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Most patients present with sudden onset of
agonizing flank pain radiating to the groin, sacrum, labia, scrotum and the
anterior surface of thigh. Presence of ureteric stone does not always required
invasive or surgical intervention. It depends upon the size, location and
degree of obstruction at initial presentation. As we all know large number of
patients passes stone spontaneously with sufficient hydration alone. According
to American
Urological Association (AUA) guidelines, about 98% of ureteric stone, size less
than 5 mm will pass spontaneously
without any medical therapy7 and about 35.2% to 61% of size less
than 10 mm.8,9,10
However this percentage does not give satisfactory results, patients with
ureteric stone less than 10 mm
without medical therapy might develop sever complications or end up in surgical
intervention if waited for longer duration. It is known that the larger the stone lower the
probability of spontaneous passage of stone. Thus conservative or medical treatment is probably most
effective for stone size of about 5-10mm.
Conservative treatment using medical therapy is found to be cost-effective
before embarking upon surgical option.11 Various randomized trials confirm the efficacy of
medical expulsion therapy and helps in reducing the pain and stone passage.
Therefore overall rate of surgical intervention is reduced with medical


In this study the
choice of medical expulsion therapy was ”Tamsulosin”- alpha blocker. The
presence of alpha adrenergic receptors in the human ureter was first described
in 1970.14 Alpha adrenergic
receptors were further classified into three different subtypes of 1A, 1B and 1D. The mechanism of action of alpha blockers on the
ureteral smooth muscle is increase in the expulsion rate of stones or decrease
in the time it takes for expulsion. This suggests that alpha adrenergic
receptor antagonists should be the preferred as Medical Expulsion Therapy for
ureteric stone.15 The goal of the Medical expulsive therapy (MET) is to accelerate stone
passage and therefore avoid surgery and to reduce analgesic requirement. Dellabella and
colleagues (2003), study the efficacy of tamsulosin and found that tamsulosin
therapy was associated with an increased stone expulsion rate and a decreased
time to stone expulsion.16 also two randomized controlled studies by Al-Ansari and colleagues8 and Kaneko and
colleagues17 validated the efficacy of tamsulosin for distal
ureteral calculi without significant side effects.

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Stone in the ureter cause partial or complete obstruction which activates the
alpha1 receptors by increasing the contraction and the frequency
of ureteral peristalsis. Blockage of alpha1 receptors decreases basal tone which prevents peristaltic amplitude and
frequency, and lower intraluminal pressure while increasing the rate of fluid transport and the chances of stone expulsion.18 Alpha1
antagonists have a crucial impact in spontaneous painless elimination of the
stones19  and viable option in selected population where there is no role for immediate
surgical stone removal. The minimally invasive therapies for ureteric stone are
accepted as gold standards. Nevertheless, these techniques are not risk free
and are quite expensive and are concentrated at tertiary care centers.20

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