title: Comparative efficacy of tadalafil versus tamsulosin as the medical expulsive therapy in lower ureteric stone: a prospective randomized trial.
abstract: BACKGROUND
  In recent years, medical expulsive therapy has been used in the management of distal ureteric stones as a supplement to conservative treatment. Therefore, we conducted a prospective randomized study to evaluate the possible role of tadalafil individually in comparison with proven tamsulosin therapy in ureteric stone expulsion. The aim of this study is to compare the safety and efficacy of a phosphodiesterase-5 inhibitor (tadalafil) and an α-1 blocker (tamsulosin) as medical expulsive therapy for distal ureteric calculi.
  
  
  METHODS
  Between August 2014 and October 2015, 207 patients who presented with distal ureteric stones of size 5-10 mm were randomly divided into two groups: tadalafil (Group A) and tamsulosin (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 noted. Both groups were compared for normally distributed data by percentage, analysis of variance, and T-test. All the classified and categorical data were analyzed for both groups using the chi-square test.
  
  
  RESULTS
  A statistically significant expulsion rate of 84.0% in Group A compared with 68.0% in Group B (P value = 0.0130), and shorter stone expulsion time in Group A (14.7±3.8) in comparison to Group B (16.8 ±4.5) was observed. Statistically significant differences were noted in renal colic episodes and analgesic requirement in Group A than Group B. No serious adverse effects were noted.
  
  
  CONCLUSIONS
  Tadalafil is safe, efficacious, and well tolerated as medical expulsive therapy for distal ureteric stones. This study showed that tadalafil increases ureteric stone expulsion quite significantly along with better control of pain and significantly lower analgesic requirement.
authors.affiliation: MS Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Puvvada
authors.affiliation: MS Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Prasad
authors.initials: P
authors.lastname: Mylarappa
authors.affiliation: MS Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Kuldeep
authors.initials: K
authors.lastname: Aggarwal
authors.affiliation: MS Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Avinash
authors.initials: A
authors.lastname: Patil
authors.affiliation: MS Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Prarthan
authors.initials: P
authors.lastname: Joshi
authors.affiliation: MS Ramaiah Medical College, Bangalore, Karnataka, India.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Desigowda
keywords: lower ureteric stone; medical expulsive therapy; tadalafil versus tamsulosin