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Objective: Urolithiasis is a common urological diseases and affects the daily life of patients. Medical expulsive therapy has become acceptable for many parents. We conducted a meta-analysis to determine the efficacy and safety of tadalafil compared with tamsulosin for treating distal ureteral stones less than 10 mm in length. Methods: Related studies were identified via searches of the PubMed, Embase, and Cochrane Library databases. All the articles that described the use of tadalafil and tamsulosin for treating distal ureteral stones were collected. Results: A total of 14 studies were included in our meta-analysis. Our results revealed that tadalafil enhanced expulsion rate [odds ratio (OR) = 0.68, 95% confidence interval (CI): 0.47 to 0.98, p = 0.04]; reduced expulsion time [mean difference (MD) = 1.22, 95% CI (0.13, 2.30), p = 0.03]; lowered analgesia use [MD = 38.66, 95% CI (7.56, 69.77), p = 0.01] and hospital visits [MD = 0.14, 95% CI (0.06, 0.22), p = 0.0006]. According to our subgroup analysis, either tadalafil 5 mg or 10 mg did not promote expulsion rate and accelerate expulsion time compared with tamsulosin. But patients receiving 5 mg tadalafil decreased analgesia usage [MD = 101.04, 95% CI (67.56, 134.01), p < 0.00001]. Conclusion: Compared with tamsulosin, tadalafil demonstrates a higher expulsion rate and less expulsion time for patients with distal ureteral stones less than 10 mm with a favorable safety profile.

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Introduction: To evaluate the efficacy and safety of performing extracorporeal physical vibrational lithecbole (EPVL) through greater sciatic foramen (GSF) for distal ureteral calculi (DUC) treatment. Materials and Methods: All patients with a diagnosis of DUC (6-10 mm in diameter) were enrolled in this study from October 2018 to May 2020. Patients were randomly divided into three groups receiving EPVL through GSF (Group A, n = 58), or abdominal (Group B, n = 60), or combined with oral use of tamsulosin at 0.4 mg daily (Group C, n = 63). Results: There was no significant difference observed in terms of demographic characteristics or size of stones among the three groups (p > 0.05). Compared with the Groups B and C, patients of the Group A displayed a significantly higher score of comfort, with a significantly decreased number of renal colic attacks or analgesics required (p < 0.01). The stone-free rate also significantly increased after 1 and 2 weeks of treatment (p < 0.01), despite such a significant difference among these groups vanishing after 4 weeks of treatment. Conclusion: EPVL in the prone position uses the GSF as the path and is a safe and effective approach to treat the distal ureteral calculi.

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Litotricia , Cálculos Ureterales , Humanos , Tamsulosina/uso terapéutico , Resultado del Tratamiento , Cálculos Ureterales/cirugía , Vibración

RESUMEN

INTRODUCTION: The obstruction of the urinary tract by calculi at the narrowest anatomical areas leads to impaired drainage and severe pain. The aim of this study was to evaluate a new technology, extracorporeal physical vibrational lithecbole (EPVL) combined with tamsulosin, as a treatment for distal ureteral calculi (DUC). MATERIALS AND METHODS: Between July 2013 and July 2014, 672 patients diagnosed with DUC were randomly divided into three groups; a group receiving EPVL plus 0.4 mg oral tamsulosin daily (PO qd) (experimental group, n = 236), a group receiving 0.4 mg tamsulosin PO qd (n = 222), and a group receiving EPVL only (n = 214) (control groups). RESULTS: There were no significant differences in general characteristics between the three groups. Stone diameters ranged from 0.32 to 1 cm. In the EPVL plus tamsulosin group, 60.1% of patients showed detectable fragment expulsion at 48 hours, and 91.1% were stone free at 7 days. Compared with the two control groups, these rates were significantly higher (EPVL group was 0% and 50.5% and medical expulsive therapy group was 0% and 50.0%, p < 0.05). The stone-free rates were similar in the three groups 2 weeks later (94.5%, 93.6%, and 93.5%; p > 0.05). Patients in the EPVL plus tamsulosin group achieved similar stone-free rates compared with the other two groups, but the speed of the stone expulsion was quicker for both sexes and all age groups (about a week; p < 0.05). CONCLUSION: This indicates that EPVL plus tamsulosin could be used as an effective, but faster treatment option for patients with DUC, alleviating the symptoms of DUC in a shorter period of time.

