Login to Access Video or Poster Abstract: MP90-19
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Introduction

Urinary stone disease is one of the most common reasons for patients visiting a urology practice, affecting about 5% to 10% of the population. Stone size and location are important predictors of stone passage. Using a selective ?-adrenoceptor blocker for medical expulsive therapy (MET) is an effective treatment approach widely used for ureteral stones. Various studies has proven that the MET is effective in the management of distal ureteric stone. The objective of this study is to assess the efficacy of an alpha-1 adrenergic receptor blocking agent (tamsulosin) on the spontaneous passage of stone (>8mm) locate in the proximal ureter (above the level of L3 transverse process).

Methods

We evaluated 500 patient diagnosed with acute ureteric colic in the emergency room and in the urology outpatient from January 2013 to December 2015.All of them underwent ultrasound or CT scan as the primary imaging modality. Patients having single radio-opaque proximal ureteral stone >8mm above the level of L3 transverse was only included for the study and were randomized into two groups. Group 1 patients (n = 250) were followed with classical conservative approach and patients in Group 2 (n = 250) additionally received tamsulosin, 0.4 mg/day during 4 weeks follow-up. The stone passage rates, stone expulsion time, change in colic episodes, and hospital re-admission were compared.

Results

Out of 500 patients, there were 350 males (70 %) and 150 females (30%). Age range was 23-55 years. The two groups were well balanced in terms of baseline patient and stone characteristics. Average stone size was (range 8-1.2 mm) The Stone expulsion rates didn’t showed any significant difference between tamsulosin receivers and non-receivers (35% vs 33%). But the time to stone expulsion period was shortened in those receiving tamsulosin (8.4 +/- 3.3 vs 11.6 +/- 4.1 days). Likewise renal colic episodes during follow-up period were significantly diminished in Group 2 patients (66 vs 36% ) and hospitalisation (25% vs33%).

Conclusions

Studies have shown that tamsulosin is a safe and effective drug that enhances spontaneous passage of ureteric stones. But our study tamsulosin was not much effective for stone (>8mm) locate in the proximal ureter (above the level of L3 transverse process).though it was effective in controlling the colic pain and shortening the time period for stone expulsion. Our study suggested that patient with stone size >8mm above the level of L3 transverse process if not responded to tamsulsoin after 5 days, then should go for the definitive treatment. Larger prospective trials are needed to make a definite clinical recommendation

Funding

none