Medical Expulsive Therapy Using Alfuzosin for Patient Presenting with Ureteral Stone Less Than 10mm: a Prospective Randomized Controlled Trial

Objectives: To assess the spontaneous passage rate for patients being treated with alfuzosin 10mg daily after presenting with an acute ureteral stone compared with a control group, and to assess the respective pain control status.

Methods: This was a prospective randomized controlled trial. Patients presenting with an acute ureteral stone (size 5-10mm) were enrolled and randomized into a medical expulsive therapy (MET) group or control group. The MET group received alfuzosin slow release (SR) 10mg daily for 4weeks and dologesic (paracetamol+dextropropoxyphene, four tablets daily on demand) for 2weeks. The control group received the same analgesics for 2weeks only. Diclofenac sodium SR 100mg daily for 2weeks was added in case of suboptimal pain control. All the patients were assessed through phone interview at week 2 and with kidney-ureter-bladder X-ray at week 5 to check for any evidence of stone passage.

Results: A total of 67 patients were included in the analysis. The overall spontaneous passage rate was increased by 31.8% with MET (P=0.006). For an upper ureteral stone, the rate was increased by 51.3% (P=0.01). The MET group used significantly less dicolofenac sodium (1.5 tablets vs 6.7 tablets, P=0.031).

Conclusions: MET using alfuzosin SR 10mg daily is effective to enhance the ureteral stone spontaneous passage rate, particularly for upper ureteral stones. Fewer analgesic drugs are consumed and more patients can avoid ureteroscopic lithotripsy and/or extracorporeal shock wave lithotripsy.