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.