Clinical Trial of Alfuzosin Stone Expulsion Therapy for Distal Ureteral Calculi : Efficacy and Patient Outcome Evaluation

Abstract

Urolithiasis plays a major role in Urological practice and has contributed to increased office visits, emergency room visits, hospitalizations and annual expenditures. Prolonged ureteral obstruction by stones may be associated with serious complications including renal failure, infection, sepsis, pyelonephritis and ureteral stricture. Spontaneous passage of ureteral stones was found to be dependent on factors such as size, location and degree of impaction. Simple watchful waiting approach has been advocated for small ureteral stones with high probability to pass. However it may result in complications such as urinary tract infection and renal function loss therefore it is recommended to not exceed 4 to 6 weeks. Medial expulsive therapy (MET) has emerged as an appealing option for the management of ureteral stones up to 10 mm in size. Several pharmacological agents have been studied and of these agents, α blockers have been demonstrated to augment stone passage. Since α1 receptors are abundant in distal ureteral smooth muscle, blockage of these receptors using α1 antagonists, inhibits basal tone, peristalsis and ureteral contraction therefore facilitating stone passage. Tamsulosin , a selective α1a and α1d receptor antagonist, has been the most commonly studied α1 blocker for MET. Alfuzosin, an α1 antagonist with similar efficacy as tamsulosin in treating obstructive uropathy due to benign prostatic hypertrophy was found to have a lower incidence of retrograde ejaculation than tamsulosin and has not been adequately studied in MET for distal ureteral stones up to 10 mm.