Authors : Dr. Akshaya Jayaprakash; Dr. Venkataramana G; Dr. Navyasree Battina; Dr. Malle Nagaveni; Dr Gowtham Prasad GV

Volume/Issue : Volume 9 - 2024, Issue 8 - August

Google Scholar : https://tinyurl.com/mry6kry6

Scribd : https://tinyurl.com/yzbuk79y

DOI : https://doi.org/10.38124/ijisrt/IJISRT24AUG281

Abstract : 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.

Keywords : Medical Expulsive Therapy, Silodosin, Tamsulosin, Distal Ureteric Calculus.

References :

1. Alan J. Wein, Louis R. Kavoussi, Alan W. Partin, Craig A. PetersWeiss.  Campbell-Walsh Urology. 11^th Edition; 2016.
2. Pietropaolo A, Proietti S, Geraghty R, Skolarikos A, Papatsoris A, Liatsikos E, Somani BK. Trends of 'urolithiasis: interventions, simulation, and laser technology' over the last 16 years (2000-2015) as published in the literature (PubMed): a systematic review from the European section of Uro-technology (ESUT). World J Urol. 2017;35:1651–1658.
3. Erturhan S, Erbagci A, Yagci F, Celik M, Solakhan M, Sarica K. Comparative evaluation of the efficacy of the use of tamsulosin and/or tolterodine for medical treatment of distal ureteral stones. Urology. 2007 Apr; 69(4):633-6. doi: 10.1016/j.urology.2007.01.009.
4. M.S. Griwan, S.K. Singh, H. Paul, D.S. Pawar, M. Verma. The efficacy of tamsulosin in lower ureteral calculi. Urol Ann, 2 (2010), pp. 63-66
5. M. Rossi, T. Roumeguère. Silodosin in the treatment of benign prostatic hyperplasia. Drug Des Dev Ther, 27 (4) (2010), pp. 291-297
6. D.M. Coll, M.J. Varanelli, R.C. Smith. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol, 178 (2002)
7. Hazem Elgalaly, Ahmed Sakr, Amr Fawzi, Emad A. Salem, Esam Desoky, Ashraf Shahin, Mostafa Kamel. Silodosin vs tamsulosin in the management of distal ureteric stones: A prospective randomized study. Arab Journal of Urology, Volume 14, Issue 1 (2016), Pages 12-17.
8. S. Gupta, B. Lodh, A.K. Singh, K. Somarendra, K.S. Meitei, S.R. Singh. Comparing the efficacy of tamsulosin and silodosin in the medical expulsion therapy for ureteral calculi. J Clin Diagn Res, 7 (2013), pp. 1672-1674
9. Abdullah A, Basoo Gupta Y, Selvaraj S, Ganapathy R, Ilangovan AK, Sivalingam S, Prasad S. A Comparison Between Silodosin and Tamsulosin for Medical Expulsive Therapy of Distal Ureteric Calculus. Cureus. 2023 Oct 14;15(10)
10. Itoh Y, Okada A, Yasui T, et al. Efficacy of selective α1A adrenoceptor antagonist silodosin in the medical expulsive therapy for ureteral stones. Int J Urol. 2011;18:672–674.
11. V. Imperatore, F. Fusco, M. Creta, S. Di Meo, R. Buonopane, N. Longo, et al. Medical expulsive therapy for distal ureteric stones: tamsulosin versus silodosin. Arch Ital Urol Androl, 86 (2014), pp. 103-107
12.  Yuksel M, Yilmaz S, Tokgoz H, et al. Efficacy of silodosin in the treatment of distal ureteral stones 4 to 10 mm in diameter. Int J Clin Exp Med. 2015;8:19086–19092. 
13. Huang W, Xue P, Zong H, Zhang Y. Efficacy and safety of silodosin in the medical expulsion therapy for distal ureteral calculi: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;81:13–22. 
14. Liu XJ, Wen JG, Wan YD, Hu BW, Wang QW, Wang Y. Role of silodosin as medical expulsive therapy in ureteral calculi: a meta-analysis of randomized controlled trials. Urolithiasis. 2018;46:211–218.