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Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association?

Abstract：

OBJECTIVES:To assess the clinical role of corticosteroids in the medical expulsive therapy of symptomatic distal ureteral stones. METHODS:Between January 2004 and September 2005, 114 patients with symptomatic distal ureteral stones with a >/=5mm diameter were enrolled in this prospective study and divided into four groups based on the urologist (of four) who treated them in the emergency unit. Group A (33 patients) received tamsulosin (0.4mg daily), group B (24 patients) received deflazacort (30mg daily), group C (33 patients) received both (0.4mg tamsulosin+30mg deflazacort daily), and control group D (24 patients) received only analgesics. The treatment duration was 10 d to prevent the side-effects of prolonged corticosteroid therapy. The end points were the expulsion rate, analgesic consumption, number of ureteroscopies, and safety. RESULTS:The groups were comparable in terms of age, sex, and stone location. The stone diameter was 5.96+/-0.33mm for group A, 5.83+/-0.4mm for group B, 5.88+/-0.23mm for group C, and 5.71+/-0.5mm (p>0.05) for group D. The rates of expulsion for the four groups were 60%, 37.5%, 84.8%, and 33.3%, respectively. There was a significant difference between group C and the other groups (p<0.001). The mean analgesic consumption was 42.5+/-0.4mg for group A, 50+/-0.3mg for group B, 27.3+/-0.5mg for group C, and 81+/-0.33mg for group D, with a significant difference between group C and the other groups (p<0.001). During the treatment period, only two cases of drug side-effects related to tamsulosin (without any drop-outs) were recorded. CONCLUSION:When the medical expulsive therapy for symptomatic distal ureteral stones is considered, the use of steroids (deflazacort) proves efficient only when administered together with alpha(1)-blockers (tamsulosin). In addition, tamsulosin used on its own as a medical expulsive therapy can be considered as an alternative treatment for those patients who are not suitable for steroid therapy, as it is generally efficient.

journal_name

Eur Urol

journal_title

European urology

authors

Porpiglia F,Vaccino D,Billia M,Renard J,Cracco C,Ghignone G,Scoffone C,Terrone C,Scarpa RM

doi

10.1016/j.eururo.2006.02.023

keywords:

subject

Has Abstract

pub_date

2006-08-01 00:00:00

pages

339-44

issue

eissn

0302-2838

issn

1873-7560

pii

S0302-2838(06)00198-9

journal_volume

pub_type

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Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association?