Introduction
Urolithiaisis is a fairly common condition and can be source of substantial morbidity and economic burden1, 2. Ureteric colics secondary to ureteric stone can be source of agonizing pain and multiple emergency visits. Lower ureter is the most common site of lodgement of stone and accounts for about 50% of stones requiring surgical interventions3. Spontaneous passage of stones in the lower ureter is seen in about 70% and 50% of the patients with stones size ≤5mm and 5-10 mm4, 5. Thus not all lower ureteric stones may need surgical intervention unless causing recurrent colics. Greatest benefit of MET has been found in patients with stone size >5mm as stones below this size have high chances of spontaneous expulsion6.
Treatment options for management of ureteric stones include medical expulsive therapy (MET), shockwave lithotripsy (SWL) and ureteroscopic lithotripsy (URSL). Shockwave lithotripsy and surgical procedures like URSL are not free of complication thus alternative conservative methods have been applied especially when stones are located n distal ureter and are less than 10 mm. Multiple drugs such as α-blockers (tamsulosin, silodosin, alfuzosin and naftopidil)7-9, nifedipine (calcium channel blockers (CCB’s))10 and phosphodiesterase inhibitors (PDEI) (sildenafil11 and tadalafil12) have been found to be effective in facilitating ureter stones compared to general measures such as use of non-steroidal inflammatory drugs (NSAIDS), hydration, anti-spasmodics, diuretics and placebo. Of these drugs tamsulosin has been widely studied and has been found to facilitate stone expulsion not only in distal as well as other parts of ureter. Efficacy of α-blockers as MET is well established for all parts of the ureter however data on use of other class of drugs is still immature and recent9, 13, 14. Further, various combinations such as α-blockers with PDEI-α-blockers15, 16 with NSAIDS17 and steroids18-22 have been tried and have found variable success as compared to these drugs alone.
The primary objective of this study was to systematically review all the available literature regarding various drugs used for MET (PDEI, α-blockers and CCB’s) for the treatment of distal ureter stones and generate evidence for best available drug or combination.