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

Introduction: 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. Methods: 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. Results: 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 (< 0.002). Conclusion: 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.