Tamsulosin as an Expulsive Therapy for Lower Ureteric Calculus after Extra Corporeal Shock Wave Lithotripsy: A Randomized Controlled Study

Background and Aims: Tamsulosin has been used in several current medical expulsion therapy experiments but the results of studies are variable. Therefore, we conducted a study to evaluate the role of tamsulosin on stone clearance in patients with lower ureteric stone with extracorporeal shock wave lithotripsy (SWL). Methods: A prospective randomized open label study was performed in 119 patients with single lower ureteric calculus undergoing shock wave lithotripsy. The study group received 0.4 mg tamsulosin daily and control group received hydration and analgesic on demand for a maximum of 30 days. Follow up visits were performed at 1, 2, 3 & 4 weeks after ESWL. Efficacy of tamsulosin was evaluated in term of success rate, time for expulsion of fragment & analgesic requirement. Results: The clearance rate was 93% in tamsulosin group and 90% in control group, when stone size was in the range of 4-7 mm and difference was statistically not significant (p=0.6). When stone size was in the range of 8-12 mm, the clearance was 80% in tamsulosin group and 52% in control group and difference in statistically significant (p=0.021). The mean time to expulsion of the fragments was 12.9 days (±7.5) in tamsulosin group and 14.2days (±7.9) in control group and difference was statistically insignificant (p=0.561). The mean dose of analgesic used in tamsulosin group was 65.83 mg (±48.26) and 116.10 mg (±55) in control group. The difference was statistically significant (p=0.000). Conclusions: Treatment with tamsulosin appears to be beneficial in lower ureteric stone clearance after ESWL, particularly in larger stone with less need of analgesic.