Does silodosin offer better results than tamsulosin as medical expulsive treatment after shock wave lithotripsy for single distal ureteric stones?

Introduction
Different antagonists of αadrenergic receptors (α-blockers) have been used as medical expulsive treatment (MET) after extracorporeal shock wave lithotripsy (ESWL).

Aim
To retrospectively evaluate the expulsion rate of fragments after extracorporeal shock wave lithotripsy performed for single ureteral stones followed by different medical expulsive treatments.

Material and methods
We retrospectively analyzed stone expulsion rates of 190 patients treated by shock wave lithotripsy (SWL) for single, 5 to 10 mm, symptomatic and uncomplicated distal ureteric stones, treated with tamsulosin 0.4 mg, silodosin 8 mg or silodosin 4 mg as MET. Beside the stone-free rate after 4 weeks of treatment, we also investigated the pain intensity using the visual analogue scale (VAS), adverse events induced by the medication, safety of drug administration and the reasons for possible early treatment discontinuation.

Results
Silodosin 8 mg and tamsulosin 0.4 mg have similar results in terms of stone-free rate. For silodosin 4 mg the stone-free rate was significantly lower than for the previous two drugs. In patients treated with silodosin 4 mg the VAS was significantly higher than in patients treated with silodosin 8 mg or tamsulosin 0.4 mg, for all the follow-up visits.

Conclusions
Alpha-blocker treatment after ESWL with silodosin 8 mg offers a similar stone-free rate compared with tamsulosin 0.4 mg, being well tolerated. A lower dose of silodosin (4 mg) has significantly poor results, irrespective of ureteric stone size, with more frequent renal colic and severe pain.