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Introduction: Stones are common cause of obstructive uropathy which may lead to decrease in renal function. Though endourological procedure like Ureteroscopic Lithotripsy (URSL) is commonly done yet Medical Expulsive Therapy (MET) is often offered as a first line therapy for mid and distal ureteric stones of size less than one cm. Aim: To compare the effect of Tamsulosin and URSL on renal function and stone free rate for solitary mid and distal ureteric stone. Materials and Methods: This prospective interventional study was done in IPGME&R and SSKM Hospital, Kolkata, West Bengal, India, from May 2020 to October 2020, on the total study population of 50 patients with 26 patients in MET and 24 patients in URSL group. Parameters measured and compared were changes in Glomerular Filtration Rate (GFR) and stone free rate after six weeks of intervention. Numerical variables and categorical variables were compared between two groups using independent t-test and chi square test respectively. Results: The mean age of patients in MET (n=26) and URSL group (n=24) was 37.12 years and 33.63 years respectively. GFR was significantly increased after completion of treatment in individual groups (p-value=0.01) and in final study population but change in GFR was not significant when compared between the groups (p-value=0.372). Difference in stone clearance rate between two groups was also insignificant (p-value=0.902) whereas within the groups was significant (p-value<0.05). Conclusion: Tamsulosin for six weeks does not result in significant functional loss in the affected kidney and proved as effective as URSL for mid and distal solitary ureteric stone upto one cm in size with similar stone free rate. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of tamsulosin compared to the combination of tamsulosin with nifedepine for the management of lower ureteral calculi less than 1 cm in size. Material and Methods: This study included 150 patients with stones <1 cm in size located in the lower ureter. The patients were divided into three groups. Group 1- Patients (N-50) received 0.4 g tamsulosin once daily. Group 2- Patients (n-50) received 0.4 g tamsulosin once daily with cap. nifedepine (5 mg) twice daily. Group 3- Patients (n-50) received placebo treatment (control group). The patients received an injection of diclofenac/injected hyoscine butyl bromide as necessary. Follow-up was performed at 6 weeks. Results: The average stone size was similar among the three groups (6.40, 6.75 and 6.25 mm in Groups 1, 2 and 3, respectively). After treatment with medication, stone expulsion was noted in 37 of 50 patients in group 1 (74%), 43 of 50 patients in group 2 (86%), and 15 of 50 patients in group 3 (30%). The average time required for expulsion of the stone in groups 1, 2, and 3 was 28.5 days, 20.5 days, and 37.7 days, respectively. The results were superior in group 1 and group 2 compared to group 3 (placebo). A significantly higher rate of expulsion was noted in group 2 compared to group 1 (12% more expulsion compared to group 1). However, postural hypotension was noted in 3 patients in group 2 but was not so severe as to require dropping these patients from the study. Conclusion: Study reveals that lower ureteral stones less than 1 cm. can be effectively managed by medical management. We have found that for this purpose combination therapy by tamsulosin with nifedipine is more effective than monotherapy by tamsulosin. [ABSTRACT FROM AUTHOR]

Abstract: Background: Drug treatment can defer surgical intervention in benign prostatic hyperplasia (BPH), a common disorder in elderly men, and is widely practiced. Various herbal formulations have been used for the treatment of BPH, but few have been compared with established modern medicines in head-to-head clinical trials. Objective: We compared the effectiveness and tolerability of an oral formulation, comprising standardized extracts of Murraya koenigii and Tribulus terrestris leaves being marketed in India under Ayurvedic license, versus tamsulosin in the treatment of symptomatic BPH. Methods: A double-blind, double-dummy, parallel-group, randomized controlled trial was conducted with treatment-naive ambulatory patients with BPH aged >50 years. Patients received either the plant drug in a dose of 2 capsules BID or tamsulosin 400 μg once daily for 12 weeks with 2 interim follow-up visits at the end of 4 and 8 weeks. The double-dummy technique was used to ensure double-blinding. The primary effectiveness measure was reduction in the International Prostate Symptom Score (IPSS). Proportion of patients becoming completely or relatively symptom free (IPSS <8), change in prostate volume (assessed by using ultrasonography conducted by a radiologist blinded to the nature or duration of treatment), and peak urinary flow rate (assessed by using uroflowmetry) were secondary measures. Treatment-emergent adverse events, changes in weight, vital signs, and routine laboratory safety parameters were recorded. Results: Forty-six patients were randomized (23 per group); 19 completed all study visits in the plant drug group and 21 in the tamsulosin group. However, applying modified intention-to-treat criterion, 23 and 21 patients, respectively, were considered for effectiveness analysis. Mean (SD) age and baseline weight were 58.5 (14.0) years and 57.5 (10.5) kg in the plant drug arm, and 62.9 (6.3) years and 59.8 (9.9) kg in the tamsulosin arm, respectively. Median (interquartile range) symptom duration was 12.0 (12.0–24.0) months and 15.0 (12.0–24.0) months, respectively, in the 2 arms. These differences were not statistically significant. IPSS (median [interquartile range]) declined from 17.0 (12.0–19.0) to 9.0 (5.0–13.0) with the plant drug and from 14.0 (11.0–18.0) to 8.0 (6.0–13.0) with tamsulosin after 12 weeks of treatment. The decline was individually significant in both groups (both, P < 0.001), but intergroup values showed no statistically significant difference at any point of time. IPSS <8 at study end was achieved by 10 and 7 patients, respectively, in the 2 arms (P = 0.548). The plant drug reduced prostate volume from 33.5 (26.2–45.9) mL to 31.6 (26.1–37.5) mL (P = 0.040). The corresponding reduction with tamsulosin, from 41.3 (29.4–51.3) mL to 39.9 (32.6–52.3) mL, was not statistically significant. Peak urinary flow rate did not change appreciably. Mild joint pain was the most common adverse event in both arms. No serious events were encountered. Compliance was satisfactory. Conclusions: These findings suggest that the M koenigii– and T terrestris–based formulation significantly lowered IPSS scores in the initial treatment of symptomatic BPH. Further trials are needed to determine if the beneficial effect is sustained beyond the 12-week observation period of this trial. [Copyright &y& Elsevier]