title: Comparative efficacy of tamsulosin versus tamsulosin with tadalafil in combination with prednisolone for the medical expulsive therapy of lower ureteric stones: a randomized trial.
abstract: OBJECTIVE
  To compare the safety and efficacy of tamsulosin and tamsulosin with the phosphodiesterase-5 inhibitor tadalafil in combination with prednisolone as medical expulsive therapies for lower ureteric stones.
  
  
  METHODS
  Between July 2011 and December 2012, 62 adult patients presenting with distal ureteric stones sized 5 to 10 mm were randomized equally to treatment with tamsulosin (group A) or tamsulosin with tadalafil (group B). Therapy was given for a maximum of 6 weeks. In addition, patients in groups A and B were given 5-mg prednisolone once daily (maximum 1 week). The stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up and endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done by using Student t-test and chi-square test.
  
  
  RESULTS
  There was a higher expulsion rate (83.9% in group B and 74.2% in group A) and a lower time to expulsion in both treatment groups than in historical controls used in earlier studies. However, these results were not statistically significant (p=0.349, p=0.074, respectively). Statistically significant differences were noted in hospitalization for colic and analgesic requirement, which were less in group B than in group A. There were no serious adverse events. Another important finding was improvement in erectile function in group B.
  
  
  CONCLUSIONS
  Medical expulsive therapy for distal ureteric stones using tamsulosin and tadalafil with prednisolone is safe and efficacious. Also, the prescription of tadalafil in cases of erectile dysfunction with the development of lower ureteric stones may provide additional advantages.
authors.affiliation: Department of Urology, PGIMER (Postgraduate Institute of Medical Education and Research), Chandigarh, India.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Surgery, PGIMER (Postgraduate Institute of Medical Education and Research), Chandigarh, India.
authors.forename: Kumar
authors.initials: K
authors.lastname: Jayant
authors.affiliation: Rabindranath Tagore Medical College, Udaipur, India.
authors.forename: Swati
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Urology, PGIMER (Postgraduate Institute of Medical Education and Research), Chandigarh, India.
authors.forename: Shrawan Kumar
authors.initials: SK
authors.lastname: Singh
keywords: Prednisolone; Tadalafil; Tamsulosin; Urinary calculi