Medical Expulsive Therapy of Distal Ureteric Stones: A Comparative Study of Tadalafil vs Tamsulosin

Background: The current era has seen a dramatic shift in the management of patients with ureteral calculi, with the conservative approach being the primary focus, with the main benefit being reduced patient morbidity. The expectant approach for distal ureteric stones can be supplemented with adjuvant medical expulsive therapy (MET), which can reduce symptoms and aid in stone expulsion. The current study was designed to determine the single best monotherapy for medical expulsive therapy of distal ureteric stones by comparing Tadalafil and Tamsulosin.

Methods: A hospital-based comparative study was carried out at a tertiary care hospital's Department of Surgery. The study included a total of 120 eligible cases of lower ureteric calculus. These 120 patients were then divided into two groups of 60 each to receive one of two medical treatments i.e. Tadalafil and Tamsulosin.

Results: Mean expulsion of calculi was significantly earlier in patients managed by tadalafil as compared to tamsulosin (13.1 vs 16.92 days; p<0.05). Complete expulsion was seen in 86.7% cases on tadalafil as compared to only 63.3% cases on tamsulosin (p<0.05). Mean analgesic use (2.69 vs 1.81; p<0.05) and episodes of colicy pain (1.41 vs 0.43; p<0.05) were significantly higher in patients managed by tamsulosin. Tamsulosin also required more hospital visits during treatment, but the difference was not statistically significant (2.56 vs 2.02 days; p=0.06). There was no difference in the adverse effect profiles of the two drugs.

Conclusions: Tadalafil also promotes early stone expulsion, a reduction in colicky pain episodes, and a reduction in analgesic requirement. Both medications are safe, effective, and well tolerated, with only minor side effects. Thus, as a medical expulsive therapy for distal ureteric stones, tadalafil is safe, effective, and well tolerated.