Comparison of safety and efficacy of tamsulosin, tadalafil, combinations and deflazacort in lower ureteric orifice negotiation by large size ureteroscope (8/9.8 Fr) prior to intracorporeal lithotripsy

Abstract

Objective: To compare the safety and efficacy of tamsulosin, tadalafil, deflazacort and combination of tamsulosin with tadalafil in lower ureteric orifice negotiation by large size ureteroscope (8/9.8 Fr) prior to intracorporeal lithotripsy. Patients and methods: In this prospective study, 180 patients presented with ureteric stone of size 8–15 mm were randomly assigned to 5 groups: tamsulosin (group A), tadalafil (group B), deflazacort (group C), combination of tamsulosin with tadalafil (group D) and placebo (group E). After 10 days of drug therapy 168 patients were underwent ureteroscopy and findings like endoscopic configuration of ureteric orifice, need for ureteric dilatation, ureteroscope negotiation, operating time, drug related side effect and procedural complication were noted in each group. Results: All four groups (A, B, C, D) were significantly better than group E in terms of ureteric orifice appearance (wide) during endoscopy. Negotiation of ureteric orifice was easy in group A (70.59%), B (58.82%) and D (78.13%) as compare to group E (31.43%) which was statistically significant. Group A (32.35%) and D (34.38%) were statistically better with group E (62.86%) in terms of ureteral dilatation. Operative time was less in all four groups as compared to group E. All patients well tolerated the drugs with no serious side effects. Conclusion: Both tamsulosin and tamsulosin with tadalafil helps in forward propagation of large size ureteroscope as compared to other groups with less operative time without any significant complications. So, we can conclude that tamsulosin alone can be helpful for lower ureteric orifice negotiation during intracorporeal lithotripsy with minimal side effects. Keywords: Hematuria, Negotiation, Ureteroscope