Comparative Study between Tadalafil versus Tamsulosin versus Halphabarol with Terpenes Mixture as a Medical Expulsive Therapy for Lower Ureteric Stones

Abstract

U rolithiasis is one of the commonest urinary tract diseases. Ureteral stones account for 20% of urolithiasis, and 70% of ureteral stones are located in the lower third of the ureter. Conservative management strategies such as observation or medical expulsive therapy using alpha-1 blockers and PDE5 inhibitors to facilitate passage of ureteral stones have commonly used during the recent years. The mechanism of action of alpha-1 blockers is blockage of α1-adrenergic receptors in the ureteric smooth muscle cells results in relaxation of the ureteric smooth muscles and, therefore, causes ureteric lumen dilatation which results in facilitation of stone expulsion. The mechanism of action of PDE5 inhibitors is by a nitric oxide (NO)/ cyclic guanosine monophosphate (cGMP)-signaling pathway of smooth muscles, resulting in high levels of cGMP, leading to ureteral smooth muscle relaxation. Therefore, PDE5 inhibitors are able to facilitate stone passage. The aim of the present study was to compare the efficacy of tadalafil (a phosphodiesterase-5 inhibitor), tamsulosin (an alpha-1blocker) and halphabarol (Proximol) with terpenes mixture (Rowatinex) as a medical expulsive therapy for lower ureteric stones.