Asunto(s)

Litotricia/métodos , Tamsulosina/uso terapéutico , Cálculos Ureterales/terapia , Agentes Urológicos/uso terapéutico , Vibración , Adulto , Anciano , Análisis de Varianza , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Físico , Estudios Prospectivos , Adulto Joven

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OBJECTIVE: The objective of this study was to demonstrate the efficacy and safety of micro-ureteroscopy (micro-URS) in the management of distal ureteral stones in the pediatric population. MATERIALS AND METHODS: A total of 11 children, who had undergone micro-URS between September 2015 and April 2016 with the indication of distal ureteral calculi in two referral centers, were retrospectively evaluated. The procedures were performed with the patient in the lithotomy position under general anesthesia using the standard URS technique with a micro-ureteroscope that has a caliber of 4.85 Fr all along its length. Demographics, perioperative data, and outcomes were assessed. RESULTS: Right (n=6) and left (n=8) ureteral stones were detected in the respective number of patients. The mean age of the children was calculated as 55.1months (range, 6-161months). The median stone size was 10.5mm (range, 6-24mm). The median operative time was 36.8min (range, 23-68min). A double 3 stent was implanted in 3 of 11 patients because of severe edema. As a postoperative complication mild hematuria (Clavien grade 1) was observed in one case and resolved spontaneously. Intraoperative minor or major complication did not occur in any of the cases. The mean hospitalization time was determined as 21.4h (range, 10-28h). Stone-free status was accomplished in all patients in the final assessment. CONCLUSION: The outcomes of our series show that micro-URS can be used safely and effectively in the treatment of pediatric distal ureteral stones. Further prospective and comparative studies comparing instruments of different size are warranted.

Asunto(s)

Cálculos Ureterales/cirugía , Ureteroscopía/métodos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Tiempo de Internación , Litotricia/métodos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento , Cálculos Ureterales/patología , Ureteroscopios

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Objective To evaluate the efficacy of combination solifenacin and tamsulosin for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy. Methods 120 patients (male:100 female:20 age:18-67 yrs) randomly assigned to 4 groups (each group 30) with the calculi diameter range from 0.5 to 1.1 cm.All patients performed extracorporeal shock wave lithotripsy (X ray oriented).The control group did not accept any medical treatment.The solifenacin group were administered solifenacin 5 mg,once per day.The tamsulosin group were administered tamsulosin 0.2 mg,once per day.The combination group were administered solifenacin 5mg,plus tamsulosin 0.2 mg,each per day.The observation duration was set at 2 weeks. Results The stone-free rate (according to KUB) within 2 weeks were 80.0％,83.3％,93.3％ and 96.7％ in the control group,solifenacin group,tamsulosin group and combination group respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The stone expulsion times were (7.6 + 3.7) d,(6.3 ± 2.5) d,(4.4 + 2.3) d and (3.5 ± 2.2) d in the 4 groups respectively.Statistical differences were significant among the tamsulosin group,the combination group and the control group.The uses of analgesics were 13,5,9 and 3 in the 4 groups respectively.The bladder irrtative symptoms were 12,6,4 and 4 in the 4 groups respectively.Statistical differences were also significant for the use of analgesics and relief of bladder irritation between the solifenacin group,the combination group and the control group. Conclusions Tamsulosin and solifenacin could be safe and effective for the treatment of distal ureteral calculi after extracorporeal shock wave lithotripsy.It could significantly improve the stone expulsion rate,relief the pain and improve bladder irrtative symptoms.