TAMSULOSINE,AN ALPHA 1 BLOCKERS EXPULSE LOWER URETIC STONE & PAIN EFFECTIVELY

TAMSULOSINE,AN ALPHA 1 BLOCKERS EXPULSE LOWER URETIC STONE & PAIN EFFECTIVELY

Prof Dr,DRAM,HIV /AIDS,HEPATITIS ,SEX DISEASES & WEAKNESS expert,New Delhi,India, +917838059592

Ureteric Stone and Colic is most common emergency in Hospital now a days and ptients are relieved by strong analgesic immediately followed by hydration therapy for life with expulsion of stone by surgical intervention but often it is repeated many times as stone formation and colic is seen repeatedly some time and so it is very distressing for the patient.So many patients wants that either stone formation is blocked or some medicines must be available which can expuse these stones completely relieving their symptoms and by few study it has been found that tamsulosine has an edge for this.

             Many minimally invasive interventional (e.g., ESWL and ureteroscopy) as well as expectant (watchful waiting) treatment exist for the management of lower ureteric calculi. But the choice of the ideal method to be taken up largely depend on the type of equipment available, type and size of stone, needs of the patient and the skills of the surgeon.[The stone burden remains the primary factor in deciding the appropriate treatment for a patient with ureteral calculi. Where a failed expectant treatment may well be complicated with hydronephrosis, deranged renal function or urosepsis, interventional techniques are not always free of complications and failures.

             Recent studies have reported excellent results relating to medical expulsive therapy (MET) for distal ureteral calculi, in terms of stone expulsion and control of ureteral colic pain, using drugs (e.g., nifedipine and prednisolone) that can modulate the function of the ureter obstructed by the stone. Recently, a a1A receptor blocker to be used in this regard is tamsulosin. Most of the work on the efficacy of tamsulosin in lower ureteral calculi expulsion has been done in western affluent countries with variable results. The disease spectrum in a developing country like ours, is different from that in developed countries, mainly because of delay in diagnosis, delay in investigations and lack of awareness which tend to modify the outcome in case of ureteral stones or for that matter any disease. 

                   Cervenakov et al, concluded that the treatment by α1 blockers considerably decreased not only lower urinary tract symptoms (LUTS) but also helped to accelerate the passing of minor calculi from the terminal parts of the ureters of 80.4% of patients. They also suggested that α1 blockers potentiate the spasmoanalgesic action of drugs used in standard methods of treatment.It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage. Appropriately used it may have substantial fiscal benefits by reducing the number of interventional procedures and the acute attacks too. However, this requires larger prospective randomized controlled trials before its application can be universally recommended.