The management of distal ureteral stones has evolved significantly, with medical expulsive therapy (MET) emerging as a non-invasive, cost-effective alternative to surgical intervention. This randomized controlled trial aimed to evaluate and compare the safety and efficacy of naftopidil versus tamsulosin, both combined with prednisolone, in facilitating spontaneous stone passage. A total of 120 adult patients with distal ureteral stones measuring 5–10 mm were enrolled between July 2010 and March 2012 and randomly assigned into three equal groups: Group A received tamsulosin 0.4 mg daily plus prednisolone 5 mg daily; Group B received naftopidil 75 mg daily plus prednisolone 5 mg daily; and Group C underwent watchful waiting with analgesics as needed. Treatment duration was up to four weeks or until stone expulsion.
Primary outcomes included stone expulsion rate and time to expulsion, while secondary endpoints involved analgesic consumption, number of hospital visits for pain, need for endoscopic intervention, and adverse effects.tert-Butyl 5-iodopentanoate custom synthesis Stone expulsion was confirmed via non-contrast CT, KUB X-ray, or ultrasonography. Statistical analysis utilized chi-square tests, Mann-Whitney U tests, and one-way ANOVA with post-hoc comparisons, with significance set at p < 0.004 after Bonferroni correction. Results showed that the expulsion rates were significantly higher in both active treatment groups compared to watchful waiting: 70% in Group A (tamsulosin + prednisolone), 87.5% in Group B (naftopidil + prednisolone), and only 32.5% in Group C (p < 0.2-(2-Bromoethyl)-1,3-dioxolane medchemexpress 001). Although Group B demonstrated a higher expulsion rate than Group A, the difference was not statistically significant (p = 0.056). The mean time to expulsion was comparable between Groups A and B (8.7 ± 1.5 days vs. 9.1 ± 2.1 days, p = 0.68), but significantly longer in Group C (14.0 ± 2.2 days, p < 0.001). Patients in Groups A and B required significantly fewer analgesic doses (2.4 ± 1.2 vs. 2.1 ± 0.9 vs. 4.1 ± 0.7, p < 0.001) and reported fewer painful episodes (0.8 ± 0.8 vs. 0.8 ± 0.7 vs. 1.4 ± 0.6, p < 0.001). Hospital visits for pain and follow-up were similar across groups, averaging 3.2, 3.1, and 4.0 respectively, with no significant differences. No serious adverse events occurred. Mild side effects included retrograde ejaculation in one patient each from Groups A and B, and dizziness in one patient from Group A. All patients who failed to pass stones within four weeks underwent uneventful semirigid ureterorenoscopy.PMID:35152755
These findings indicate that combining either naftopidil or tamsulosin with prednisolone enhances stone expulsion rates and reduces pain and medication use compared to expectant management. The superior expulsion rate observed with naftopidil may be attributed to its greater affinity for α1D-adrenoceptors, which are highly expressed in the distal ureter and detrusor muscle. This action likely promotes relaxation of the intramural ureter and bladder neck, reducing obstruction at the narrowest segment of the ureter. While the current study suggests a trend toward better outcomes with naftopidil, larger, multicenter trials are warranted to confirm its advantage over tamsulosin.
In conclusion, MET using naftopidil or tamsulosin with low-dose prednisolone is safe and effective for distal ureteral stones, offering a viable, non-surgical option that improves patient comfort and reduces healthcare burden.MedChemExpress (MCE) offers a wide range of high-quality research chemicals and biochemicals (novel life-science reagents, reference compounds and natural compounds) for scientific use. We have professionally experienced and friendly staff to meet your needs. We are a competent and trustworthy partner for your research and scientific projects.Related websites: https://www.medchemexpress.com