title: Tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones: a randomized controlled trial.
abstract: OBJECTIVE
  To compare the efficacy of tamsulosin versus tamsulosin plus tadalafil as medical expulsive therapy for lower ureteric stones.
  
  
  METHODS
  Between January 2013 and December 2013, 244 patients presenting with distal ureteric stones (size 5-10 mm) were randomized equally to tamsulosin (group A) or tamsulosin plus tadalafil (group B). 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, endoscopic treatment and adverse effects of drugs were recorded. Statistical analyses were carried out using Student's t-test and the χ(2) -test.
  
  
  RESULTS
  There was a statistically significant higher expulsion rate in group B compared with group A (83.6% vs 65.5%; P-value = 0.031) and a shorter time to expulsion (14.9 ± 4.4 days vs 16.7 ± 4.8 days; P-value = 0.003). Statistically significant differences were noted in terms of the number of hospital visits and analgesic requirement in favor of group B. There was no serious adverse event. An improvement in erectile function was noted in patients of group B compared with those of group A.
  
  
  CONCLUSIONS
  Medical expulsive therapy for distal ureteric stones using tamsulosin plus tadalafil is safe, effective and well tolerated. Furthermore, tadalafil provides the additional advantage of improving erectile dysfunction when this condition coexists with a lower ureteric stone.
authors.affiliation: Department of Urology, Sudha Hospital and Medical Research Centre, Kota, Rajasthan, India.
authors.forename: Kumar
authors.initials: K
authors.lastname: Jayant
authors.forename: Rajendra
authors.initials: R
authors.lastname: Agrawal
authors.forename: Swati
authors.initials: S
authors.lastname: Agrawal
mesh_terms: D000328:Adult; D002243:Carbolines / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D004542:Ejaculation / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects; D056844:Renal Colic / Q000209:etiology; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use*; D000068581:Tadalafil; D000077409:Tamsulosin; D013997:Time Factors; D014514:Ureteral Calculi / Q000150:complications / Q000188:drug therapy*; D064804:Urological Agents / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D002243:Carbolines; D013449:Sulfonamides; D064804:Urological Agents; D000068581:Tadalafil; D000077409:Tamsulosin
keywords: distal ureteric stone; tadalafil; tamsulosin