Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association?
OBJECTIVE
To assess the clinical role of corticosteroids in the medical expulsive therapy of symptomatic distal ureteral stones.


METHODS
Between January 2004 and September 2005, 114 patients with symptomatic distal ureteral stones with a >/=5mm 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 (0.4mg daily), group B (24 patients) received deflazacort (30mg daily), group C (33 patients) received both (0.4mg tamsulosin+30mg 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.


RESULTS
The groups were comparable in terms of age, sex, and stone location. The stone diameter was 5.96+/-0.33mm for group A, 5.83+/-0.4mm for group B, 5.88+/-0.23mm for group C, and 5.71+/-0.5mm (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+/-0.4mg for group A, 50+/-0.3mg for group B, 27.3+/-0.5mg for group C, and 81+/-0.33mg 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.


CONCLUSIONS
When the medical expulsive therapy for symptomatic distal ureteral stones is considered, the use of steroids (deflazacort) proves efficient only when administered together with alpha(1)-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.
Department of Urology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy. porpiglia@libero.it
Francesco
F
Porpiglia
Davide
D
Vaccino
Michele
M
Billia
Julien
J
Renard
Cecilia
C
Cracco
Gianpaolo
G
Ghignone
Cesare
C
Scoffone
Carlo
C
Terrone
Roberto Mario
RM
Scarpa
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D016009:Chi-Square Distribution; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011282:Pregnenediones / Q000627:therapeutic use*; D011446:Prospective Studies; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones; D000317:Adrenergic alpha-Antagonists; D011282:Pregnenediones; D013449:Sulfonamides; D000077409:Tamsulosin; C021988:deflazacort