THE ROLE OF TADALAFIL AND TAMSULOSIN ALONE AND IN COMBINATION THERAPY IN LOWER URETERIC STONE EXPULSION

OBJECTIVES To compare the safety and efficacy of tamsulosin, tadalafil, and combination of tamsulosin with tadalafil as medical expulsive therapies for lower ureteric stones. MATERIALS AND METHODS A total of 90 patients who presented with distal ureteric stones between September 2013 and August 2015 were simply randomised equally based on a computer generated table into three groups, group A received tamsulosin, group B patients received tadalafil alone, and group C patients received a combination of tamsulosin with tadalafil. Therapy was given for a maximum of 4 weeks. The stone expulsion rate, time to stone expulsion, analgesic use, number of hospital visits for pain, followup endoscopic treatment, and adverse effects of the drugs were noted. Statistical analyses were done by using Student's t-test and chi-square test. RESULTS There was a higher expulsion rate 78% in group C, which received combination therapy compared to 75% in group B and 70% in group A. There was an increase in expulsion rate in patients with combination therapy, though statistical significance could not be demonstrated in this sample size. The analgesic requirement and hospital visits due to colic were decreased significantly in the combination therapy group and time to expulsion was also lesser in group C compared to group A and B. There were no serious adverse effects noted. CONCLUSION Medical expulsive therapy for distal ureteric stones using combination of tamsulosin and tadalafil is safe and efficacious compared to monotherapy with either of the drugs alone. It significantly decreases the analgesic dose requirement and aids in pain relief as well.