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Abstract

Objectives: To compare efficacy of tamsulosin versus tamsulosin with tadalafil in lower ureteral stones as the medical expulsive therapy for lower ureteric stone. Methods: Between Jan 2013 and Dec 2013, 244 patients presenting with distal ureteric stones of size 5 to 10 mm were randomized equally to tamsulosin (group A), tamsulosin with tadalafil (group B). Therapy was given for a maximum of four weeks. Stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, follow-up and endoscopic treatment and adverse effects of drugs were noted. Statistical analyses were done using Student?s t test and Chi-square test. Results: There was a statistically significant expulsion rate 83.6% in group B than 65.5% in group A with lower time (p-value=0.031, p-value=0.003). Statistically significant differences were noted in lesser hospitalization for colic and analgesic requirement in group B than group A. There was no serious adverse event. Another important finding was improvement in the erectile function in group B. Conclusions: The current randomized trial was the largest research trial of its kind and the results obtained were statistically significant; therefore we could draw a conclusion that combination of tadalafil with tamsulosin is better and efficacious modality for lower ureteric stone expulsion. The result of this study indicates that addition of tadalafil with tamsulosin increases ureteric stone expulsion quite significantly along with significant control of pain, significantly lesser analgesic requirement and lesser hospital visits. Also the prescription of tadalafil in cases of lower ureteric stone may provide additional advantage of improvement in erectile dysfunction.

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