• Alpha-blockers
• Alternative treatments
• Bias
• Masturbation
• Medical expulsive therapy
• Sexual activity
• Silodosin
• Stones
• Tamsulosin
• Ureteral stones
• Urinary stones

• Male
• Humans
• Delusions
• Adrenergic alpha-Antagonists/therapeutic use
• Data Accuracy
• Erectile Dysfunction/drug therapy
• Ethnicity

• medical expulsive therapy
• stone passage
• ureteral calculi
• ureterorenoscopic lithotripsy
• urolithiasis

• Alkali therapy
• Medical expulsive therapy
• Thiazide
• Urolithiasis

• Female
• Humans
• Male
• Ureteral Calculi/prevention & control
• Urinary Calculi/prevention & control
• Urolithiasis

• Humans
• Network Meta-Analysis
• Pharmaceutical Preparations
• Randomized Controlled Trials as Topic
• Tamsulosin
• Treatment Outcome
• Ureter
• Ureteral Calculi/drug therapy

• MET
• distal ureteral stone
• medical expulsive therapy
• silodosin
• terpen combination
• urolithiasis

• Humans
• Indoles
• Retrospective Studies
• Terpenes
• Treatment Outcome
• Ureteral Calculi/drug therapy

• Humans
• Indoles
• Retrospective Studies
• Ureteral Calculi/diagnostic imaging
• Ureteral Calculi/drug therapy
• Urinary Calculi

The efficacy of alpha-blockers as medical expulsive therapy (MET) is well established. However, it is not known which of the three most commonly used alpha-blockers (tamsulosin, alfuzosin and silodosin) is the most efficacious. With this study we aimed to assess the efficacy of the three commonly used alpha-blockers as MET for distal ureter stones.

For this review, we searched multiple databases such as PubMed/Medline, Scopus, Embase, OviD SP, CINAHL, and web of science to identify all the relevant randomized studies comparing the efficacy of tamsulosin, alfuzosin, and silodosin. Preferred reporting items for systematic reviews for network meta-analysis (PRISMA-NMA) were followed while conducting this review and the study protocol was registered with PROSPERO (CRD42020175706).

In this review, 31 studies with 7077 patients were included. Compared to placebo all the treatment groups were more effective for both stone expulsion rate (SER) and stone expulsion time (SET). For both SER and SET, silodosin had the highest SUCRA (94.8 and 90.4) values followed by alfuzosin (58.8 and 64.9) and tamsulosin (46.2 and 44.5). The incidence of postural hypotension was similar with all the drugs, whereas, the incidence of retrograde ejaculation was significantly higher for silodosin. Overall confidence for each comparison group in this review ranged from “very low” to “moderate” according to the CINeMA approach.

Among the three commonly used alpha-blockers silodosin is the most efficacious drug as MET for lower ureter stones followed by alfuzosin and tamsulosin.

• Adrenergic alpha-Antagonists
• Meta-Analysis [Publication Type]
• Therapeutics

• Children
• Medical expulsive therapy
• Placebo
• Silodosin
• Tamsulosin

• Masturbation
• Tamsulosin
• Ureteral stone

• Adult
• Humans
• Male
• Masturbation
• Prospective Studies
• Single-Blind Method
• Treatment Outcome
• Ureteral Calculi/therapy

• medical expulsive treatment
• ureteral stone
• viburnum opulus

• expulsive
• side effects
• tamsulosin
• urinary stone

• Humans
• Tamsulosin/therapeutic use
• Ureteral Calculi/drug therapy
• Urological Agents/therapeutic use

• Adrenergic alpha-Antagonists/adverse effects
• Adrenergic alpha-Antagonists/therapeutic use
• Adult
• Analgesics/therapeutic use
• Diclofenac/therapeutic use
• Hospitalization/statistics & numerical data
• Humans
• Randomized Controlled Trials as Topic
• Time Factors
• Ureteral Calculi/diagnostic imaging
• Ureteral Calculi/drug therapy

The objective of this study was to compare the relative efficacy of tamsulosin and tadalafil as medical expulsive therapy for distal ureteric stones.

This was a prospective study performed between December 2014 and February 2016. A total of 123 adult patients (>18 years of age) presenting with distal ureteric stones sized 6–10 mm were randomized to treatment with tamsulosin 0.4 mg once daily (Group A) or tadalafil10 mg once daily (Group B). Therapy was given for a maximum of 4 weeks. The stone expulsion rate was the primary endpoint. Time to stone expulsion, number of colic episodes, analgesic use, number of hospital visits for pain, endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done using Fisher's exact test and Chi-square test.

