USING TAMSULOSINE IN THE MANAGEMENT OF LOWER URETERIC CALCULI: OUR EXPERIENCE OF MEDICAL EXPUSIVE THERAPY OF URETERIC CALCULI IN A RANDOMIZED CONTROLLED TRIAL

Background: Lower ureteric calculi can be treated by different modalities. There are many minimally invasive interventional (e.g.,ESWL, ureterorenoscopy, the holmium: YAG laser and basket devices) as well as expectant (watchful waiting) treatments are in practice for the management of distal ureteric calculi. selected method depend on the type of equipment available, location, type and size of stone, needs of the patient and skills of the surgeon. Most of the work on the potency of tamsulosin in lower ureteric calculi expulsion has been done in the developed countries. Methods: Our randomized controlled trial in Avicenna Hospital Lahore included 100 patients over 18 years of age with stone Size ≤8mm in distal one third of ureter. Patients were randomly assigned into two groups (A & B). Group A Patients were given Capsule Tamsulosin 0.4 mg, once daily up to four weeks while group B patients were given placebo, one Capsule daily up to four weeks. The final result was the expulsion rate. Informed consent was obtained from all the patients. Stone Expulsion time, analgesia requirement, need for hospitalization and drug adverse effects were secondary endpoints. Results: A total of 49 patients in group A and 48 patients in group B came for follow up, therefore 97 out of 100 patients were evaluated. Mean age of the patients was 36.34 years (range 18–57 years). Mean stone size was 5.78 mm (range 4–8 mm) in largest dimension. A stone expulsion rate of 85.71% (42 patients) was noted in group A and 54.20% (26 patients) in group B. Group A showed a statistically significant advantage in terms of stone expulsion rate (p=0.032). Considering expulsion time in days group A demonstrated statistically significant advantage (p=0.015). Regarding age, sex, stone size and stone lateralization (right/left), there was no remarkable difference between the group A and B. No drug adverse effects were seen in both the groups. Conclusion: Tamsulosine can be used as medical expulsion therapy in lower ureteric calculi of size less than or equal to 8mm.