Efficacy of nifedipine and alfuzosin in the management of distal ureteric stones: A randomized, controlled study.
BACKGROUND
Stone disease is a significant and world-wide health problem. Recently, certain drugs have been used as a supplement to observation alone in an effort to improve spontaneous stone expulsion. We evaluated the efficacy of nifedipine and alfuzosin in the medical treatment of symptomatic, uncomplicated distal ureteral stones.


METHODS
This was a randomized controlled prospective study to determine the efficacy of alfuzosin and nifedipine as an adjunctive medical therapy, to increases the stone-expulsion rates in distal ureteric calculus of size ≤10 mm. Investigators and patients were blinded to the randomization scheme. Patients were randomly divided into three equal groups of 35 patients each. Patients in Group I received tablet nifedipine 30 mg/day, Group II received alfuzosin 10 mg/day and Group III was the control group received tablet diclofenac sodium. The patient blood pressure, stone position on imaging, number of pain attacks, time of stone-expulsion, hospital re-admission and any adverse events were assessed. Patients were followed-up weekly and continued until the patient was rendered stone free or up to 28 days. Statistical analysis was performed and P < 0.05 was considered to be significant.


RESULTS
Stone-expulsion was observed in 60%, 85.7% and 20% patients in Group I, II and III respectively. A statistically significant difference was noted in between Groups I versus III, Groups II versus III and Groups I versus II (P < 0.0001, P < 0.0001, and P < 0.0315 respectively). The mean number of pain attacks was 2.91 ± 1.01 for Group I, 1.8 ± 0.83 for Group II, and 2.82 ± 1.12 for Group III, which is statistical significant in Groups II versus III, and Groups I versus II (P < 0.001 and P < 0.001). Hospital re-admission rate was less in treatment groups when compare to control group (P < 0.0001).


CONCLUSIONS
The use of alfuzosin and nifedipine as a medical expulsive therapy for distal ureteric stones proved to be safe and effective in term of increased stone-expulsion rate, reduced pain attacks and decrease hospital re-admissions.
Department of Surgery, ESI-PGIMSR and Model Hospital, Basaidarapur, New Delhi, India.
Sameer
Department of Surgery, ESI-PGIMSR and Model Hospital, Basaidarapur, New Delhi, India.
Shyam
S
Lal
Department of Surgery, ESI-PGIMSR and Model Hospital, Basaidarapur, New Delhi, India.
K S
KS
Charak
Department of Surgery, ESI-PGIMSR and Model Hospital, Basaidarapur, New Delhi, India.
Sumit
S
Chakravarti
Department of Radiology, ESI-PGIMSR and Model Hospital, Basaidarapur, New Delhi, India.
Supreeti
S
Kohli
Department of PSM, IMS, BHU, Varanasi, Uttar Pradesh, India.
Shamshad
S
Ahmad
Alfuzosin; distal ureteral stones; medical expulsive therapy; nifedepine