Safety and effectiveness of medical expulsive therapy for ureteric stone in three tertiary Hospitals in Ethiopia

Abstract

Background: Urinary tract stone disease is the most common pathology, with a global prevalence of 12%; 20% of them are located in the ureters, of which 70% are in the distal third of the ureters. Within 7 years of treatment, the recurrence rate reaches up to 55%. Medical expulsive therapy for ureteric stones is a non-invasive modality, and avoids complications related to other treatment options. The aim of the present study is to evaluate the safety and effectiveness of medical expulsive therapy for ureteric stone in Tikur Anbesa Specialized Hospital, Menilik II Referral Hospital and Yekatit 12 Hospital Medical College urology divisions.

Methods: Prospective longitudinal study was conducted among patients with ureteric stones in the three hospitals from March 1 to June 31, 2023. Convenient sampling technique was applied to select the study participants. Combination therapy was given randomly to the study participants. Data were collected using data collection tool and analyzed using SPSS version 27. Associations were evaluated using chi-square test adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The results are presented using text, tables, and graphs.

Results: Sixty patients were included with mean age 35+13.71 years and 78.7% of patients were between 20 and 50 years old. Forty-nine (81.7%) of the patients were treated with tamsulosin. Treatment success was 76.7% and confirmed by ultrasound and CT for 86.7% of the cases. Thirteen-point three percent of cases reported drug-related lightheadedness and dizziness. There was no worsening of the disease during treatment period. Higher success rate was noticed in early treatment initiation (AOR: 17.5; 95% CI: 2.2, 139.4). Stone expulsion rate was higher in patients with distal ureteric stones compared to proximal ureteric stones (AOR: 4.5; 95% CI: 1.01, 20.5). Complications were lower in combination therapy than single drug (p= 0.001).

Conclusion: Based on our findings, medical expulsive therapy is successful, safe and the only non-operative modality of treatment for ureteric stones, with high success in distal ureteric stones sized 5 – 10 mm.