Alfuzosin Treatment Improves The Rate and Time for Stone Expulsion in Patients with Distal Uretral Stones: A Prospective Randomized Controlled Study

OBJECTIVE To evaluate the safety and efficacy of alfuzosin treatment on rate and time of stone expulsion in patients with uncomplicated distal ureteral stones. PATIENTS AND METHODS Prospective, randomized, open-label, controlled study. Patients > 18 years of age presenting to the outpatient urology clinic with uncomplicated radio-opaque stones located in the distal third of the ureter and of size <= 10 mm were included. Patients were randomly assigned to either a control group (n=26) and received standard of care management (daily oral hydration and diclofenac 75 mg IM on demand) or to the alfuzosin group (n=28) and received alfuzosin SR 5 mg twice daily in addition to standard of care management. Patients were followed weekly at office visits and twice weekly by telephone for 4 weeks or until stone expulsion. Assessments included stone passage rate and time, and patients were monitored for occurrence of adverse drug events, complications, number of pain episodes, analgesic consumption, and number of hospital revisits. Mann-Whitney, chi(2), and Fisher exact test were used for data analysis. RESULTS All 54 patients completed the study. Stone expulsion rate was higher in the alfuzosin arm (53.6%, 15/28) compared to the control arm (26.9%, 7/26, p=0.04). Median stone passage time was lower in the alfuzosin group than in the control group (9 vs 19 days, respectively, p=0.006). Ureteral sepsis, uncontrollable pain, and hospitalization readmissions were reported in the control group only. There were no differences between groups in number of pain episodes, pain scores, or analgesic consumption. Alfuzosin therapy was tolerable with only minor adverse effects (headache, dizziness, mild postural hypotension, and rhinitis). CONCLUSION Alfuzosin is safe and effective in increasing stone expulsion rates and shortening stone passage times for uncomplicated distal ureteral stones.