Comparison of Synergistic Action of Alpha Blockers and Tadalafil in the Management of Lower Ureteric Stones as Medical Expulsive Therapy: A Prospective Cohort Study

Introduction: Medical Expulsive Therapy (MET) involves the utilisation of different drugs that act on the ureter through various mechanisms. Alpha-1 adrenoceptor and Phosphodiesterase (PDE) regulate ureteric motility thus combination of these drugs can increase the ureteric stone expulsion rate by complementing each other’s actions. Aim: To assess the synergistic role of alpha-blocker and Tadalafil therapy in facilitating the spontaneous expulsion of distal ureteral stones. Materials and Methods: A prospective cohort study was conducted in the Department of Urology at a Tertiary Care Centre (NSCB Medical College) from April 2020 to January 2022. A total of 281 patients diagnosed with lower ureteric stones (5-10 mm) were divided into five study groups: Group A was treated with tamsulosin, group B with silodosin, group C with tadalafil alone, group D with tamsulosin and tadalafil, and group E treated with a combination of silodosin and tadalafil. Corticosteroid (deflazacort 6 mg) was also included in every group. All patients were reassessed after three weeks of treatment for stone expulsion rate, expulsion time, the number of hospital visits for pain, and adverse effects of drugs. The statistical data was analysed using Statistical Package for Social Sciences (SPSS) software (version 21.0, IBM Corp, USA). The Chi-square test and Analysis of Variance (ANOVA) test were used to determine the effect on stone expulsion rate and expulsion time. The confidence interval was 95%, and the significance level of the p-value was set <0.05. Results: The stone expulsion rates in group A, B, C, D, and E were 70.91%, 79.63%, 52.63%, 84.21%, and 86.20%, respectively, which was significant (p=0.00194). The mean time taken for stone expulsion in group A, B, C, D, and E were 8.95±1.73, 8.43±1.57, 9.86±1.90, 7.96±2.03, and 7.75±1.84 days (p=0.0001). Minor side effects were not significant, except for retrograde ejaculation in group B and E, and 22.8% of patients needed hospitalisation in group C (tadalafil alone). Conclusion: Combination therapy is safe, efficacious, and welltolerated as MET for distal ureteric calculi in the 5-10 mm range, thereby avoiding surgical procedures and providing faster relief for the patients.