Comparison of Silodosin and Tamsulosin for Medical Expulsive Therapy in Patients With Ureteral Stones
Phase: NA
Conditions: Tamsulosin, Silodosin, Medical Expulsive Therapy
Sponsor: Fatima Jinnah Medical University

1 
 
 
 
COMPARISON OF SILODOSIN AND TAMSULOSIN USED AS 
MEDICAL EXPULSIVE THERAPY FOR URETERAL STONES. 
 
 
Author: Dr. Faiza Khan 
RTMC No. PHR-2022-059-25 
Qualification: M.Phil. (Pharmacology)  
Supervisor: Prof. Dr. Muniza Qayyum 
Qualification: PhD (Pharmacology)  
Institution: Fatima Jinnah Medical University Lahore  
Date: 23-07-2024 
 
 
                                                 
 
 
 
 
 

2 
 
 
 
 
 
 
                                     ACKNOWLEDGEMENTS  
 
Glory Be to Allah Who is the creator of heavens and the earth. This endeavor would 
not have been possible without my supervisor Professor Muniza Qayyum whose 
guidance and support is instrumental in providing me with this valuable learning 
opportunity.  
 
I am deeply indebted to Prof Saadia Shehzad Alam (PhD) Head Deptt of 
Pharmacology Shaikh Zayed FPGMI Lahore for her constant support in my synopsis 
and thesis and her efforts in recommending me to Professor Muniza Qayyum. 
 
I want to thank Prof Khalid Gondal Masud Gondal, (VC FJMU) and College of 
Physicians and Surgeons Pakistan for providing FCPS opportunity in basic sciences.  
 
I am thankful to Professor Dr. Lubna Amir, Associate Prof. Dr. Gulpash Saghir and 
Associate. Prof. Dr. Nazia Rashid and Dr Javeria Farast in Pharmacology Department 
FJMU, for their guidance throughout my research work. 
 
I want thank Dr Yasir Rasheed Urologist from Agha Khan Hospital, Dr Azfar and Dr 
Zaibish from Urology department FJMU for helping in queries related to Urology. 
 
I am eternally grateful to my loving husband for his constant support and shouldering 
the responsibilities of caring for our children. Lastly I want to  thank  my sister and my  

3 
 
 
 
mother for their selfless love and support, I would not be standing here today if it 
were not for them 
 
 
 
 
 
                                                  Supervisor’s Certificate 
 
 
I hereby certify that Dr. Faiza Khan having R & RC Enrolment no PHR- 2022-
059-25, has been working under my direct supervision with effect from 1-1-
2022 to 1-1-2024 in the department of Pharmacology and therapeutics in 
training institution, Fatima Jinnah Medical University, Lahore. 
The enclosed thesis titled, “COMPARISON OF SILODOSIN AND 
TAMSULOSIN USED AS MEDICAL EXPULSIVE THERAPY FOR 
URETERAL STONES” is prepared according to the guidelines for thesis 
writing by CPSP. I have read the thesis and found it satisfactory for the FCPS 
examination in this subject. 
 
 
 
                                

4 
 
 
 
 
 
 
 
 
 
                                           TABLE OF CONTENTS 
 
 
Sr.No. 
 CONTENTS 
PAGE No. 
 1. 
ABSTRACT 
1 
2.. 
 INTRODUCTION  
3  
3.   
REVIEW OF LITERTAURE  
6 
4.  
OBJECTIVES  
22 
5.  
MATERIAL AND METHODS  
25 
6.  
RESULTS  
31 
7.  
DISCUSSION  
46 
8. 
CONCLUSION  
60 
9.  
REFRENCES  
71 
 
 
 

5 
 
 
 
 
 
                                          
                                                      
                                        
 
 
                                       List of Tables 
 
 
Sr No. 
Table 
Page Number 
Table 1 Frequency and percentage of demographic 
data  
 
31 
 
Table 2   
 
Association 
between 
 
Tamsulosin 
and 
Silodosin with side effects  
 
 
 35 
 
 
 

6 
 
 
 
 
 
 
 
                                        
 
 
      
