Role of Tamsulosin, Tadalafil, and Silodosin as the Medical Expulsive Therapy in Lower Ureteric Stone: A Randomized Trial (a Pilot Study)

ObjectiveTo evaluate the role of 2 different α-1 blockers and 1 phosphodiesterase-5 inhibitor as medical expulsive therapy for distal ureteric calculi.Materials and MethodsBetween January 2011 and December 2012, 285 patients presenting with distal ureteric stones of size 5-10 mm were on consent randomly assigned to 1 of 3 outpatient treatment arms: tamsulosin (group A), silodosin (group B), and tadalafil (group C). Therapy was given for a maximum of 4 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up, and endoscopic treatment and adverse effects of drugs were noted. All 3 groups were compared for normally distributed data by the analysis of variance, Bonferroni or Kruskal-Wallis test, and Mann-Whitney U test, as required. All the classified and categorical data were analyzed for all 3 groups by using the chi-square test.ResultsThere was a statistically significant expulsion rate of 83.3% in group B compared with 64.4% and 66.7% in groups A and C, respectively, with lower time of stone expulsion (P value = .006 and P value = .016, respectively). Statistically significant differences were noted in colicky episodes and analgesic requirement in group B than groups A and C. There was no serious adverse event.ConclusionMedical expulsive therapy for the distal ureteric stones using tamsulosin, silodosin, and tadalafil is safe, efficacious, and well tolerated. The result of this pilot study showed that silodosin increases ureteric stone expulsion quite significantly along with better control of pain with significantly lesser analgesic requirement.