Corticosteroids and Tamsulosin in the Medical Expulsive Therapy for Symptomatic Distal Ureter Stones: Single Drug or Association?

ObjectivesTo assess the clinical role of corticosteroids in the medical expulsive therapy of symptomatic distal ureteral stones.MethodsBetween January 2004 and September 2005, 114 patients with symptomatic distal ureteral stones with a ≥5 mm diameter were enrolled in this prospective study and divided into four groups based on the urologist (of four) who treated them in the emergency unit. Group A (33 patients) received tamsulosin (0.4 mg daily), group B (24 patients) received deflazacort (30 mg daily), group C (33 patients) received both (0.4 mg tamsulosin + 30 mg deflazacort daily), and control group D (24 patients) received only analgesics. The treatment duration was 10 d to prevent the side-effects of prolonged corticosteroid therapy. The end points were the expulsion rate, analgesic consumption, number of ureteroscopies, and safety.ResultsThe groups were comparable in terms of age, sex, and stone location. The stone diameter was 5.96 ± 0.33 mm for group A, 5.83 ± 0.4 mm for group B, 5.88 ± 0.23 mm for group C, and 5.71 ± 0.5 mm (p > 0.05) for group D. The rates of expulsion for the four groups were 60%, 37.5%, 84.8%, and 33.3%, respectively. There was a significant difference between group C and the other groups (p < 0.001). The mean analgesic consumption was 42.5 ± 0.4 mg for group A, 50 ± 0.3 mg for group B, 27.3 ± 0.5 mg for group C, and 81 ± 0.33 mg for group D, with a significant difference between group C and the other groups (p < 0.001). During the treatment period, only two cases of drug side-effects related to tamsulosin (without any drop-outs) were recorded.ConclusionWhen the medical expulsive therapy for symptomatic distal ureteral stones is considered, the use of steroids (deflazacort) proves efficient only when administered together with α1-blockers (tamsulosin). In addition, tamsulosin used on its own as a medical expulsive therapy can be considered as an alternative treatment for those patients who are not suitable for steroid therapy, as it is generally efficient.