Silodosin versus tamsulosin as medical expulsive therapy for distal ureteral stones: a prospective randomized study

The aim of this study was to compare the safety and efficacy of silodosin (8 mg) versus tamsulosin (0.4 mg) as a medical expulsive therapy for distal ureteral stones. 136 patients (aged 18 years or older) had presented with renal colic, were diagnosed to have a single, unilateral, radiopaque, proximal ureteral stone (range 4-10 mm in size), and agreed to undergo conservative management.For a 3-week period, 68 patients per group were assigned to the following treatments: Group A (gA) received tamsulosin 0.4 mg once daily, and Group B (gB) received silodosin 8 mg once daily. The time to expulsion, analgesic use, follow-up, endoscopic treatment and adverse effects of drugs were noted. Considering all the patients enrolled (136), one patient in gA and two patients in gB were unable to continue the study because of orthostatic hypotension within a week from commencing the treatment. A total of 133 patients (gA: 67; gB: 66) were included in this study. A stone expulsion rate of 61.2% (41 out of 67 patients) was observed in gA, and 80.3% (53 out of 66) was observed in gB. gB showed a statistically relevant advantage in terms of stone expulsion rate (p: 0.003), as well as in terms of expulsion time (weeks) (p: 0.002). No severe complications were recorded in both groups. Four patients (10.2%; 4/39) in gA and ten patients (22.7%; 10/44) in gB experienced retrograde ejaculation (lt;0.002). The patients treated with silodosin showed a significant increase in expulsion rate and a decrease in expulsion time of lower ureteral stones in our study.