ROLE OF DEFLAZACORT AS AN ADJUVANT TO TAMSULOSIN IN ENHANCING EXPULSION OF MIDDLE AND LOWER URETERIC CALCULI: A PROSPECTIVE COMPARATIVE STUDY
DOI:
https://doi.org/10.22159/ijcpr.2026v18i1.8047Keywords:
Tamsulosin, Deflazacort, Medical expulsive therapy, Ureteric calculi, Stone expulsion, UrolithiasisAbstract
Objective: Ureteric calculi constitute a significant proportion of urolithiasis cases and commonly present with acute colicky pain, urinary symptoms, and recurrent morbidity. Medical expulsive therapy (MET) using α-blockers such as tamsulosin is widely practiced; however, adjunctive corticosteroids may further facilitate stone passage by reducing ureteric edema and inflammation. This study evaluates the effectiveness of combining deflazacort with tamsulosin versus tamsulosin monotherapy in enhancing expulsion of middle and lower ureteric stones.
Methods: This prospective comparative study was conducted at People’s Hospital, Bhopal, from November 2022 to March 2024. A total of 170 eligible patients with unilateral middle or lower ureteric calculi (4–8 mm) were randomized into two groups: group A received tamsulosin 0.4 mg daily plus deflazacort (6 mg twice daily for 2 w, tapered to 6 mg once daily for 2 more weeks), and group B received tamsulosin monotherapy. Patients were followed for up to 4 w, with serial assessment of stone expulsion, analgesic requirement, and adverse events. Statistical analyses were performed using SPSS v26, with p<0.05 considered significant.
Results: Stone expulsion at 3 w was significantly higher in Group A compared to Group B (23.5% vs. 7.1%; p<0.01). By 4 w, expulsion rates further increased to 88.2% versus 52.9%, respectively (p<0.01). The overall treatment success rate was markedly superior in Group A (90.4%) compared to Group B (56.1%; p<0.01). Analgesic requirements were significantly lower with combination therapy (mean 4.59 vs. 6.38 doses; p<0.01). Adverse events were mild and comparable between groups.
Conclusion: Deflazacort as an adjunct to tamsulosin significantly enhances stone expulsion rates, accelerates clearance, and reduces analgesic use without increasing adverse effects. Combined MET is a safe and effective strategy for middle and lower ureteric calculi.
Downloads
References
1. Tamm EP, Silverman PM, Shuman WP. Evaluation of the patient with flank pain and possible ureteral calculus. Radiology. 2003;228(2):319-29. doi: 10.1148/radiol.2282011726, PMID 12819343.
2. Sohgaura A, Bigoniya P. A review on epidemiology and etiology of renal stone. Am J Drug Discov Dev. 2017;7(2):54-62. doi: 10.3923/ajdd.2017.54.62.
3. Jendeberg J, Geijer H, Alshamari M, Cierzniak B, Liden M. Size matters: the width and location of a ureteral stone accurately predict the chance of spontaneous passage. Eur Radiol. 2017 Nov;27(11):4775-85. doi: 10.1007/s00330-017-4852-6, PMID 28593428.
4. Preminger GM, Tiselius HG, Assimos DG. Guideline for the management of ureteral calculi. J Urol. 2007;178(6):2418-34. doi: 10.1016/j.juro.2007.09.107.
5. Wang CJ, Huang SW, Chang CH. Efficacy of an alpha1 blocker in expulsive therapy of lower ureteral stones. J Endourol. 2008;22(1):41-6. doi: 10.1089/end.2007.0133, PMID 18315472.
6. 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 Jan-Mar;108(1):128-33.
7. Coutinho AE, Chapman KE. The anti-inflammatory and immunosuppressive effects of glucocorticoids recent developments and mechanistic insights. Mol Cell Endocrinol. 2011;335(1):2-13. doi: 10.1016/j.mce.2010.04.005, PMID 20398732.
8. Pace KT, Weir MJ, Tariq N, Honey RJ. Low success rate of repeat shock wave lithotripsy for ureteral stones after failed initial treatment. J Urol. 2000;164(6):1905-7. doi: 10.1016/S0022-5347(05)66914-5, PMID 11061877.
9. Kim SC, Coe FL, Tinmouth WW, Kuo RL, Paterson RF, Parks JH. Stone formation is proportional to papillary surface coverage by Randall’s plaque. J Urol. 2005;173(1):117-9. doi: 10.1097/01.ju.0000147270.68481.ce, PMID 15592050.
10. Kim SC, Coe FL, Tinmouth WW, Kuo RL, Paterson RF, Parks JH. Stone formation is proportional to papillary surface coverage by Randall’s plaque. J Urol. 2005;173(1):117-9. doi: 10.1097/01.ju.0000147270.68481.ce, PMID 15592050.
11. Pearle MS, Calhoun EA, Curhan GC, Urologic Diseases of America Project. Urologic diseases in America project: urolithiasis. J Urol. 2005;173(3):848-57. doi: 10.1097/01.ju.0000152082.14384.d7, PMID 15711292.
12. Simforoosh N, Aminsharifi A, Tabibi A, Noor Alizadeh A, Zand S, Radfar MH. Laparoscopic anatrophic nephrolithotomy for managing large staghorn calculi. BJU Int. 2008 May;101(10):1293-6. doi: 10.1111/j.1464-410X.2008.07516.x, PMID 18284405.
13. Lingeman JE. Extracorporeal shock wave lithotripsy. Development instrumentation and current status. Urol Clin North Am. 1997 Feb;24(1):185-211. doi: 10.1016/S0094-0143(05)70363-3, PMID 9048861.
14. Matlaga BR, Assimos DG. Changing indications of open stone surgery. Urology. 2002 Apr;59(4):490-3. doi: 10.1016/S0090-4295(01)01670-3, PMID 11927296.
15. Park JM. Normal development of the urogenital system Wein AJ, editor. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007. p. 3121-48.
16. Anderson JK, Kabalin JN, Cadeddu JA. Surgical anatomy of retroperitoneum adrenals kidneys and ureters. Campbell-Walsh Urology. 9th ed Wein AJ, editor. Vol. 1. Amsterdam: Saunders Elsevier; 2007. p. 3-37.
17. Sinha AR, Siwach V. Evaluation of the efficacy of tamsulosin and deflazacort versus tamsulosin alone in expulsion of lower ureteric stones in a tertiary center. Int J Sci Stud. 2019;6(10):68-72.
Published
How to Cite
Issue
Section
This work is licensed under a Creative Commons Attribution 4.0 International License.