Muhammad Seerwan, Ghazi Khan, Muhammad Ilyas, Dastgeer Waheed, Atta Ur Rehman, Fawad Humayun


Background: Urolithiasis is the third common disease of the urinary tract after UTIs and pathological diseases of the prostate. The objective of this study was to compare the efficacy of doxazosin versus tamsulosin in lower ureteric stone expulsion in adult population of District Dera Ismail Khan, Pakistan.

Materials & Methods: This non-randomized control trial was conducted in the Department of Urology, Gomal Medical College, Dera Ismail Khan, Pakistan from February 2020 to December 2020. The 252 patients included in our study were divided in to two groups. The patients in experimental group received Tab. doxazosin 4 mg daily for 4 weeks and Tab. diclofenac sodium 50 mg B.D for 5 days and then on need basis. The patients in control group received Cap. tamsulosin 0.4 mg daily for 4 weeks and similarly Tab. diclofenac sodium 50 mg as in experimental group. All the patients were followed regularly for expulsion of ureteric stones for four weeks. Sex, age and stone size were matching, while stone expulsion was a research variable. Hypothesis was verified by McNemar chi-square test.

Results: Out of 252 patients, 113 (89.68%) patients in experimental group, while 77 (61.11%) patients in control group passed the stones. There was statistically significant difference in efficacy in doxazosin group as compared to tamsulosin group (p-value=<.0001).

Conclusion: The use of doxazosin as the medical expulsion therapy for the lower ureteric stone proved to be more effective as compared to tamsulosin as demonstrated by our results.


Lower Ureteric Stone; Doxazosin; Tamsulosin; Experimental Group; Control Group; Adult; Pakistan.

Full Text:



Marshall L, Stoller MD. Urinary stone disease. In: Tanagho EA, Mcaninch JW, Lue TF editors. Smith and Tanagho,s general urology 18th edition, 2012. P.249-59

Margaret SP, Yair L. Urinary lithiasis: etiology, epidemiology, and pathogenesis. In: Wein AJ, Kavoussi LR, Novick AC et al, editors. Cambell-walsh urology. 10th edition, 2012. P.1257

García Morúa A, Gutiérrez García JD, Martínez Montelongo R, Gómez Guerra LS. Use of alfuzosin for expulsion of stones in the distal third of ureter. Actas Urol Esp 2009; 33: 1005–10

Ahmed AF, Al-Sayed AY. Tamsulosin versus alfuzosin in the treatment of patients with distal ureteral stones: prospective, randomized, comparative study. Korean J Urol 2010; 51: 193–7

Sáenz Medina J, Alarcón Parra RO, Redondo González E et al. Prognostic factors of spontaneous expulsion in ureteral lithiasis. Actas Urol Esp 2010; 34: 882–7

Bensalah K, Pearle M, Lotan Y. Cost-effectiveness of medical expulsive therapy using alpha-blockers for the treatment of distal ureteral stones. Eur Urol 2008; 53:411–8

Sfoungaristos S, Kavouras A, Katafigiotis I, Perimenis P. Role of white blood cell and neutrophil counts in predicting spontaneous stone passage in patients with renal colic. BJU Int 2012; 110:339–345.

Türk C, Knoll T, Petrik A, Sarica K, Straub M, Seitz C 2012; EAU Guidelines on urolithiasis.

Healy KA, Ogan K. Nonsurgical management of urolithiasis: an overview of expulsive therapy. J. Endourol. 2005; 19: 759–67.

Parsons KJ, Hergan LA, Sakamoto K, Lakin C. Efficacy of a-blockers for the treatment of ureteral

stones. J. Urol. 2007; 177: 983–7.

Singh A, Alter HJ, Littlepage A. A systematic review of medical therapy to facilitate passage of

ureteral calculi. Ann. Emerg. Med. 2007; 50: 552–63.

Hollingsworth JM, Rogers MA, Kaufman SR et al. Medical therapy to facilitate urinary stone passage: a meta-analysis. Lancet 2006; 368: 1171–9.

Seitz C, Liatsikos E, Porpiglia F, Tiselius H-G, Zwergel U. Medical therapy to facilitate the passage

of stones: what is the evidence? Eur. Urol. 2009; 56: 455–71.

