EFFICACY OF TADALAFIL MONOTHERAPY VERSUS COMBINATION THERAPY WITH TAMSULOSIN FOR MEDICAL EXPULSIVE THERAPY OF URETERIC CALCULI: A PROSPECTIVE RANDOMIZED STUDY
Main Article Content
Keywords
Ureteric calculi, Medical expulsive therapy, Tadalafil, Tamsulosin, Combination therapy
Abstract
Background: Ureteric calculi represent a significant burden in urological practice. While alphablockers like tamsulosin have been widely studied for medical expulsive therapy (MET), the potential of phosphodiesterase type 5 (PDE5) inhibitors such as tadalafil, alone or in combination, has gained recent attention.
Objective: To compare the efficacy of tamsulosin and tadalafil combination therapy versus monotherapy with either agent for MET of ureteric calculi.
Methods: This prospective, randomized study included 165 patients with 5-10 mm ureteric stones, divided into three groups of 55 each: tamsulosin plus tadalafil, tadalafil monotherapy, and tamsulosin monotherapy. The study was conducted over 12 months. The primary outcomes were stone expulsion rate and time. Secondary outcomes included pain management and side effects.
Results: The combination therapy showed superior stone expulsion rates (76.4%) compared to tadalafil monotherapy (63.6%) and tamsulosin monotherapy (69.1%) (p<0.001). Mean expulsion time was significantly shorter in the combination group (5.8±1.9 days) compared to tadalafil (7.2±2.1 days) and tamsulosin (6.5±2.0 days) (p<0.001). The combination therapy also demonstrated better pain control, fewer hospital visits, and improved quality of life scores. Subgroup analysis revealed that the combination therapy was more effective for 5-7 mm and 8-10 mm stones. The need for ureteroscopy after two weeks was lowest in the combination group (12.7%) compared to tadalafil (21.8%) and tamsulosin (18.2%) (p<0.001).
Conclusion: Combination therapy with tamsulosin and tadalafil is more effective than monotherapy with either agent for MET of ureteric calculi, with higher stone expulsion rates, shorter expulsion times, and better pain control. This regimen could be considered as a first-line treatment for ureteric stones, potentially reducing the need for surgical intervention.
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Dr. Janet Joy
postgraduate student, dept of pharmacology, RIMS, Raichur,
Dr. Pradeep.M. Kulkarni
assistant professor, dept of urology, RGSSH (OPEC) attached to RIMS, Raichur
Dr. Raghunandan.M.
associate professor, dept of pharmacology, RIMS, Raichur,
