Effect of Alpha-Blocker on Distal Ureteric Calculi: A Comparative Study

Introduction Silodosin is a recently introduced selective alpha- blocker in Medical Expulsive Therapy for the management of distal ureteric calculi. The efficacy and safety of silodosin compared to tamsulosin are controversial, however the former is considered to be more effective. The objective of the study is to assess the efficacy and safety of silodosin compared to tamsulosin in the treatment of ureteral stones less than 10mm.  Methods This prospective randomized study was conducted in the Department of General Surgery, Navodaya Medical College, Raichur, Karnataka. Sixty patients were included in the study who presented with abdominal or loin pain and were diagnosed with unilateral solitary distal ureteric stone measuring <10mm with no complications. Participants in Group I received Tablet Silodosin 8mg OD until the passage of stone or up to two weeks, and Group II received Tablet Tamsulosin 0.4mg OD until the passage of stone or up to two weeks. Analgesic Tablet Diclofenac sodium 50mg was given to both patients on demand.  Results A total of 60 patients were included in the study, divided into 30 patients in each group of Silodosin and tamsulosin respectively. In Group I (silodosin), out of 30 patients, 25 patients expelled the calculus, whereas in Group II (tamsulosin), out of 30 patients, 15 patients expelled the calculus. Group I showed a significantly higher rate of expulsion, with a p-value of 0.005. Stone expulsion time was notably shorter in Group I compared to Group II, with averages of 4.73 days versus 6.33 days (p=0.009). Additionally, analgesic use during the medical expulsive therapy was lower in Group I, averaging 8.25 compared to 4.13 (p=0.0001) in the tamsulosin group. Significant differences were observed in the outcomes such as stone expulsion time, and analgesic requirement. However, no significant differences were found when comparing the groups based on age, gender, stone size, and side of the ureter involved. The 20 patients who failed the medical management underwent ureterorenoscopy with 100% clearance. 3 patients in Group II experienced orthostatic hypotension, and zero patients experienced any side effects in Group I. Compared to tamsulosin, silodosin provides significantly higher stone expulsion rates, fewer colic episodes, and shorter stone expulsion duration than tamsulosin.