Korean J Urol.  2010 Mar;51(3):193-197.

Tamsulosin versus Alfuzosin in the Treatment of Patients with Distal Ureteral Stones: Prospective, Randomized, Comparative Study

• Ahmed AF
• Al-Sayed A

Abstract

PURPOSE
We evaluated and compared the efficacy of tamsulosin and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones. MATERIALS AND METHODS: A total of 87 patients with distal ureteral stones of < or =10 mm were randomly divided into 3 groups. Group I patients (n=29) received 0.4 mg tamsulosin daily, group II patients (n=30) received 10 mg alfuzosin daily, and group III patients (n=28) were not given tamsulosin or alfuzosin. Patients in all groups received Diclofenac sodium regularly for 1 week and then on demand. Follow-up was done on a weekly basis for 30 days. RESULTS: The mean stone size was comparable in the 3 groups (4.97+/-2.24, 5.47+/-2.13, and 5.39+/-1.81 mm, respectively). The stone expulsion rate was 86.2%, 76.6%, and 50% in groups I, II, and III, respectively. The difference in groups I and II with respect to group III was significant (p=0.0028 and 0.035). The mean expulsion time for groups I to III was 7.52+/-7.06, 8.26+/-7.34, and 13.90+/-6.99 days, respectively. The expulsion time was significantly shorter in groups I and II than in group III (p=0.0097 and 0.026). Patients taking tamsulosin and alfuzosin had fewer pain attacks than did group III patients (1.24+/-0.57 vs. 1.43+/-0.67 vs. 1.75+/-1.17). Only 3 cases of drug side effects, 2 in group I and 1 in group II, were recorded. CONCLUSIONS: The use of tamsulosin or alfuzosin for the medical treatment of lower ureteric stones proved to be safe and effective. Moreover, tamsulosin did not have any significant benefits over alfuzosin.

Keyword

Urinary calculi; Ureter; Alfuzosin; Tamsulosin

MeSH Terms

Diclofenac
Follow-Up Studies
Humans
Prospective Studies
Quinazolines
Sulfonamides
Ureter
Urinary Calculi
Diclofenac
Quinazolines
Sulfonamides

Reference

1. Wolf JS Jr. Treatment selection and outcomes: ureteral calculi. Urol Clin North Am. 2007. 34:421–430.

2. Sur R, Marguet C, Priminger G. Management of ureteral calculi. AUA Update. 2006. 25:161–171.

3. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. The American Urological Association. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. J Urol. 1997. 158:1915–1921.

4. Ueno A, Kawamura T, Ogawa A, Takayasu H. Relation of spontaneous passage of ureteral calculi to size. Urology. 1977. 10:544–546.

5. Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck AC, Gallucci M, et al. 2007 guideline for the management of ureteral calculi. Eur Urol. 2007. 52:1610–1631.

6. Weiss R. Walsh PC, Retik AB, Vaughan JR, Wein AJ, editors. Physiology and pharmacology of the renal pelvis and ureter. Campbell's urology. 2002. 8th ed. Philadelphia: Saunders;399–400.

7. Sigala S, Dellabella M, Milanese G, Fornari S, Faccoli S, Palazzolo F, et al. Evidence for the presence of alpha1 adrenoceptor subtypes in the human ureter. Neurourol Urodyn. 2005. 24:142–148.

8. Agrawal M, Gupta M, Gupta A, Agrawal A, Sarkari A, Lavania P. Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones. Urology. 2009. 73:706–709.

9. Yilmaz E, Batislam E, Basar MM, Tuglu D, Ferhat M, Basar H. The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol. 2005. 173:2010–2012.

10. Kinder RB, Osborn DE, Flynn JT, Smart JG. Ureteroscopy and ureteric calculi: how useful? Br J Urol. 1987. 60:506–508.

11. Sahin A, Erdemli I, Bakkaloglu M, Ergen A, Basar I, Remzi D. The effect of nifedipine and verapamil on rhythmic contractions of human isolated ureter. Arch Int Physiol Biochim Biophys. 1993. 101:245–247.

12. Davenport K, Timoney A, Keeley FX. A comparative in vitro study to determine the beneficial effect of calcium-channel and alpha (1)-adrenoceptor antagonism on human ureteric activity. BJU Int. 2006. 98:651–655.

13. Ukhal MI, Malomuzh OI, Strashny V. Administration of doxazosin for speedy elimination of stones from lower section of ureter. Eur Urol. 1999. 35:4–6.

14. Porpiglia F, Vaccino D, Billia M, Renard J, Cracco C, Ghignone G, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol. 2006. 50:339–344.

15. Cervenakov I, Fillo J, Mardiak J, Kopecny M, Smirala J, Lepies P. Speedy elimination of ureterolithiasis in lower part of ureters with the alpha 1-blocker--tamsulosin. Int Urol Nephrol. 2002. 34:25–29.

16. Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol. 2003. 170:2202–2205.

17. De Sio M, Autorino R, Di Lorenzo G, Damiano R, Giordano D, Cosentino L, et al. Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol. 2006. 20:12–16.

18. Pedro RN, Hinck B, Hendlin K, Feia K, Canales BK, Monga M. Alfuzosin stone expulsion therapy for distal ureteral calculi: a double-blind, placebo controlled study. J Urol. 2008. 179:2244–2247.

19. Han MC, Park YY, Shim BS. Effect of tamsulosin on the expectant treatment of lower ureteral stones. Korean J Urol. 2006. 47:708–711.

20. Cooper JT, Stack GM, Cooper TP. Intensive medical management of ureteral calculi. Urology. 2000. 56:575–578.

21. Liatsikos EN, Katsakiori PF, Assimakopoulos K, Voudoukis T, Kallidonis P, Constantinides C, et al. Doxazosin for the management of distal-ureteral stones. J Endourol. 2007. 21:538–541.

22. Hübner WA, Irby P, Stoller ML. Natural history and current concepts for the treatment of small ureteral calculi. Eur Urol. 1993. 24:172–176.