A total of 61 patients were included in tamsulosin group and 62 patients in tadalafil group. A statistically insignificant difference was found for stone clearance rate between both groups as a whole (Group A-73.77%, Group B-69.35%, P = 0.690) as well as when we considered both subgroups (A1-78.05%, B1-75.0%, P = 0.802; A2-65.0%, B2-55.6%, P = 0.741). All the primary and secondary outcome measures were more in favour of stones ≤8 mm size than stones >8 mm size. No statistical difference was found for adverse drug effects except for retrograde ejaculation, which was significantly high in tamsulosin group (P < 0.001).

This study showed that although tamsulosin is more effective for stone clearance than tadalafil, but this difference was not significant (P = 0.690).

• Lower ureteric stones
• medical expulsive therapy
• tadalafil
• tamsulosin

• AR, adrenergic receptor
• Efficacy
• KUB, kidney, ureter, and bladder
• MET, medical expulsive therapy
• PDE(-5), phosphodiesterase (type 5)
• Silodosin
• Tadalafil
• Tamsulosin
• USG, ultrasonography
• Ureteric calculi
• cGMP, cyclic guanosine monophosphate

Introduction

Our aim was to contribute a study that includes a higher patient population to the limited number of studies comparing tamsulosin and silodosin in the treatment of distal ureteral stones.

Material and methods

Patients who presented with renal colic to the urology emergency clinic and were diagnosed with ureteral stones and followed-up with conservative treatment between January 2010 and January 2016 were retrospectively screened. According to the inclusion-exclusion criteria, the patients were divided into three groups. Group 1: 150 patients followed with watchful waiting (WW), Group 2: 156 patients who received 0.4 mg of tamsulosin daily, and Group 3: 159 patients who received 8 mg of silodosin daily. The side effects of the used drugs, duration of stone reduction, and expulsion rates were evaluated and compared separately.

Results

A total of 465 patients were included in the study. No statistically significant difference was found in terms of age, gender, and stone size among the groups. The patient characteristics and results are shown in Table 1. The differences in stone expulsion rate between the groups in the first week were calculated using the Chi-square test and found to be non-significant (p = 0.155); whereas, the stone expulsion rates between Group 1 versus Group 2 and Group 1 versus Group 3 were found to be significantly different after the second and third week.

Conclusion

According to our results, no statistically significant superiority between tamsulosin and silodosin was shown in the treatment of distal ureteral stones in the Turkish population.

• silodosin
• stone
• tamsulosin
• ureter

• Medical expulsive therapy
• Sexual intercourse
• Tamsulosin
• Ureteral stone

This study aims to evaluate the efficacy of tamsulosin and alfuzosin for the distal ureteral stone. This study assessed the spontaneous passage and expulsion of the stone.

The study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, from May 2013 to May 2014. A total number of 136 patients diagnosed as distal ureteric stone (US) of size <10 mm were included in this study. It was divided into two groups (I and II) out of which 36 cases were excluded. Group I received tablet tamsulosin 0.4 mg/day, and Group II received alfuzosin 10 mg/day. The efficacy of tamsulosin and alfuzosin as an adjunctive medical therapy was determined.

Both the drugs can be safely used for the distal USs. The stone expulsion rate was seen in 36 patients (72.0%) in Group I, and in 34 patients (68.0%) in Group II (P = 0.545). The passage of stones noticed by 32 patients in each Groups I and II (P = 1.000). The mean number of pain attacks was 2.91 ± 1.01 for Group I, and 1.8 ± 0.83 for Group II (P < 0.001 and P < 0.001). Thus, we propagate the use of alfuzosin significantly lower number of pain attacks. The drug-related side-effects were postural hypertension (four in Group I and one in Group II) and retrograde ejaculation (eight in Group I, and one in Group II). Thus, the difference was statistically significant in terms of retrograde ejaculation but insignificant for postural hypotension.

There is no difference between both medications in term of efficacy (passing stones) for the management of distal ureteral stones. Both medications are safe and effective. In addition, alfuzosin was better tolerated than tamsulosin as it has fewer side effects.

• Alfuzosin
• medical therapy
• pain
• stones
• ureter

Supporting an “ultrasound-first” approach to evaluating renal colic in the emergency department (ED) remains important for improving patient care and decreasing healthcare costs. Our primary objective was to compare emergency physician (EP) ultrasound to computed tomography (CT) detection of hydronephrosis severity in patients with suspected renal colic. We calculated test characteristics of hydronephrosis on EP-performed ultrasound for detecting ureteral stones or ureteral stone size >5mm. We then analyzed the association of hydronephrosis on EP-performed ultrasound, stone size >5mm, and proximal stone location with 30-day events.

This was a prospective observational study of ED patients with suspected renal colic undergoing CT. Subjects had an EP-performed ultrasound evaluating for the severity of hydronephrosis. A chart review and follow-up phone call was performed.

