Pharmacologic Expulsive Treatment of Ureteral Calculi

OBJECTIVE: To evaluate the role of nifedipine and the alpha(1)-adrenoreceptor antagonists tamsulosin, terazosin, and doxazosin in the expulsive treatment of ureteral calculi. DATA SOURCES: Literature was searched via MEDLINE (1966-February 2006) with subsequent bibliographic review. MeSH headings included ureteral calculi, nifedipine, doxazosin, and adrenergic alpha-antagonists. Key terms were ureteral calculi, nifedipine, tamsulosin, terazosin, and doxazosin. STUDY SELECTION AND DATA EXTRACTION: Trials evaluating nifedipine, tamsulosin, terazosin, and doxazosin for expulsion of ureteral stones were reviewed. All were published in English-language, peer-reviewed journals. DATA SYNTHESIS: Several trials have evaluated the effects of nifedipine and tamsulosin on ureteral stone passage rates and mean time to stone passage in stones no larger than 15 mm. In 28 day trials, the rates of ureteral stone passage were 35-70% in the control groups compared with 77.1-80% in patients treated with nifedipine and 79.3-100% in patients treated with tamsulosin. Average number of days to stone passage in the control groups was 4.6-20, and the time to stone passage was only 5-9.3 days in patients receiving nifedipine and 2.7-7.9 days in those receiving tamsulosin. The stone passage rates and time to stone passage appeared to be similar in one trial that compared tamsulosin with terazosin and doxazosin. Limited data suggest that these agents may have a role as adjuncts to shock wave lithotripsy. Adverse drug reactions were uncommon. CONCLUSIONS: Nifedipine, tamsulosin, terazosin, and doxazosin are safe and effective options in enhancing ureteral stone expulsion in selected patients with uncomplicated presentations.