Gnyawali Diwas, Pradhan Manish Man, Sigdel Prem Raj, Parajuli Purushottam, Chudal Sampanna, Poudyal Sujeet, Chapagain Suman, Luitel Bhoj Raj, Chalise Pawan Raj, Sharma Uttam, Gyawali Prem Raj
Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgung, Kathmandu 44600, Nepal.
Adv Urol. 2020 Jan 29;2020:4347598. doi: 10.1155/2020/4347598. eCollection 2020.
Urolithiasis is one of the common disorder with which about 1/5 is found in the ureter, of which 2/3 is seen in the lower ureter. Medical expulsive therapy is one of the routine modalities of treatment which uses various drugs acting on the ureter smooth muscle by different mechanism. We aim to compare the efficacy of combination vs. single drug.
This randomized controlled trial was done in 176 consecutive patients over a period of six months (March 2019 to August 2019) in Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching. Participants were divided into two groups (Group A, tamsulosin plus tadalafil, and Group B, tamsulosin) from computer-generated random numbers. Therapy was continued for a maximum of 3 weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of colic and emergency room visits for pain, early intervention, and adverse effects of drugs were recorded.
Among 176 patients who were enrolled in study, 7 were lost to follow-up, and 5 people required immediate intervention. There was a significant higher stone passage rate in group A than group B (64 vs. 50; =0.025) and shorter expulsion time (1.66 vs. 2.32 weeks =0.001) and less number of emergency room visits and colic episodes. No significant side effects were noted during study.
Tamsulosin plus Tadalafil is more effective than tamsulosin with early passage of stone and decreased number of colic episodes and emergency visits without significant side effects for lower ureteric calculi of 5 mm to 10 mm.
尿路结石是一种常见疾病，约五分之一的结石位于输尿管，其中三分之二见于输尿管下段。药物排石疗法是常规治疗方式之一，该疗法使用多种通过不同机制作用于输尿管平滑肌的药物。我们旨在比较联合用药与单一药物的疗效。
这项随机对照试验于2019年3月至2019年8月在特里布万大学教学医院泌尿外科和肾移植外科对176例连续患者进行，为期六个月。通过计算机生成随机数将参与者分为两组（A组，坦索罗辛加他达拉非；B组，坦索罗辛）。治疗最长持续3周。记录结石排出率、结石排出时间、镇痛药物使用情况、绞痛次数以及因疼痛到急诊室就诊的次数、早期干预情况和药物不良反应。
在纳入研究的176例患者中，7例失访，5例需要立即干预。A组的结石排出率显著高于B组（64%对50%；P=0.025），排出时间更短（1.66周对2.32周；P=0.001），急诊室就诊次数和绞痛发作次数更少。研究期间未观察到明显副作用。
对于5毫米至10毫米的输尿管下段结石，坦索罗辛加他达拉非比坦索罗辛更有效，结石排出更早，绞痛发作次数和急诊就诊次数减少，且无明显副作用。
