Role of medical expulsive therapy in lower ureteral calculus

Rohit G. Rangaiah, Ananth J. Kamath, Ashok Kumar Saini


Background: Urolithiasis is a chronic disease with a significant burden on the healthcare system. The aim of this study was to evaluate the role of medical expulsive therapy (tamsulosin alone or in combination with deflazacort) in the treatment of lower ureteric calculi.

Methods: This was a prospective, randomized, controlled trial conducted at a tertiary care centre between November 2015 and October 2017. Patients aged more than 18 years solitary ureteral calculus 5-10 mm in size, located at distal ureter were randomized (1:1:1) to receive tamsulosin 0.4 mg once-daily (OD), deflazacort 6 mg twice-daily (BD) and analgesic OD (Group A); tamsulosin 0.4 mg and analgesic OD (Group B); or only analgesic OD (Group C, control Group) for 7 days. The treatment duration was extended to 28 days or until the expulsion of stone. Patients were followed-up weekly during the treatment period.

Results: A total of 105 patients were enrolled in the study. Overall, 51.5% of patients in Group A, 48.5% of patients in Group B and 54.3% of patients in Group C had calculus size 7-10 mm. Patients allocated to Group A (80%) and Group B (74.3%) showed higher stone expulsion rate as compared to those in Group C (48.6%).  The mean time taken for stone expulsion was around 12 days in Group A, whereas around 15 days in Group B and C.

Conclusions: The combination of tamsulosin and deflazacort resulted in higher stone expulsion rate in patients with lower ureteral calculus.


Deflazacort, Medical expulsive therapy, Tamsulosin, Ureteral calculi

Full Text:



Pak CY. Kidney stones. Lancet. 1998;351:1797-801.

Ramello A, Vitale C, Marangella M. Epidemiology of nephrolithiasis. J Nephrol. 2000;13(3):S45-50.

Ahmed AF, Al-Sayed AY. Tamsulosin versus alfuzosin in the treatment of patients with distal ureteral stones: prospective, randomized, comparative study. Korean J Urol. 2010;51:193-7.

Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. J Urol. 1997;158:1915-21.

Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al. Guideline for the management of ureteral calculi. J Urol. 2007;178:2418-34.

Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR. 2002;178:101-3.

Hollingsworth JM, Rogers MA, Kaufman SR, Bradford TJ, Saint S, Wei JT, et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet. 2006;368:1171-9.

Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi. J Urol. 1997;158:1915-21.

Kc HB, Shrestha A, Acharya GB, Basnet RB, Shah AK, Shrestha PM. Tamsulosin versus tadalafil as a medical expulsive therapy for distal ureteral stones: A prospective randomized study. Investig Clin Urol 2016;57:351-6.

Dellabella M, Milanese G, Muzzonigro G. Efficacy of tamsulosin in the medical management of juxtavesical ureteral stones. J Urol. 2003;170:2202-5.

Morita T, Wada I, Saeki H, Tsuchida S, Weiss RM. Ureteral urine transport: changes in bolus volume, peristaltic frequency, intraluminal pressure and volume of flow resulting from autonomic drugs. J Urol. 1987;137:132-5.

Takei R, Ikegaki I, Shibata K, Tsujimoto G, Asano T. Naftopidil, a novel alpha1-adrenoceptor antagonist, displays selective inhibition of canine prostatic pressure and high affinity binding to cloned human alpha1-adrenoceptors. Japan J Pharmacol. 1999;79:447-54.

Porpiglia F, Vaccino D, Billia M, Renard J, Cracco C, Ghignone G, et al. Corticosteroids and tamsulosin in the medical expulsive therapy for symptomatic distal ureter stones: single drug or association? Eur Urol. 2006;50:339-44.

Dellabella M, Milanese G, Muzzonigro G. Medical expulsive therapy for distal ureterolithiasis: randomized prospective study on role of corticosteroids used in combination with tamsulosin-simplified treatment regimen and health-related quality of life. Urol. 2005;66:712-5.

Autorino R, De Sio M, Damiano R, Di Lorenzo G, Perdonà S, Russo A, et al. The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res. 2005;33:460-4.

Sio MD, Autorino R, Di Lorenzo G, Damiano R, Giordano D, Cosentino L, et al. Medical expulsive treatment of distal-ureteral stones using tamsulosin: a single-center experience. J Endourol. 2006;20;12-6.

Ramesh A, Karthick P, Shiva Kumar R. Medical expulsion therapy for ureteric calculus: possible! Int Surg J. 2016;3:113-8.