Urological Research

, Volume 40, Issue 3, pp 219–224 | Cite as

Role of combined use of potassium citrate and tamsulosin in the management of uric acid distal ureteral calculi

  • Osama El-Gamal
  • Mohamed El-BendaryEmail author
  • Maged Ragab
  • Mohamed Rasheed
Original Paper


In this article, we investigated the effect of the combined use of tamsulosin and potassium citrate (Uralyt-U®) for the treatment of uric acid stones in the distal ureter. The study was designed as a prospective, double blind randomized controlled trial. A total of 191 adult patients with radiolucent distal ureteral calculi were recruited. We included patients with solitary stones ≥5 mm with mild or moderate hydronephrosis and a normal contralateral tract. The patients were randomized into four equal groups (the placebo, tamsulosin, Uralyt-U®, and the combined treatment groups). The patients were treated for a maximum duration of 4 weeks or until stone expulsion. The stone size in all groups ranged from 5 to 11 mm (7.69 ± 1.7 mm). The total expulsion rate of the stones was significantly lower in the control group (26.1%) compared with that of any of the other three groups (68.8, 58.7, and 84.8% respectively) (P < 0.05). Meanwhile, the difference between the Uralyt-U® group and the combined treatment group was also statistically significant (P < 0.05). When we studied the patients with stones >8 mm as a separate subgroup to find the effect of the used drugs on the relatively large stones, we detected that the expulsion rate of these stones was significantly higher in the patients who received the combined treatment in comparison with any of the other three groups (P < 0.05). In conclusion, the use of urinary alkalization with tamsulosin can increase the frequency of spontaneous passage of distal ureteral uric acid stones especially those of 8–11 mm.


Ureter Calculi Uric acid Tamsulosin 


  1. 1.
    Hubner WA, Irby P, Stoller ML (1993) Natural history and current concepts for the treatment of small ureteral calculi. Eur Urol 24:172–176PubMedGoogle Scholar
  2. 2.
    Ueno A, Kawamura T, Ogawa A et al (1977) Relation of spontaneous passage of ureteral calculi to size. Urology 10:544–546PubMedCrossRefGoogle Scholar
  3. 3.
    Miller OF, Kane CJ (1999) Time to stone passage for observed ureteral calculi: a guide for patient education. J Urol 162:688–690PubMedCrossRefGoogle Scholar
  4. 4.
    Dellabella M, Milanese G, Muzzonigro G (2005) Randomized trial of the efficacy of tamsulosin, nifedipine and phloroglucinol in medical expulsive therapy for distal ureteral calculi. J Urol 174:167–172PubMedCrossRefGoogle Scholar
  5. 5.
    Yilmaz E, Batislam E, Basar MM et al (2005) The comparison and efficacy of 3 different alpha1-adrenergic blockers for distal ureteral stones. J Urol 173:2010–2012PubMedCrossRefGoogle Scholar
  6. 6.
    Hollingsworth JM, Rogers MA, Kaufman SR et al (2006) Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet 368:1171–1179PubMedCrossRefGoogle Scholar
  7. 7.
    Singh A, Alter HJ, Littlepage A (2007) A systematic review of medical therapy to facilitate passage of ureteral calculi. Ann Emerg Med 50:552–563PubMedCrossRefGoogle Scholar
  8. 8.
    Arrabal-Martin M, Valle-Diaz de la Guardia F, Arrabal-Polo MA et al (2010) Treatment of ureteral lithiasis with tamsulosin: literature review and meta-analysis. Urol Int 84:254–259PubMedCrossRefGoogle Scholar
  9. 9.
    Yencilek F, Erturhan S, Canguven O et al (2010) Does tamsulosin change the management of proximally located ureteral stones? Urol Res 38:195–199PubMedCrossRefGoogle Scholar
  10. 10.
    Schuster TG, Hollenbeck BK, Faerber GJ et al (2001) Complications of ureteroscopy: analysis of predictive factors. J Urol 166:538–540PubMedCrossRefGoogle Scholar
  11. 11.
    Hochreiter WW, Danuser H, Perrig M et al (2003) Extracorporeal shock wave lithotripsy for distal ureteral calculi: what a powerful machine can achieve. J Urol 169:878–880PubMedCrossRefGoogle Scholar
  12. 12.
    Lotan Y, Gettman MT, Roehrborn CG et al (2002) Management of ureteral calculi: a cost comparison and decision making analysis. J Urol 167:1621–1629PubMedCrossRefGoogle Scholar
  13. 13.
    Shekarriz B, Stoller ML (2002) Uric acid nephrolithiasis: current concepts and controversies. J Urol 168:1307–1314PubMedCrossRefGoogle Scholar
  14. 14.
    Sayed MA, Abolyosr A, Abdalla MA et al (2008) Efficacy of tamsulosin in medical expulsive therapy for distal ureteral calculi. Scand J Urol Nephrol 42:59–62PubMedCrossRefGoogle Scholar
  15. 15.
    Wang CJ, Huang SW, Chang CH (2008) Efficacy of an alpha1 blocker in expulsive therapy of lower ureteral stones. J Endourol 22:41–46PubMedCrossRefGoogle Scholar
  16. 16.
    Sterrett SP, Nakada SY (2008) Medical expulsive therapy. Curr Opin Urol 18:210–213PubMedCrossRefGoogle Scholar
  17. 17.
    Al-Ansari A, Al-Naimi A, Alobaidy A et al (2010) Efficacy of tamsulosin in the management of lower ureteral stones: a randomized double-blind placebo-controlled study of 100 patients. Urology 75:4–7PubMedCrossRefGoogle Scholar
  18. 18.
    Porpiglia F, Ghignone G, Fiori C et al (2004) Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol 172:568–571PubMedCrossRefGoogle Scholar
  19. 19.
    Autorino R, De Sio M, Damiano R et al (2005) The use of tamsulosin in the medical treatment of ureteral calculi: where do we stand? Urol Res 33:460–564PubMedCrossRefGoogle Scholar
  20. 20.
    De Sio M, Autorino R, Di Lorenzo G et al (2006) Medical expulsive treatment of distal ureteral stones using tamsulosin: a single center experience. J Endourol 20:12–16PubMedCrossRefGoogle Scholar
  21. 21.
    Nakada SY, Hoff DG, Attia S et al (2000) Determination of stone composition by noncontrast spiral computed tomography in the clinical setting. Urology 55:816–819PubMedCrossRefGoogle Scholar
  22. 22.
    Low RK, Stoller ML (1997) Uric acid-related nephrolithiasis. Urol Clin North Am 24:135–148PubMedCrossRefGoogle Scholar
  23. 23.
    Asplin JR (1996) Uric acid stones. Semin Nephrol 16:412–424PubMedGoogle Scholar
  24. 24.
    Moran ME, Abrahams HM, Burday DE et al (2002) Utility of oral dissolution therapy in the management of referred patients with secondarily treated uric acid stones. Urology 59:206–210PubMedCrossRefGoogle Scholar
  25. 25.
    Granados Loarca EA (2001) Medical treatment of uric acid lithiasis of the urinary tract and usefulness of double J catheter. Arch Esp Urol 54:157–161PubMedGoogle Scholar
  26. 26.
    Rodman JS (2002) Intermittent versus continuous alkaline therapy for uric acid stones and ureteral stones of uncertain composition. Urology 60:378–382PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Osama El-Gamal
    • 1
  • Mohamed El-Bendary
    • 1
    Email author
  • Maged Ragab
    • 1
  • Mohamed Rasheed
    • 1
  1. 1.Department of UrologyTanta UniversityTantaEgypt

Personalised recommendations