Tamsulosin alone and in combination with Deflazacort for medical expulsion therapy of distal ureteric calculus (less than 8mm): a randomized control study

Medical expulsion therapy (MET) is a non-surgical therapeutic option that is used for expulsion of calculus in uncomplicated symptomatic ureteral calculus cases . A variety of medications including alpha blockers, calcium channel blockers, phosphodiesterase inhibitors and corticosteroids have been tried to increase the expulsion rates and provide symptomatic relief to patients during the course of treatment. [1-4] But uncertainty still persist on the natural history of stone passage versus MET. Data and recommendations regarding use of alpha blockers are available, but insufficient data is available on use of corticosteroids to make a strong recommendation for its use.[5] Based on mechanism of action selective Alpha blockers act on Alpha1a receptors thereby causing dilatation of ureter and increased passage of ureteric calculus. Corticosteroids acts by reducing ureteral oedema, often seen at the time of ureteroscopy, thereby increasing the stone passage.   Overall lifetime prevalence of kidney stone disease varies from 1-15 % depending on race, sex, region and ethnicity with complications ranging from severe colicky pain to non-functional kidney requiring nephrectomy. Severity of pain affects the quality life of patients. Medical expulsion therapy helps in alleviating symptoms and avoiding active surgical intervention thereby reducing the cost, complications (surgical and anaesthesia related) and loss of work. MET also reduces the time of spontaneous stone passage and symptom. Through this study we aim to assess effect of alpha blockers alone and in combination with corticosteroid on stone expulsion rates in patients with distal ureteric calculus and to assess the effect of these medication on reduction in analgesics requirement.