We enrolled 302 subjects who had an EP-performed ultrasound. CT and EP ultrasound results were comparable in detecting severity of hydronephrosis (x²=51.7, p<0.001). Hydronephrosis on EP-performed ultrasound was predictive of a ureteral stone on CT (PPV 88%; LR+ 2.91), but lack of hydronephrosis did not rule it out (NPV 65%). Lack of hydronephrosis on EP-performed ultrasound makes larger stone size >5mm less likely (NPV 89%; LR− 0.39). Larger stone size > 5mm was associated with 30-day events (OR 2.30, p=0.03).

Using an ultrasound-first approach to detect hydronephrosis may help physicians identify patients with renal colic. The lack of hydronephrosis on ultrasound makes the presence of a larger ureteral stone less likely. Stone size >5mm may be a useful predictor of 30-day events.

To conduct a systematic review and meta-analysis investigating the efficacy and safety of medical expulsive therapy (MET) in low risk of bias (RoB) randomised controlled trials (RCTs).

A Cochrane style systematic review was conducted on published literature from 1990 to 2016, to include low RoB and a power calculation. A pooled meta-analysis was conducted.

The MET group included 1387 vs 1381 patients in the control group. The analysis reveals α-blockers increased stone expulsion rates (78% vs 74%) (P < 0.001), whilst calcium channel blockers (CCBs) had no effect compared to controls (79% vs 75%) (P = 0.38). In the subgroup analysis, α-blockers had a shorter time to stone expulsion vs the control group (P < 0.001). There were no significant differences in expulsion rates between the treatment groups and control group for stones <5 mm in size (P = 0.48), proximal or mid-ureteric stones (P = 0.63 and P = 0.22, respectively). However, α-blockers increased stone expulsion in stones >5 mm (P = 0.02), as well as distal ureteric stones (P < 0.001). The α-blocker group developed more side-effects (6.6% of patients; P < 0.001). The numbers needed to treat for α-blockers was one in 14, for stones >5 mm one in eight, and for distal stones one in 10.

The primary findings show a small overall benefit for α-blockers as MET for ureteric stones but no benefit with CCBs. α-blockers show a greater benefit for large (>5 mm) ureteric stones and those located in the distal ureter, but no benefit for smaller or more proximal stones. α-blockers are associated with a greater risk of side-effects compared to placebo or CCBs.

• ARR, absolute risk reduction
• CCB, calcium channel blocker
• Calcium channel blockers
• MD, mean difference
• MET, medical expulsive therapy
• MeSH, medical subject headings
• Medical expulsive therapy (MET)
• NNT, numbers needed to treat
• RCT, randomised controlled trial
• RR, risk ratio
• RoB, risk of bias
• Ureteric stones
• Urinary stones
• α-Blockers

• Adrenergic alpha-antagonists
• Distal ureteral stones
• Meta-analysis
• Pediatrics
• Randomized controlled trials

• alpha blockers
• medical expulsive therapy
• renal colic
• ureteric lithiasis

• Adrenergic alpha-Antagonists/therapeutic use
• Analgesics/therapeutic use
• Diclofenac/therapeutic use
• Humans
• Pain/drug therapy
• Pain/etiology
• Pain Measurement
• Time Factors
• Ureteral Calculi/complications
• Ureteral Calculi/drug therapy

• Adrenergic alpha-Antagonists/therapeutic use
• Humans
• Randomized Controlled Trials as Topic
• Ureteral Calculi/drug therapy

• Tadalafil
• Tamsulosin
• Ureteral calculi

• Conservative management
• Cost-effective
• Tamsulosin
• Ureteral calculus
• Urolithiasis

To compare the safety and efficacy of tamsulosin, alfuzosin, and their combinations with methylprednisolone, in the medical management of lower ureteric stones.

Between September 2012 and June 2014, patients diagnosed with a single lower ureteric stone of ⩽10 mm (longest dimension) were enrolled. Patients with urinary tract infection, severe hydronephrosis, pregnancy, hypertension, diabetes, ulcer disease, or renal insufficiency were excluded. According to the medication added to the analgesic anti-inflammatory, patients were stratified into four groups, with 53 patients in each. Group I patients received tamsulosin 0.4 mg and those in Group II received tamsulosin 0.4 mg and methylprednisolone 8 mg. Group III patients received alfuzosin 10 mg and those in Group IV received alfuzosin 10 mg and methylprednisolone 8 mg. Treatment was continued until stone expulsion or to a maximum of 2 weeks. The patients’ demographics, stone criteria, and stone-free rates were calculated and analysed.