                                         LIST OF FIGURES 
 
 
Serial No. 
  Figure 
Page No 
Figure 1: 
Pie chart of patients using Silodosin and 
Tamsulosin (Medicine Advised) 
33 
Figure 2 
Bar Chart showing comparison of stone 
expulsion rate in Tamsulosin and Silodosin 
groups  
 
43 
Figure 3 
Survival function 
41 

7 
 
 
 
 
 
 
 
 
                      
        
                              LIST OF ABBREVIATIONS 
 
 AUA 
   American Urology Association  
 EAU 
   European Association of Urology  
 MET 
   Medical expulsive therapy  
 PNL 
   Percutaneous Nephrolithotomy  
RCTs 
  Randomized controlled clinical trials 
SPSS 
   Statistical Package for the Social Sciences 
α-AR 
   Alpha adrenergic receptor 
 LUTS 
   Lower Urinary Tract Symptoms 

8 
 
 
 
SWL  
  Shock wave lithotripsy 
ESWL 
Extracorporeal Shock Wave Lithotripsy 
CKD 
Chronic kidney disease 
SET               Stone ejection time 
USD              Ureteric stone disease 
SER  
Stone ejection rate 
 
 
 
 
 
 
                                                              
 
 
 
 
 

9 
 
 
 
Abstract 
Introduction: Ureteric stones is a very common disease world over. Medical 
Expulsive therapy (MET) for stones is a recognized treatment option practiced.  
Tamsulosin is used commonly in our population for MET however Silodosin 
another highly uroselective   newer drug, with lesser side effects, is not used 
frequently for this purpose and is still under research.  Both of these drugs lead 
to relaxation of lower ureteric smooth muscle hence facilitate in stone removal. 
The rationale of this study is to compare the efficacy of Tamsulosin and 
Silodosin in MET (medical expulsive therapy) with regards to stone expulsion 
rate as well as to compare the side effect profile in our population. 
Methodology: This is a prospective randomized control trial in Outpatient 
department of Sir Ganga Ram hospital, Lahore, on 208 patients with ureteric 
stone who fulfil the inclusion criterion, divided randomly into two groups with 
104 patients in the Tamsulosin group and 104 patients in Silodosin group (1:1 
ratio). However, 16 patients were subsequently excluded on account of 
premature end of study, and 12 due to being lost to follow-up (Figure 1).  Out 
of remaining 180 patients 89 were of Tamsulosin and 93 were in Silodosin 
group. Demographic data including patients’ age and comorbid, stone-related 
data including size, location, laterality and number of stones and duration of 
symptoms were recorded. The patients were called for follow up at 4 weeks 

10 
 
 
 
with an X-ray KUB without bowel preparation. We noted if the stone had 
passed or not. 
Results: Our results showed that Silodosin turned out to be better in expulsing 
stone as well as in producing lesser side effects and hence better safety profile 
than Tamsulosin. Silodosin showed greater stone expulsion rate with about 55 
patients expulsing stone in less than 14 days in comparison to just about 5 
patients on Tamsulosin. Similarly, patients on Silodosin, showed lesser side 
effects as compared to Tamsulosin. Nine patients on tamsulosin (60.0%) and six 
patients on silodosin (40.0%) developed orthostatic hypotension. Only a very 
tiny percentage of patients reported abnormal ejaculation; two individuals on 
tamsulosin (66.7%) and one patient on silodosin (33.3%). Another side effect 
that was identified involved headaches, seen by four patients on silodosin 
(44.4%) and five patients on tamsulosin (55.6%). 
 
 
 
 
 
 

11 
 
 
 
                                          INTRODUCTION 
 
Stone disease is one of the most frequent presentations in the field of urology. A 
large number of these patients arrive with ureteric stones(1). Globally, 
occurrence of stone formation is 10-12% for men and 6-8% for women. Its 
prevalence in Pakistan is approximately 16%. The disease's burden has 
increased in all age categories and both genders over the past 20 years(2). The 
incidence of urolithiasis in different age groups is 12.2% in the persons 20-29 
year old, 29.6% in those who are 30-39-year-old, and 31.5% in 40–49-year-old 
patients(3). 
Medical management ae well as surgical removal are various options available 
for treating ureteric stones as per American Urology Association (AUA) and 
European Association of Urology (EAU) guidelines. However, due to risks of 
surgical approaches there is always an attempt for treatment by using medical 
expulsive treatment (MET) for ureteric stones first keeping in view different 
parameters. According to European Association of Urology Guidelines (EAU), 
the ureteric stones less than 10 mm can be treated with MET(4). 
 
