Stone Disease Corticosteroids and Tamsulosin in the Medical Expulsive Therapy for Symptomatic Distal Ureter Stones: Single Drug or Association? Francesco Porpiglia *, Davide Vaccino, Michele Billia, Julien Renard, Cecilia Cracco, Gianpaolo Ghignone, Cesare Scoffone, Carlo Terrone, Roberto Mario Scarpa Department of Urology, University of Turin, San Luigi Hospital, Orbassano (TO), Italy european urology 50 (2006) 339–344 available at www.sciencedirect.com journal homepage: www.europeanurology.com Article info Article history: Accepted February 6, 2006 Published online ahead of print on March 3, 2006 Keywords: Deflazacort Steroids Tamsulosin Ureter Ureteral calculi Abstract Objectives: To assess the clinical role of corticosteroids in the medical expul- sive therapy of symptomatic distal ureteral stones. Methods: Between January 2004 and September 2005, 114 patients with symptomatic distal ureteral stones with a 5 mm diameter were enrolled in this prospective study and divided into four groups based on the urologist (of four) who treated them in the emergency unit. Group A (33 patients) received tamsulosin (0.4 mg daily), group B (24 patients) received deflazacort (30 mg daily), group C (33 patients) received both (0.4 mg tamsulosin + 30 mg deflazacort daily), and control group D (24 patients) received only analgesics. The treatment duration was 10 d to prevent the side-effects of prolonged corticosteroid therapy. The end points were the expulsion rate, analgesic consumption, number of ureteroscopies, and safety. Results: The groups were comparable in terms of age, sex, and stone location. The stone diameter was 5.96  0.33 mm for group A, 5.83  0.4 mm for group B, 5.88  0.23 mm for group C, and 5.71  0.5 mm ( p > 0.05) for group D. The rates of expulsion for the four groups were 60%, 37.5%, 84.8%, and 33.3%, respectively. There was a significant difference between group C and the other groups ( p < 0.001). The mean analgesic consumption was 42.5  0.4 mg for group A, 50  0.3 mg for group B, 27.3  0.5 mg for group C, and 81  0.33 mg for group D, with a significant difference between group C and the other groups ( p < 0.001). During the treatment period, only two cases of drug side- effects related to tamsulosin (without any drop-outs) were recorded. Conclusion: When the medical expulsive therapy for symptomatic distal ureteral stones is considered, the use of steroids (deflazacort) proves efficient only when administered together with a 1 -blockers (tamsulosin). In addition, tamsulosin used on its own as a medical expulsive therapy can be considered as an alternative treatment for those patients who are not suitable for steroid therapy, as it is generally efficient. # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. * Corresponding author. Department of Urology, San Luigi Hospital, Regione Gonzole 10, 10043, Orbassano, Torino, Italy. Tel. +39 0119025349; Fax: +39 0119026244. E-mail address: porpiglia@libero.it (F. Porpiglia). 0302-2838/$ – see back matter # 2006 European Association of Urology. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.eururo.2006.02.023