M E D I C U S - Shoqata e Mjekëve Shqiptarë të Maqedonisë-Hipokrati

group 1. Adverse effects from the drug therapy were seen in 1 patient in group 1 (4%)
while 3 (12%) patients in the group 2 were submitted to ureteral stenting due to recurrent
colic. Conclusions: Medical treatment with tamsulosin showed to be safe and effective
represented by the better stone expulsion rate and reduced expulsion time, as well as the
lesser need for analgesics. This conservative approach should be considered as an option
in the management of uncomplicated lower third ureteral stones after first pain
manifestation.
Key words: Tamsulosin, distal ureteral stones, expulsion, therapy
Medicus 2009, Vol. XI (1):
INTRODUCTION
Urolithiasis is a disease that affects approximately 8% to 15% of the population in
Europe and North America and renal colic represents the most common condition
observed by the urologist in the outpatient department and the emergency units (1). The
frequency of this disease tends to increase in the western countries. Among all ureteral
stones, 70% are found in the lower third of the ureter (2). The efficacy of minimallyinvasive
procedures such as extracorporeal shockwave lithotripsy (SWL) and
ureteroscopy has been proven by few studies (3, 4). Still, the spontaneous passage of the
stone evades the pain, and the risk and cost of surgery. Spontaneous expulsion can occur
in 25-53% of cases having a distal ureteral stone ranged from 5 to 10 mm in size (3).
There are several factors thought to influence the spontaneous passage of ureteral stones,
such as their size, configuration and location, smooth muscle spasm, submucosal edema
and ureteral anatomy (5, 6). When a spontaneous passage of ureteral stones is expected,
conservative treatment can be used. It comprises good hydration, analgesics and antiinflammatory
agents to reduce submucosal edema and spasm of the ureter. However, this
treatment may not always be sufficient, especially for intramural ureteral stones, where
smooth muscle tonus is more evident (7).
Recently, use of the watchful waiting approach has been extended by using
pharmacologic therapy to reduce symptoms and facilitate stone expulsion (8, 9, 10).
The role of medical expulsive therapy in the treatment of stones in the distal third
of the ureter remains unclear. Alpha-1-receptors ( 1R) are the most abundant adrenergic
receptors in the ureteral smooth muscle cells. The blockade of these receptors by a
specific antagonist inhibits basal tone, peristaltic activity and ureteral contractions (11,
12, 13). These receptors have been divided into four groups, with the 1D-R type being
found mostly in the intramural ureter (14). Based on these findings selective 1A/ 1Dadrenoreceptors
antagonist tamsulosin have been tested in different trials (9, 15, 16) in
the treatment of distal ureteral stones and obtained encouraging results.
The current study was performed to evaluate the effects of the addition of
tamsulosin to our standard therapy for the treatment of distal ureteral stones. In the stone
migration process, the sympathetic nervous system modulates ureteral activity, as
demonstrated by the presence of adrenergic receptors in the ureter (17) In addition, the -
adrenergic antagonists are able to inhibit basal tone and peristaltic frequency, dilating the
ureteral lumen and facilitating stone passage (18). Some investigators have reported