF TAMSULOSIN IN UPPER URETERIC STONES A RANDOMISED CONTROLLED TRIAL

ABSTRACT
Background: Twenty percent of the population is affected by renal stone disease. Treatment include conservative
management, shockwave lithotripsy, percutaneous nephrolithotomy (PCNL), endourological retrieval and open surgery.
Controversy exists regarding the role of tamsulosin as the agent for medical management of small stones without
obstruction.
Objective: We aim to investigate and compare the effectiveness of tamsulosin versus standard medical therapy (SMT)
for conservative management of ureteric stones in terms of time needed for stone expulsion, reduction in pain episodes
and stone expulsion rates.
Methods: This is a prospective randomised controlled study conducted between January 2016 and December 2016.
We included 110 patients, 57 for group 1 (tamsulosin) and 53 for group 2 (standard medical therapy). Patients with
single upper ureteric stone of ≤10 mm, presenting with acute colic and confirmed with ultrasound and X-Ray KUB
were included. Data for both treatment groups was compared for pain scores, time to spontaneous stone passage,
pain episodes and adverse effects from the treatment.
Results: Of the 110 patients, there were 79 (71.8%) men and 31 (28.2%) women with a mean age of 32.5 ± 5.6 years
(22-42 years). For group 1, the total stone expulsion rate was 78.9% (n = 45) while for group 2, it was 64.2% (n = 34).
This stone expulsion rate for the two treatment groups was statistically significant as shown by the independent samples
t-test with a mean difference in stone clearance time of -4.9 days (95% CI: -7.32 to -2.55, p <0.0001) as the mean
stone expulsion time for group 1 was 12.6 ± 6.8 days while for group 2 it was 17.5 ± 5.7 days.
Conclusions: Medical expulsive therapy using analgesia with tamsulosin is effective in clearance of upper ureteric
stones. It also reduces the severity and number of colic episodes as well as reducing the need for oral and parenteral
analgesics.
Keywords: Upper ureteric stones, tamsulosin, medical expulsive therapy