Enhancing stone expulsion: The efficacy of combined medical therapy with tamsulosin and dexamethasone in renal colic patients.

Background: Ureteral stones are a common aspect of daily urologic practice, affecting 10%-15% of people worldwide over their lifetime. This study aimed to assess the efficacy of combined medical expulsive therapy (MET) with intravenous dexamethasone and oral tamsulosin compared to tamsulosin alone in the frequency and duration of distal ureteral stone expulsion.

Materials and methods: This prospective, double-blind, randomized controlled trial with 1:1 balanced randomization was conducted from September 2022 to March 2023 at Al-Zahra Hospital, a tertiary care facility affiliated with Isfahan University of Medical Sciences. Of 213 patients admitted to our center with acute renal colic, 134 had distal ureteral stones and were assessed. Among them, 105 patients were eligible and included in the trial and were randomly assigned into the intervention group (n = 52) and control group (n = 53). Data from four patients in the case group were omitted from the analysis due to the drop-out from the study.

Results: Mean initial stone size was 6.5 ± 1.2 mm in the intervention, and 6.3 ± 1.0 mm in the control groups, which was not statistically significant (P = 0.488). Gender was comparable between both groups (P = 0.196), whereas the distribution of BMI (27.2 ± 4.0 vs. 29.8 ± 3.9 kg/m², P = 0.001) and age (41.5 ± 12.9 vs. 47.9 ± 16.2 years, P = 0.031) was not in balance. In total, 43 patients had expelled the stone by the end of the 2 weeks, resulting in an overall expulsion rate of 42.5%. Specifically, 28 (58.3%) patients in the intervention group and 15 (28.3%) patients in the control group had expelled the stone, a difference that was statistically significant (P = 0.002). The time to stone expulsion did not exhibit a significant difference between the intervention and control groups (9.8 vs. 5.4 days, respectively). However, it is noteworthy that the variability in the time to stone expulsion in the tamsulosin + dexamethasone group was considerably smaller than that in the control group, as indicated by the smaller standard deviation in the former (1.0 vs. 3.8 days, respectively).

Conclusion: Adding dexamethasone to standard MET with tamsulosin for distal ureterolithiasis appears to increase the stone expulsion rate, although it did not significantly shorten the expulsion time.