Corticosteroids and Tamsulosin in the Medical Expulsive Therapy for Symptomatic Distal Ureter Stones: Single Drug or Association?

Objectives: To assess the clinical role of corticosteroids in the medical expulsive therapy of symptomatic distal ureteral stones. Methods: Between January 2004 and September 2005, 114 patients with symptomatic distal ureteral stones with a ≥5 mm diameter were enrolled in this prospective study and divided into four groups based on the urologist (of four) who treated them in the emergency unit. Group A (33 patients) received tamsulosin (0.4 mg daily), group B (24 patients) received deflazacort (30 mg daily), group C (33 patients) received both (0.4 mg tamsulosin + 30 mg deflazacort daily), and control group D (24 patients) received only analgesics. The treatment duration was 10 d to prevent the side-effects of prolonged corticosteroid therapy. The end points were the expulsion rate, analgesic consumption, number of ureteroscopies, and safety. Results: The groups were comparable in terms of age, sex, and stone location. The stone diameter was 5.96 ± 0.33 mm for group A, 5.83 ± 0.4 mm for group B, 5.88 ± 0.23 mm for group C, and 5.71 ± 0.5 mm (p > 0.05) for group D. The rates of expulsion for the four groups were 60%, 37.5%, 84.8%, and 33.3%, respectively. There was a significant difference between group C and the other groups (p < 0.001). The mean analgesic consumption was 42.5 ± 0.4 mg for group A, 50 ± 0.3 mg for group B, 27.3 ± 0.5 mg for group C, and 81 ± 0.33 mg for group D, with a significant difference between group C and the other groups (p < 0.001). During the treatment period, only two cases of drug side-effects related to tamsulosin (without any drop-outs) were recorded. Conclusion: When the medical expulsive therapy for symptomatic distal ureteral stones is considered, the use of steroids (deflazacort) proves efficient only when administered together with α₁-blockers (tamsulosin). In addition, tamsulosin used on its own as a medical expulsive therapy can be considered as an alternative treatment for those patients who are not suitable for steroid therapy, as it is generally efficient.