 
 

12 
 
 
 
Medical expulsive therapy (MET) is a well-established treatment option for 
distal ureteric stones, despite a sharp increase in minimally invasive 
techniques(5). Stones smaller than 5 mm have passage rates ranging from 71% 
to 98%, while stones with size more than 5 mm had expulsion rates ranging 
from 25% to 53%(6). 
Many factors affect stone removal and must be considered while selecting MET 
for stones like ureteric spasm, location, size, and number of stones and duration 
for which it is present and also the ureteric architecture etc(7). 
Distal part of the ureter contains a large number of alpha-1 receptors (8).The 
physiological effect of blocking these receptors is, reduction in peristalsis and 
force of contraction of ureter (hence aiding in lessening of ureteric spasm), and 
increased volume of fluid carried down the ureter. These  effects help in 
removing ureteral stones(9). 
Tamsulosin an α1A-receptor and α1D- blocker is used commonly for ureteric 
stones removal in our population. This drug has its side effects like postural 
hypotension, retrograde ejaculation, headache, etc.(10). 
 
 

13 
 
 
 
Another highly uroselective drug silodosin which is α1A-receptor antagonist 
has also been used for this purpose in many countries and due to its highly 
selective nature, it is found to have lesser side effects. Both of these drugs lead 
to relaxation of lower ureteric smooth muscle(11). 
A systematic review from various data base of science was undertaken to check 
the effectiveness of the alpha blockers including tamsulosin and silodosin for 
urinary tract stones. Silodosin was found to be the most effective drug in 
treating urinary tract stones followed by tamsulosin (10).  
Another systematic review and meta-analysis from 2018, from EMBASE, 
PubMed, Scopus databases and Cochrane library also compared the same effect 
and concluded that silodosin had better efficacy in expulsion of the stone and 
also better pain relief(12).  
Tamsulosin is used commonly in our population for MET however Silodosin, a 
newer drug, is not used frequently for this purpose and is still under research.  
Also, comparison of Silodosin and Tamsulosin has not been explored in our 
population earlier.  
The rationale of this study is to compare the efficacy of Tamsulosin and 
Silodosin in MET (medical expulsive therapy) with regards to stone expulsion 
rate as well as to compare the side effect profile in our population. 

14 
 
 
 
 
LITERATURE REVIEW 
 
Background 
Ureteric stone  is a very common presentation  in urology practice (1). One of 
the most prevalent genito-urinary tract disorders, urolithiasis affects between 5 
and 15% of the global population. Since almost 50% of affected patients will 
experience a recurrence within five years, the illness is lifelong (13). 
 
Prevelance 
Worldwide prevalence 
Urolithiasis has been more common in the past few years. Its frequency ranges 
from 1 to 5% in Asia to 7 to 13% and 5 to 9%, respectively, in North America 
and Europe.  
Another study showed nephrolithiasis prevalence varies greatly across the 
globe. According to estimates, it is 8,8% in the US, 10% in Spain, 9% in Italy, 
15% in Greece, 14,8% in Turkey, 10% in Japan, 5% in South Korea, 2.5–9.6% 
in China, 20% in Saudi Arabia, and 3.96% in Argentina. Furthermore, there has 
the prevalence of KS has steadily increased during the past few decades. For 
example, the estimated prevalence of USD in England increased from 7.14 to 

15 
 
 
 
11.62% in the first decade of this century, and therapies linked to this condition 
increased as well(14). 
Worldwide prevalence of stone formation in males is 10- 12% (2). Additionally, 
however, it is becoming more common in females in recent times and is about 
6-8%.  
Each country has a particular male to female ratio, which is balanced between 
males and women or marginally in the countries of Europe, South America, 
North America, and China, but skewed significantly in favor of men in Iraq, 
Egypt, Pakistan, and India. This resulted in the confirmation of the tendency 
toward increased stone formation in women from Western countries (9), and 
more recently from China. In contrast, the male-to-female ratio in Egypt, 
Pakistan, India, and Iraq remains unchanged from forty years ago(15). 
 
