A Prospective Randomized Comparative Study between the Effect of Silodosin and Tamsulosin on Expulsion of Lower Third Ureteric Stones

Objectives: To compare the efficacy of silodosin (8 mg) vs tamsulosin (0.4 mg), as a medical expulsive therapy (MET), in the management of distal ureteric Calculi (DUC) in terms of stone clearance rate and stone expulsion time.

Patients and Methods: A prospective randomised study was conducted on 130 patients, aged more than 18 years, who had unilateral DUS less than 1 cm. Patients were divided into two groups. Group A received silodosin (8 mg) and Group B received tamsulosin (0.4 mg) daily for 1 month. The patients were followed-up by urine analysis & serum creatinine. Kidney ureter bladder x-ray (KUB) (for detection of the stone size and site), Pelvi-abdominal ultrasound (U/S) (for diagnosis & monitoring of the degree of hydronephrosis), Non contrast spiral CT abdomen & pelvis (NCCT): for detection of site, size and density of the stone and detection of degree of hydronephrosis.

Results: There was a significantly higher stone clearance rate of 88.3% in Group A vs 68.3% in Group B. Group also showed a significant advantage for stone expulsion time but as regard analgesic use no significant difference between both groups.

No severe complications were recorded during the treatment period. An ejaculation was recorded in 8 and 1 patients in Groups A and B, respectively. However, complication as headache hypotension are more common in group B, 4: 13 in group A and group B respectively.

Conclusion: Our data showed that silodosin is more effective than tamsulosin in the management of DUC for stone clearance rates and stone expulsion times. A multicenter study on larger scale is needed to confirm the efficacy and safety of silodosin.