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

efficacy of pharmacologic therapies in increasing ureteral stone expulsion and reducing
total analgesic use (15,19).
AIM
To perform a study to evaluate the clinical role of 1A- 1D-specific antagonists
in the medical expulsive therapy of symptomatic lower third ureteral stones.
MATERIAL AND METHODS
This prospective study was performed at the University Clinic of Urology in
Skopje for a period of twelve months, from 01.01 to 31.12.2008. Fifty patients were
enrolled in the study. The inclusive parameters were: stone diameter less than 10 mm,
radiopaque stone visualized in the distal ureter on a plain x-ray of the kidney, ureters and
bladder (KUB), beginning of first renal colic within 6 hours. Exclusive parameters were
any previous surgical or conservative therapy for renal and ureteral stones as well as any
previous pelvic surgery or irradiation, presence of urinary system infection, radiolucency
stones, hypotension.
Before the treatment all patients were evaluated with KUB and a urinary tract
ultrasonography. Stone size was recorded for each patient. The treatment was fully
explained to patients.
Biochemical and hematological evaluation of the patients were obtained before
the treatment. Also, complete urine analyses were performed before, during and after
treatment. Patients were randomly divided into 2 groups. The 25 patients in the Group 1
received tamsulosin (0.4 mg daily) while the 25 patients in group 2 received placebo.
Tamsulosin was recommended to be taken after breakfast in the morning with a lot of
fluid. The medication was given for up to 30 days. All patients were given symptomatic
therapy with injections of 100 mg ketoprofenum and trospium chloride 20 mg, twice a
day. Every additional need for analgesics was noted. There were no differences between
the groups with respect to age, sex distribution, or stone size (Table 1). They were
required to consume a minimum of 2 liters of water daily. For more adequate detection of
the spontaneous passage of the stones, patients were directed to filter their urine, and
those who had passed their stones were asked to stop all the medications. Every patient
was controlled with KUB plus urinary ultrasonography every week. The number of pain
episodes, total ketoprofenum and trospium dosage, time of the spontaneous passage of
the calculi and side effects of the medications were also noted. In patients who could not
experience spontaneous passage of the calculi ureteroscopy and extracorporeal shock
wave lithotripsy (ESWL) treatments were started. Statistical analysis were performed
with ANOVA, the Pearson chi-square test using the parameters of stone size, expulsion
rate, time to expulsion, amount of analgesic compound and pain episodes.
RESULTS
The stone expulsion rate was 72% (18 of 25 patients) in group 1 and 48% (12 of
25) in group 2 with a mean expulsion time of 5.9±1.8 and 10.2 ± 3.1 days, respectively
(Fig. 1). Group 1 showed a statistically advantage in respect of both expulsion rate