Elsevier

Urology

Volume 66, Issue 4, October 2005, Pages 712-715
Urology

Adult urology
Medical-expulsive therapy for distal ureterolithiasis: Randomized prospective study on role of corticosteroids used in combination with tamsulosin—simplified treatment regimen and health-related quality of life

https://doi.org/10.1016/j.urology.2005.04.055Get rights and content

Abstract

Objectives

To assess the clinical efficacy of the addition of a corticosteroid drug to tamsulosin in the medical-expulsive therapy of distal ureterolithiasis.

Methods

Sixty consecutive patients with a symptomatic distal ureteral stone were included in our study and randomized to one of two home treatment groups. Group 1 patients (n = 30) received tamsulosin (0.4 mg daily), and group 2 patients (n = 30) were treated with a corticosteroid drug (deflazacort, 30 mg daily) plus tamsulosin. The treatment duration was until stone expulsion or 28 days, whichever came first. The primary endpoint of the study was the stone expulsion rate. The secondary endpoints were the expulsion time; use of analgesics; number of emergency room admissions, hospitalizations, and workdays lost; drug side effects; and quality of life of the patients (EuroQol questionnaire, EQ-5D) during treatment.

Results

The two groups had a similar expulsion rate (90% for group 1 and 96.7% for group 2; P = 0.612), but the expulsion time was significantly reduced in group 2 patients (P = 0.036). During the treatment period, we did not observe significant differences between the two groups in the number of emergency room visits or hospitalizations, analgesic use, number of workdays lost, or incidence of drug side effects. The quality of life of the patients during therapy, as determined using the EQ-5D, was similar in both groups.

Conclusions

The use of a corticosteroid drug in association with tamsulosin seemed to induce more rapid stone expulsion. In addition, tamsulosin alone as medical-expulsive therapy for distal ureteral calculi had excellent expulsive effectiveness.

Section snippets

Material and methods

At the department of urology, we recruited patients coming from the emergency room (ER) because of symptomatic ureterolithiasis from February 2004 to August 2004. Men and women aged older than 18 years were eligible for inclusion in this study if they had distal ureterolithiasis with stones 4 mm or larger detectable by ultrasonography and/or radiologic tests. The exclusion criteria were lithiasis of the ureteral intramural tract, marked hydronephrosis; acute kidney failure; fever; multiple

Results

During the study period, we observed 179 patients with a diagnosis of renal colic, and the presence of a distal ureteral stone was detected in 75 subjects. Of these patients, 60 were eligible for the trial, and 15 were excluded from the study because of severe hydronephrosis in 3, fever in 2, renal colic that could not be controlled within 1 hour in 2, lithiasis of the ureteral intramural tract in 4, and a history of renal colic for more than 1 day in 4. All 60 eligible patients opted for the

Comment

Recent studies have highlighted the interesting opportunity to treat distal ureterolithiasis through a conservative approach using MET.1, 2, 3, 4 Currently, studied MET regimens have always implied the use of a corticosteroid drug, thus limiting this treatment to patients for whom therapy with corticosteroids is not contraindicated. In addition, the actual clinical effect of corticosteroids on the natural course of distal ureteral stones has never been investigated. Recently, an Italian group

Conclusions

The addition of a corticosteroid drug to tamsulosin in the MET of distal ureterolithiasis seemed to produce a more rapid stone expulsion only, but not an increase in the expulsion rate. The use of tamsulosin, with or without corticosteroids, has proved very effective for stone expulsion. Our study results also confirmed the excellent control of pain and very good quality of life for patients while waiting for stone expulsion. MET with tamsulosin may be recommended without corticosteroids and

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