Prevalence in Pakistan 
 In Pakistan approximately 16%. Patients are of ureteric stone. Over the past 
few years there is  an increase in the prevalence of disease in all age groups as 
well as in both  genders (2).  
A study showed, in Pakistan, urolithiasis affects between 1–5% of people. The 
prevalence of asymptomatic stones was determined to be 2.8% in that study, 

16 
 
 
 
which is in line with the findings of earlier research studies. Stones typically 
don't say anything at first, but over time, they begin to cause symptoms for the 
person who has them. Typical symptoms include nausea, vomiting, hematuria, 
restlessness, urine urgency, and flank discomfort (renal colic). Research 
indicates that approximately 20% of patients experience symptoms of urinary 
tract stones over the course of a decade(16). 
Additionally, a study conducted in Pakistan found that the general population 
has a 3% prevalence and a 5% chance of silent stones(16). 
In different  age groups the incidence of urolithiasis is around 30% in 40-49 
year-old persons, around 28-29% in those who are 30-39 year-old, and around 
13% in persons of 20-29 year age(3). 
According to another study, male patients had greater rates of urolithiasis than 
female patients. Similar results were obtained by other researchers [18] in their 
investigation, with male to female ratios of 3.3:1, 1.35:1, and 1.8:1, 
respectively. The explanation for the increased frequency in male patients may 
be because androgens, which are more prevalent in men than in women, 
encourage the production of stones. Estrogens, on the other hand, repress stone 
formation(17). 
 

17 
 
 
 
Risk Factors 
 The development of ureteric calculi is influenced by an unknown number of 
predisposing variables. Dietary practices, hydration levels, and coexisting 
conditions such as obesity and diabetes mellitus are significant contributors to 
its etiopathogenesis. Though several hypotheses have been put up to explain the 
genesis and progression of urologic calculi, none have been able to provide a 
comprehensive response to the questions surrounding the formation of 
stones(18). 
Urolithiasis development is aided by bacteria. Ammonium urate, magnesium 
ammonium phosphate, and carbonate apatite are the constituents of infection 
stones that are formed by urease-producing bacteria infections that persist. 
However, non-infection stones like calcium phosphate and oxalate may serve as 
a breeding ground for bacteria. Layers of urine bacteria are incorporated into 
the growth of urinary stones. According to our univariate analysis, patients with 
urosepsis were more likely than those in the non-urosepsis group to have 
infection stones, as well as positive urine and stone cultures. These findings 
suggest that the urosepsis group in this study had a persistent UTI prior to the 
bacteria forming ureteral stones(19). 
 

18 
 
 
 
Most Common Presenting Complaint 
Most common symptom with which patients of ureteric stone present is colicky 
pain in lumbar region(20). In addition to incidental findings, urolithiasis can 
manifest as fever, nausea, vomiting, and loin discomfort. If a patient exhibits 
symptoms that point to an infection or a single kidney, they ought to be 
investigated immediately. Urinary tract symptoms (LUTS) are the most 
common way that bladder stones manifest, although haematuria and suprapubic 
pain can also be present(4). 
Adults frequently complain of macroscopic hematuria, poorly localized pain, 
and irritability, while younger children are more prone to present with 
nonspecific symptoms like vomiting and irritation(21). 
Treatment Options. 
Depending on the size of the stone and how much discomfort it causes, there 
are several options for treating ureter stones, ranging from careful observation 
to surgery. 
Medical management and various surgical techniques as mentioned below are 
available for ureteric stones as per American Urology Association (AUA) and 
European Association of Urology (EAU) guidelines. However, due to risks of 
surgical approaches there is always an attempt for treatment of ureteric stones 

