title: Role of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in lower ureteric stone: a randomized trial (a pilot study).
abstract: OBJECTIVE
  To evaluate the role of 2 different α-1 blockers and 1 phosphodiesterase-5 inhibitor as medical expulsive therapy for distal ureteric calculi.
  
  
  METHODS
  Between January 2011 and December 2012, 285 patients presenting with distal ureteric stones of size 5-10 mm were on consent randomly assigned to 1 of 3 outpatient treatment arms: tamsulosin (group A), silodosin (group B), and tadalafil (group C). 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, and endoscopic treatment and adverse effects of drugs were noted. All 3 groups were compared for normally distributed data by the analysis of variance, Bonferroni or Kruskal-Wallis test, and Mann-Whitney U test, as required. All the classified and categorical data were analyzed for all 3 groups by using the chi-square test.
  
  
  RESULTS
  There was a statistically significant expulsion rate of 83.3% in group B compared with 64.4% and 66.7% in groups A and C, respectively, with lower time of stone expulsion (P value = .006 and P value = .016, respectively). Statistically significant differences were noted in colicky episodes and analgesic requirement in group B than groups A and C. There was no serious adverse event.
  
  
  CONCLUSIONS
  Medical expulsive therapy for the distal ureteric stones using tamsulosin, silodosin, and tadalafil is safe, efficacious, and well tolerated. The result of this pilot study showed that silodosin increases ureteric stone expulsion quite significantly along with better control of pain with significantly lesser analgesic requirement.
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: santoshsp1967jaimatadi@yahoo.co.in.
authors.forename: Santosh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kumar
authors.initials: K
authors.lastname: Jayant
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Mayank Mohan
authors.initials: MM
authors.lastname: Agrawal
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Shrawan Kumar
authors.initials: SK
authors.lastname: Singh
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Swati
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kalpesh M
authors.initials: KM
authors.lastname: Parmar
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000627:therapeutic use*; D000328:Adult; D002243:Carbolines / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D013449:Sulfonamides / Q000627:therapeutic use*; D000068581:Tadalafil; D000077409:Tamsulosin; D014514:Ureteral Calculi / Q000188:drug therapy* / Q000473:pathology
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D002243:Carbolines; D007211:Indoles; D058986:Phosphodiesterase 5 Inhibitors; D013449:Sulfonamides; D000068581:Tadalafil; C095285:silodosin; D000077409:Tamsulosin