The mean (SD) maximum stone dimension was 7.8 (1.5), 8.1 (1.3), 7.9 (1.6) and 8.0 (1.4) mm in Groups I, II, III and IV, respectively. Groups II and IV had significantly higher stone-free rates than Groups I and III (P < 0.05), whilst there were no statistically significant differences between Groups I and III or between Groups II and IV. There was no statistical difference among the four groups for the time to stone expulsion. Three patients in Group II and two patients in Group IV developed transient hyperglycaemia, which resolved after cessation of methylprednisolone.

The combination of alfuzosin or tamsulosin with methylprednisolone seems to be effective and safe for managing lower ureteric stones of <1 cm.

• KUB, plain abdominal radiograph of the kidneys, ureters and bladder
• MET, medical expulsive therapy
• Methylprednisolone
• SWL, shockwave lithotripsy
• URS, ureteroscopy
• Ureteric stones
• Urolithiasis
• α-Blockers

To study the effect of sildenafil citrate on spontaneous passage of distal ureteric stones (DUS).

This was a randomised double-blinded placebo-controlled study of 100 patients with DUS. Inclusion criteria were: male, age 18–65 years, normal renal function, and a single radiopaque unilateral DUS of 5–10 mm. Patients were randomly allocated into two equal groups, one that received placebo and the other that received 50 mg sildenafil citrate once daily. Both investigators and patients were masked to the type of treatment. Patients self-administered the medication until spontaneous passage of the DUS. In patients where there was uncontrolled pain, fever, an increase in serum creatinine of >1.8 mg/dL, progressive hydronephrosis or no further progress after 4 weeks, a decision was taken for further treatment.

In all, 47 and 49 patients were available for analysis in both the placebo and sildenafil citrate groups; respectively. Both groups were comparable for age and stone characteristics. Spontaneous expulsion occurred in 19 of 47 patients (40.4%) in the placebo group and in 33 of 49 (67.3%) in the sildenafil citrate group (P = 0.014). The mean time to stone expulsion was significantly shorter in the sildenafil citrate group (P < 0.001). A multivariable Cox proportional hazards model showed that receiving sildenafil citrate was the only independent factor that had a significant impact on stone passage with a hazard ratio of 2.7 (95% confidence interval 1.5–4.8; P < 0.001).

Sildenafil citrate enhances spontaneous passage of 5–10 mm DUS.

• DUS, distal ureteric stones
• ESWL, extracorporeal shockwave lithotripsy
• KUB, plain abdominal radiograph of the kidneys, ureters and bladder
• MET, medical expulsive therapy
• Medical expulsive therapy
• NCCT, noncontrast computed tomography
• NO, nitric oxide
• PDE5, phosphodiesterase 5
• Phosphodiesterase inhibitors
• RCT, randomised controlled trial
• Sildenafil citrate
• Stone
• Ureter
• cAMP, cyclic adenosine monophosphate
• cGMP, cyclic guanosine monophosphate

• medical expulsion therapy
• silodosin
• stone and randomized controlled trials
• ureteral calculi
• urolithiasis

• Adrenergic alpha-1 Receptor Antagonists/therapeutic use
• Humans
• Indoles/adverse effects
• Indoles/therapeutic use
• Sulfonamides/therapeutic use
• Tamsulosin
• Ureteral Calculi/drug therapy

• DUS, distal ureteric stones
• Distal
• KUB, plain abdominal radiograph of the kidneys, ureters and bladder
• MET, medical expulsive therapy
• SWL, shockwave lithotripsy
• Silodosin
• Stone
• Tamsulosin
• Ureteric

• Medical expulsive therapy
• Naftopidil
• Ureteral stone
• α-Blockers

Over half a million patients present to emergency departments and nearly 3 million patients visit healthcare providers annually due to problems associated with urolithiasis. Despite updated guidelines from the American Urological Association and European Association of Urology for the evaluation and management of nephrolithiasis, considerable variability still exists regarding treatment for acute symptomatic upper urinary tract stones. Therefore, this article will review the current evaluation and management of acute symptomatic nephrolithiasis. Initial management includes analgesia and antiemetics. Additionally, a urinalysis and creatinine are required laboratory evaluations. Acute imaging with a non-contrast computed tomography (CT) scan is the diagnostic imaging modality of choice. However, concerns over radiation exposure have led towards low-dose and even ultra-low-dose protocols for the detection of urinary calculi. Low-dose non-contrast CT scans are now standard of care for the initial diagnosis of renal colic in patients with a body mass index ≤ 30. Medical expulsive therapy is recommended for patients with a ureteral calculus < 10 mm and no signs of infection. Emergency urinary decompression is mandatory for a specific subset of patients, especially those with infection. Although limited data exists, emergency ureteroscopy or even shock wave lithotripsy may also be therapeutic options.

• Nephrolithiasis
• Low-dose computed tomography scan
• Medical expulsive therapy
• Ureteroscopy
• Extracorporeal shockwave lithotripsy