title: Tamsulosin versus nifedipin in medical expulsive therapy for distal ureteral stones and the predictive value of Hounsfield unit in stone expulsion.
abstract: We evaluated the efficacy of tamsulosin and nifedipine in medical expulsive therapy (MET) in patients with distal ureteral stone. In addition, we tried to determine the predictive value of Hounsfield Unit (HU) of the stone in the success of MET. A total of 75 patients with a distal ureteral stone of 5-10 mm diameter were randomly divided into three groups. Group 1 (n = 25) received tamsulosin 0.4 mg/d; group 2 (n = 25) received nifedipine 10 mg/day p.o and group 3 (n = 25) received diclofenac sodium 50 mg p.o. when required. At the beginning of each treatment, the HU of the stone was also measured using a non-contrast computerized tomography in all the patients. The results were evaluated at week four. The mean age of the patients was 36.8 (range, 16-68) years. Stone expulsion was observed in 19 (76%) patients in group 1, 16 (64%) patients in group 2 and 9 (36%) patients in group 3 (pgroup1-3 = 0.004, pgroup2-3 = 0.048 and pgroup1-2 = 0.355). The mean expulsion time was 9, 9.1 and 10.3 d, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.619). The mean diclofenac sodium dose per patient was 544, 602 and 1408 mg in groups 1, 2 and 3, respectively (pgroup1-3 < 0.001, pgroup2-3 < 0.001 and pgroup1-2 = 0.977). The mean HU of the stone in patients with and without a successful MET was 363 and 389, respectively (p = 0.462). Our results showed that MET with both nifedipine and tamsulosin provided a similar increase in the expulsion rate for distal ureteral stones. HU does not seem to be a predictive parameter for stone expulsion.
authors.affiliation: Third Department of Urology, Ministry of Health, Ankara Numune Research and Training Hospital , Ankara , Turkey .
authors.forename: Melih
authors.initials: M
authors.lastname: Balci
authors.forename: Altug
authors.initials: A
authors.lastname: Tuncel
authors.forename: Omur
authors.initials: O
authors.lastname: Aydin
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Aslan
authors.forename: Ozer
authors.initials: O
authors.lastname: Guzel
authors.forename: Ugur
authors.initials: U
authors.lastname: Toprak
authors.forename: Fazli
authors.initials: F
authors.lastname: Polat
authors.forename: Ali
authors.initials: A
authors.lastname: Atan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009543:Nifedipine / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D014057:Tomography, X-Ray Computed; D014514:Ureteral Calculi / Q000000981:diagnostic imaging / Q000188:drug therapy*; D064804:Urological Agents / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D013449:Sulfonamides; D064804:Urological Agents; D014665:Vasodilator Agents; D000077409:Tamsulosin; D009543:Nifedipine
keywords: Hounsfield unit; nifedipine; tamsulosin; treatment; urolithiasis