Adult urologyMedical-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
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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Medical Management of Renal and Ureteral Stones
2022, Comprehensive PharmacologyMedical Expulsive Therapy in Urolithiasis: A Review of the Quality of the Current Evidence
2017, European Urology FocusOutcome of α-blockers, with or without methylprednisolone combination, in medical expulsive therapy for lower ureteric stones: A prospective randomised study
2016, Arab Journal of UrologyCitation Excerpt :They reported an 84.8% stone expulsion rate in the combination arm (deflazacort and tamsulosin). Conversely, Dellabella et al. [17] found no statistically significant difference in the stone expulsion rate when they compared tamsulosin alone to its combination with steroids (P = 0.612). In our present study, we found a significant increase in the stone expulsion rate when using the combination of methylprednisolone and tamsulosin compared with tamsulosin alone, with no significant difference for the time to stone expulsion.
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