Itoh Y, Kojima Y, Yasui T, Tozawa K, Sasaki S, Kohri K. Examination of alpha 1 adrenoceptor subtypes in the human ureter. Int. J. Urol. 2007; 14: 749–53.

Agrawal M, Gupta M, Gupta A, Agrawal A, Sarkari A, Lavania P. Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones. Urology 2009; 73: 706–9.

Pricop C, Novac C, Negru D, Ilie C, Pricop A, Tanase V. Can selective alpha- blockers help the spontaneous passage of the stones located in the uretero-bladder junction? Rev. Med. Chir. Soc. Med. Nat. Iasi 2004; 108: 128–33.

Celik S, Akdenis F, Yildirim A et al. Tadalafil versus alpha blockers (alfuzosin, doxazosin, tamsulosin and silodosin) as medical expulsive therapy for < 10 mm distal and proximal ureteral stones. Archivio Italiano di Urologia e Andrologia 2018; 90, 2:117-122

Tzortzis V, Mamoulakis C, Rioja J, Gravas S, Michel MC, de la Rosette JJ. Medical expulsive therapy for distal ureteral stones. Drugs. 2006;69(6):677-92

Coll DM, Varanelli MJ, Smith RC. Relationship of spontaneous passage of ureteral calculi to stone size and location as revealed by unenhanced helical CT. AJR Am J Roentgenol 2002;178:101-3.

Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: A guide for patient education. J Urol 1999;162:688-91

Lotan Y, Gettman MT, Roehrborn CG, Cadeddu JA, Pearle MS. Management of ureteral calculi: A cost comparison and decision making analysis. J Urol 2002;167:1621-9

Malin JM Jr, Deane RF, Boyarsky S. Characterisation of adrenergic eceptors in human ureter. Br J Urol 1970;42:171-4.

Salman S, Castilla C, Vela NR. Action of calcium antagonists on ureteral dynamics. Actas Urol Esp 1989;13:150-2

Hollingsworth JM, Rogers MA, Kaufman SR, Bradford TJ, Saint S, Wei JT, et al. Medical therapy to facilitate urinary stone passage: A meta-analysis. Lancet 2006;368:1171-9

Preminger GM, Tiselius HG, Assimos DG, Alken P, Buck C, Gallucci M, et al. Guideline for the management of ureteral calculi. J Urol 2007 2007;178:2418-34

Zehri AA, Ather MH, et al. Preliminary study of efficacy of doxazosin as a medical expulsive therapy of distal ureteric stones in a randomized clinical trial. J.Urology 2009;10:069

Sen H, Erturhan S, et al. A comparison of efficacy of doxazosin 4 and 8 mg in medical expulsive therapy of distal ureteral stones: a prospective randomized clinical trial. Urolithiasis 2017 oct;45(5):461-464

Ayubov B, Arustamov D, Mukhtarov S et al. Efficacy of doxazosin in the management of ureteral stones. European urology supplements, 2007, 6(2), 114 | added to CENTRAL: 31 October 2011 | 2011 Issue 4

Gnyawali D, Pradhan M, Raj P et al. Efficacy of Tamsulosin plus Tadalafil ersus Tamsulosin as Medical Expulsive Therapy for Lower Ureteric Stones:

A Randomized Controlled Trial. Advances in Urology,Volume 2020, Article ID 4347598, 5 pages, https://doi.org/10.1155/2020/4347598.

Zar JH. Biostatistical Analysis. 5th ed. Englewood Clifts, New Jersey: Prentice-Hall, Inc. p.127.

Pegano M, Gauvreau K. Principals of Biostatistics. 2nd ed. Boston, MA, USA: Cengage Learning; 2000. p.349-52.

Motulsky HJ. GraphPad, QuickCalcs. McNemar’s test to analyze experimental studies. Accessed 1 Nov 2015. GraphPad Software, San Diego, CA, USA. Availableat:https://www.graphpad.com/quickcalcs/McNemar1.cfm

DOI: https://doi.org/10.46903/gjms/19.04.942


  • There are currently no refbacks.

Copyright (c) 2021. Muhammad Seerwan, Ghazi Khan, Muhammad Ilyas, Dastgeer Waheed, Atta Ur Rehman, Fawad Humayun

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.