Comparison of Tadalafil and Tamsulosin in Medical Expulsive Therapy for Ureteric Calculus: Prospective, randomized, placebo controlled study

Introduction and objectives: Ureteric calculi usually present as acute episode of ureteral colic. Primary aim of our study was to compare the stone expulsion rate for tadalafil and tamsulosin. We also compared time to stone expulsion, need for an analgesic requirement and side effect associated with these drugs. Methods:  150 patients presenting with single lower ureteral stone  (juxtavesical ureteral lithiasis at lower 5 cm of the ureter), 4 to ? 10 mm in size were randomized in three groups. Patients in group one received placebo and served as control, group two received phosphodiesterase 5 inhibitors (tadalafil 10mg OD) and group 3 received alfa one blockers (tamsulosin 0.4 mg OD) for accelerating the passage of the stone. Results: The stone expulsion rate was 58% (36 of 50 patients) for the placebo group, 80 % (40 of 50 patients) for tadalafil group and 74 % for the tamsulosin group (37 of 50 patients). Tadalafil was superior to placebo in terms of stone expulsion rate (p-value: 0.017) but comparable to tamsulosin (p: 0.139). Patients in the tadalafil group had significantly less pain scores at 1 and 2 weeks follow up in comparison to the other two groups. Mean analgesic requirement for placebo, tadalafil and tamsulosin was 331, 132.93 and 277.08 mg of diclofenac respectively. Conclusion: Tadalafil has better stone expulsion rate and faster stone expulsion as compared to tamsulosin but the difference is not statistically significant. Tadalafil results in statistically significant improvement in pain scores and decreased requirement of analgesic as compared to other two groups.