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Aktuelle Urol 2022; 53(05): 454-460
DOI: 10.1055/a-0770-2627
Original Article

Is Medical Therapy for Distal Ureteral Stones Efficient? Tamsulosin versus Deflazacort: A Prospective Randomised Trial

Wie wirksam ist die medizinische Behandlung distaler Harnleitersteine? Tamsulosin versus Deflazacort – eine prospektive randomisierte Studie
Salim Kucukpolat
1   Bayrampasa State Hospital, Urology, Istanbul, Turkey
,
Ramazan Kocaaslan
2   Kafkas Universitesi Tip Fakultesi, Urology, Kars, Turkey
,
Mustafa Kadihasanoglu
3   Istanbul Training and Research Hospital, Urology, Istanbul, Turkey
,
Murat Bagcioglu
2   Kafkas Universitesi Tip Fakultesi, Urology, Kars, Turkey
,
Huseyin Kocan
4   Istanbul Kanuni Sultan Suleyman Egitim ve Arastirma Hastanesi, Urology, Istanbul, Turkey
,
Kemal Sarica
2   Kafkas Universitesi Tip Fakultesi, Urology, Kars, Turkey
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Abstract

Introduction To evaluate the efficacy of tamsulosin and deflazacort in the spontaneous expulsion of distal ureteral stones when applied in an independent or combined manner.

Methods 134 patients with distal ureteral stones (4 – 10 mm) were included in tothe study. All patients were randomized into four groups: group 1 (n = 37) patients receiving tamsulosin (0.4 mg/day); group 2 (n = 26) patients receiving deflazacort (30 mg/day); group 3 (n = 37) patients receiving combined treatment (tamsulosin and deflazacort) with the same dosages; and group 4, control group cases (n = 34), receiving paracetamol on demand. Although deflazacort treatment was limited to 10 days due to the possible associated side effects, α-blocker and paracetamol lasted up to four weeks. Patients were followed up on a weekly basis and at the end of four weeks all groups were compared primarily with respect to the stone expulsion rates.

Results No statistically significant difference was noted between all groups regarding the age, sex, or stone burden (p > 0.05). Spontaneous stone expulsion rates after 4 weeks were 64.8 %, 69.2 %, 75.7 %, and 26.4 % in group 1, 2, 3, and 4 respectively. Spontaneous passage rates were statistically higher in all treatment groups when compared with the control group. Despite the highest spontaneous stone expulsion rate noted in group 3; this difference was not statistically significant when compared with the group 1 and 2. No major side effect related to the medications was observed.

Conclusions Tamsulosin facilitated the spontaneous passage of distal ureteral stones < 10 mm in size in an effective manner particularly when applied in combination with an oral corticosteroid.

Zusammenfassung

Einleitung Beurteilung der Wirksamkeit von Tamsulosin und Deflazacort bez. des Spontanabgangs distaler Harnleitersteine bei Anwendung als Mono- oder Kombinationstherapie.

Methoden In diese Studie wurden 134 Patienten mit distalen Harnleitersteinen (4 – 10 mm) aufgenommen. Diese Patienten wurden randomisiert auf vier Gruppen verteilt: Patienten in Gruppe 1 (n = 37) erhielten Tamsulosin (0,4 mg/Tag); Patienten in Gruppe 2 (n = 26) erhielten Deflazacort (30 mg/Tag); Patienten in Gruppe 3 (n = 37) erhielten eine Kombinationsbehandlung (Tamsulosin und Deflazacort) in der gleichen Dosierung. Die Patienten in Gruppe 4 dienten als Kontrollgruppe (n = 34) und wurden bedarfsweise mit Paracetamol behandelt. Die Behandlung mit Deflazacort war wegen möglicher Nebenwirkungen auf 10 Tage begrenzt. Die α-Blocker und Paracetamol hingegen wurden bis zu vier Wochen lang verabreicht. Die Patienten wurden einmal wöchentlich untersucht und nach vier Wochen wurden alle Gruppen primär in Bezug auf die Steinabgangsrate miteinander verglichen.

Ergebnisse Es fand sich kein statistisch signifikanter Unterschied in den verschiedenen Gruppen bez. des Alters oder Geschlechts oder der Steinbelastung p > 0,05). Nach 4 Wochen wurden folgende Spontanabgangsraten erreicht: Gruppe 1: 64,8 %, Gruppe 2: 69,2 %, Gruppe 3: 75,7 % und Gruppe 4: 26,4 %. In allen Behandlungsgruppen wurden statistisch höhere Spontanabgangsraten erreicht als in der Kontrollgruppe. Obwohl in Gruppe 3 die höchste Spontanabgangsrate beobachtet wurde, war der Unterschied im Vergleich zu Gruppe 1 und Gruppe 2 nicht statistisch signifikant. Es wurden keine größeren Nebenwirkungen in Zusammenhang mit den Arzneimitteln beobachtet.

Schlussfolgerungen Tamsulosin erleichterte wirksam den Spontanabgang distaler Harnleitersteine mit einer Größe < 10 mm, insbesondere bei Anwendung in Kombination mit einem oralen Kortikosteroid.

Keywords

ureteral stone - tamsulosin - deflazacort - medical treatment - urolithiasis

Schlüsselwörter

Harnleiterstein - medizinische Behandlung - Urolithiasis - Tamsulosin - Deflazacort


Publication History

Article published online:
19 September 2019

© 2019. Thieme. All rights reserved.

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