الفهرس 
ANATOMY OF THE URETEROnly 14 pages are availabe for public view
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Abstract
U
rolithiasis is one of the commonest urinary tract diseases. Ureteral stones account for 20% of urolithiasis, and 70% of ureteral stones are located in the lower third of the ureter. Conservative management strategies such as observation or medical expulsive therapy using alpha-1 blockers and PDE5
inhibitors to facilitate passage of ureteral stones have
commonly used during the recent years.
The mechanism of action of alpha-1 blockers is blockage
of α1-adrenergic receptors in the ureteric smooth muscle cells
results in relaxation of the ureteric smooth muscles and,
therefore, causes ureteric lumen dilatation which results in
facilitation of stone expulsion.
The mechanism of action of PDE5 inhibitors is by a
nitric oxide (NO)/ cyclic guanosine monophosphate (cGMP)-
signaling pathway of smooth muscles, resulting in high levels
of cGMP, leading to ureteral smooth muscle relaxation.
Therefore, PDE5 inhibitors are able to facilitate stone passage.
The aim of this study is to compare the efficacy and safety of silodosin , tadalafil and silodosin in combination with tadalafil as medical expulsive therapy of lower ureteric stones using reporting methodology.
The present study was a prospective randomized
comparative study conducted on 90 patients between the ages of 18 and 55 years and complaining of unilateral single lower ureteric stone 6-10mm presented through the outpatient clinics of Urology in Ain Shams University Hospitals over a period of 6 months. The patients were randomly divided into 3 equal groups: group I: 30 patients received silodosin (8 mg) once daily, group II: 30 patients received tadalafil (10 mg) once daily and group III: 30 patients received tadalafil (10 mg) in combination with silodosin (8 mg) once daily with follow up weekly until stone passage or maximum for four weeks.
Our study showed that the stone explusion rate was statistically significant between three group (group I 76.7% vs group II 60.0% vs group III 90.0%) p-value 0.025 (P>0.05), the stone explusion days was highly statistically significant between three group (group I 12.50±1.66 vs group II 14.67±1.24 vs group III 11.23±3.14) p-value 0.000 (P>0.05), the number of hospital visit for pain was statistically significant between three group (group I 1.35±0.9 vs group II 1.65±1.09 vs group III 1.02±0.80) p-value 0.038 (P>0.05) and the amount of analgesic of diclofenac sodium 75mg tablet orally was highly statistically significant between three group (group I 613.44±483.62 vs group II 716.97±685.3 vs group III 313.6±2.85.5) p-value 0.008 (P>0.05).
Also, it showed that there was no significant difference among the studied groups regarding headach, dizziness, backache, myalgia, orthostatic hypotension and retrograde ejaculation. However there was significant difference among the studied group regarding increased erection (P<0.05). 26.7% in combination silodosine and tadalafil 23.3% in tadalafil and 0% in silodosine groups.
Therefore, the prescription of tadalafil in combination with silodosin is safe and more effective than silodosin or tadalafil alone and provides additional advantage of increased erection which may be useful especially in patients with erectile dysfunction.
CONCLUSION
T
he prescription of tadalafil in combination with silodosin is safe and more effective than silodosin or tadalafil alone and provides additional advantage of increased erection which may be useful especially in patients with erectile dysfunction.