Comparison of Safety and Efficacy of Tamsulosin alone and Combination of Tadalafil and Tamsulosin as Medical Expulsive Therapy for Ureteric Stone
DOI:
https://doi.org/10.56056/Keywords:
Medical expulsion therapy, Tadalafil, Tamsulosin, Ureteric stoneAbstract
Background and objectives: The medical expulsion therapy is essential to avoid invasive treatment of ureteric stones. The aim was to compare the safety and efficacy of Tamsulosin alone and combination of Tadalafil and Tamsulosin.
Methods: A retrospective cross-sectional study implemented in private clinic in Erbil city, Kurdistan Region-Iraq from 1st of February, 2022 to 31st of January, 2024 on one hundred and eighty-four patients with ureteric stones (92 patients with Tamsulosin only and 92 patients with Tadalafil & Tamsulosin). Post-treatment outcomes and adverse effects were assessed and managed accordingly.
Results: Number of analgesic injections were higher among patients treated by Tamsulosin only zero injection (39/92),1-3 times (44/92), and >3 times (9/92) while in Tamsulosin Tadalafil group were zero injection ( 65/92) , 1-3 times (24/92) and >3 times ( 3/92) with statistical value (p<0.001).also number of emergency visits were higher in Tamsulosin only group zero visit (57/92),1-3 visits (30/92),>3 visits (5/92) in compare to the Tamsulosin Tadalafil group zero visit(85/92) , 1-3 visits (5/92) and >3 visits (2/92) and the statistical value was ( p<0.001). also, stone expulsion rates were higher with Tadalafil & Tamsulosin therapy (70/92) while in Tamsulosin only group (66/92) and the statistical value was (p=0.02). dizziness adverse effect was more with Tadalafil & Tamsulosin therapy (5/92) in compare to the Tamsulosin only were (0/92) with statistical value (p=0.02).
Conclusion: Tadalafil & Tamsulosin is safe and more effective in medical expulsion therapy of ureteric stones than Tamsulosin alone.
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1.Ziemba JB, Matlaga BR. Epidemiology and economics of nephrolithiasis. Investig Clin Urol 2017; 58(5):299-306.
2.Eisner BH, Sheth S, Dretler SP, Herrick B, Pais VM. Abnormalities of 24-hour urine composition in first-time and recurrent stone-formers. Urology 2012; 80(4):776-9.
3.Pearle MS, Goldfarb DS, Assimos DG, Curhan G, Denu-Ciocca CJ, Matlaga BR, et al; American Urological Association. Medical management of kidney stones: AUA guideline. J Urol. 2014; 192(2):316-24.
4.Afaj AH, Sultan MA. Mineralogical composition of the urinary stones from different provinces in Iraq. The Sci. World J. 2005; 5(1); 24–38.
5.Puvvada S, Mylarappa P, Aggarwal K, Patil A, Joshi P, Desigowda R. Comparative efficacy of Tadalafil versus Tamsulosin as the medical expulsive therapy in lower ureteric stone: a prospective randomized trial. Cent European J Urol 2016; 69(1):178-82.
6.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(1):196-200.
7.Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al. 2007 guideline for the management of ureteral calculi. J Urol 2007; 178(1):2418-1734.
8.Wang Y, Chang X, Li J, Han Z. Efficacy and safety of various surgical treatments for proximal ureteral stone ?10mm: A systematic review and network meta-analysis. Int Braz J Urol 2020; 46(1):902-26.
9.Pietropaolo A, Proietti S, Geraghty R, Skolarikos A, Papatsoris A, Liatsikos E, et al. Trends of ‘urolithiasis: interventions, simulation, and laser technology’ over the last 16 years (2000–2015) as published in the literature: a systematic review from European section of Urotechnology. World J Urol 2017; 35(1):1651–8.
10.Pickard R, Starr K, MacLennan G, Lam T, Thomas R, Burr J, McPherson G, et al. Medical expulsive therapy in adults with ureteric colic: a multi-Centre, randomized, placebo-controlled trial. Lancet 2015; 386(9991):341-9.
11.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):1-6.
12.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(1):491-7.
13.Hsu YP, Hsu CW, Bai CH, Cheng SW, Chen KC, Chen C. Silodosin versus Tamsulosin for medical expulsive treatment of ureteral stones: A systematic review and meta-analysis. PLoS One 2018; 13(1):43-7. e0203035.
14.Falahatkar S, Khosropanah I, Allahkhah A, Jafari A. Open surgery, laparoscopic surgery, or trans ureteral lithotripsy--which method? Comparison of ureteral stone management outcomes. J Endourol 2011; 25(1):31-4.
15.Shabsigh R, Seftel AD, Rosen RC, Porst H, Ahuja S, Deeley MC, et al. Review of time of onset and duration of clinical efcacy of phosphodiesterase type 5 inhibitors in treatment of erectile dysfunction. Urology 2006; 68(4):689–96. Available from: https://doi.org/10.1016/j.urology.2006.05. 009/
16.Alwan MG, Nima MH, Alquraishi FS, Rashid NR. Deciding on a novel predictive value to gauge how well patients with lower ureteric stones respond to medical expulsive therapy. Urolithiasis 2024; 52(1):41-8.
17.Wood KD, Gorbachinsky I, Gutierrez J. Medical expulsive therapy. Indian J Urol 2014; 30(1):60-4.
18.Goyal SK, Singh V, Pandey H, Chhabra MK, Aggarwal SP, Bhat A. Comparative efficacy of Tamsulosin versus Tadalafil as medical expulsive therapy for distal ureteric stones. Urol Ann 2018; 10(1):82-6.
19.Gnyawali D, Pradhan MM, Sigdel PR, Parajuli P, Chudal S, Poudyal S, et al. Efficacy of Tamsulosin plus Tadalafil versus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones: A Randomized Controlled Trial. Adv Urol 2020; 20(1):32-8. 4347598.
20.El Hadj Sidi AM, Abdel Wehab T, El-Shazly AM, El Dakhakhni AS, Abdel-Azim AF. Efficacy of Silodosin versus Silodosin plus Tadalafil as Medical Expulsive Therapy for Lower Ureteric Stones: A Prospective Randomized Placebo Controlled Study. BMFJ 2023; 40(1):254-63.
21.Reda A, Kamel M, Loay M, Abdelsalam YM, Zarzour MA. Efficacy of the combination of Tadalafil and Tamsulosin versus tadalafil alone as a medical expulsive therapy for stone L1/3 ureter 10 mm or less: A prospective comparative placebo-controlled study. Curr Urol 2023; 42 (1):53–7.
22.Neeli S. Effect of Tamsulosin versus Tamsulosin plus Tadalafil on renal calculus clearance after shock wave lithotripsy: An open-labelled, randomised, prospective study. Asian J Urol 2021; 8(4):430-5.
23.Kc HB, Shrestha A, Acharya GB, Basnet RB, Shah AK, Shrestha PM. Tamsulosin versus Tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study. Investig Clin Urol 2016; 57(5):351-6.
24.Ragheb AM, Mohamed AG, Mostafa AS, Abd Elatif A, Elmarakbi AA, Ibrahim RM, et al. Tadalafil versus tamsulosin for distal ureteric stone expulsion; a prospective randomized comparative study. Afr J Urol 2024; 30(1): 20-4. Available from: https://doi.org/10.1186/s12301-024-00425-2/
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