19 
 
 
 
with medical expulsive therapy (MET) first keeping in view different 
parameters. 
Watchful Waiting for the Treatment of Ureter Stones 
The most conservative course of therapy for a ureter stone is careful waiting, 
which entails four to six weeks without receiving any medical attention to 
remove the stone. Instead, to make sure the stone is not expanding or changing, 
the doctor periodically takes x-rays or ultrasounds of it. If the stone's diameter 
is smaller than 7 mm, this method may work well. However, the biggest 
challenges in waiting for a kidney stone to pass through the body are infection 
and urinary tract blockage. 
Extracorporeal Shock Wave Lithotripsy (ESWL) for the Treatment of 
Ureter Stones 
Using shock waves administered outside to the body, extracorporeal shock 
wave lithotripsy is a minimally invasive therapy that breaks up the ureter stone 
into tiny fragments. The fragments of the ureter stone may be better able to 
naturally flow through the ureter, bladder, and urethra once they have broken 
down. ESWL is frequently carried out with the use of general or local 
anesthesia, and it may cause discomfort for the patient. While ureter stones can 

20 
 
 
 
be effectively treated with ESWL, more than one session may be required to 
remove the stone entirely. 
Ureteroscopy for the Treatment of Ureter Stones 
A ureteroscope is inserted into the ureter during ureteroscopy, a more invasive 
technique. To see the stone, the thin viewing device is introduced through the 
bladder and urethra and into the ureter. A flexible basket can be inserted into the 
ureter by the surgeon to remove the stone once it is visible.  
When a stone is too large to pass naturally and is less than 10 mm in diameter, 
ureteroscopy is often performed to remove it from the lower end of the ureter. 
For the purpose of removing stone pieces that might not be able to pass through 
the ureter on their own, this method can be utilized in combination with ESWL. 
Percutaneous Nephrolithotomy (PNL) for the Treatment of Ureter Stones 
To reach the kidney during a percutaneous nephrolithotomy, or PNL, the 
surgeon must create an incision in the skin on the back, between the ribs and 
the hip. The kidney is then slightly incised to allow for the insertion of a tiny 
guide wire that runs from the kidney to the ureter. To see the guide wire and 
make sure it is positioned correctly, an x-ray is utilized. The surgeon dilates the 
guide wire once it enters the ureter to allow a stone-removal tool to be inserted. 
 

21 
 
 
 
Open Surgery for the Treatment of Ureter Stones 
Open surgery can be required to remove the ureter stone if less invasive 
methods prove ineffective. To reach the ureter during open surgery, a lower 
abdominal incision must be made. In order to remove the stone directly, the 
ureter is sliced open during this treatment. The patient must recuperate from 
this invasive and complicated procedure for at least six weeks.  
Since its first description, the underlying technology has not seen many 
developments in comparison to alternative endourological treatments. But in 
order to produce greater results, SWL (Shock wave lithotripsy) has drawn 
attention and undergone changes. In a study, a number of potential causes were 
found for enhanced SFR within the framework of SWL.Thirteen These 
included boosting lithotripter training, decreasing shock wave rate and ramping 
energy, improving coupling, reevaluating the present patient and stone selection 
criteria, and better localizing the stone. Predictive models and nomograms have 
received attention recently, and new research is emphasizing the importance of 
novel urine biomarkers in detecting or forecasting infection or bleeding after 
surgical wound closure(22). 
 
 

22 
 
 
 
Stone Size For Considering Medical Expulsive Therapy 
 According to European Association of Urology Guidelines (EAU), the ureteric 
stones less than 10 mm can be treated with medical expulsive therapy MET (4). 
Pharmacological options for stones removal  
For medical expulsive therapy, α-blockers are the primary recommendation in 
the current guidelines. Other drugs Calcium channel inhibitors such as 
nifedipine, has shown promise in the treatment of renal colic and stone 
expulsion.  
Increasing the rate of stone ejection throughout the ureter to prevent ureteral 
obstruction and diminish ureteral colic are the main objectives of medical 
expulsive therapy. In the end, this will help patients avoid the need for more 
intrusive and potentially problematic surgical procedures. Patients can benefit 
from 
effective 
medical 
expulsive 
therapy 
by 
lowering 
the  
hospital stays and invasive surgical treatments are required to treat the illness. 
Furthermore, shockwave lithotripsy is a non-invasive process in which shock 
waves are used to shatter stones. This pharmaceutical therapy can help the 
fragmented stones travel through the body more easily(23). 
 

23 
 
 
 
As a stone treatment, medical expulsive therapy increases the rate of stone 
evacuation while lowering the risk of infection, fever, and surgical procedures. 
While many research has been conducted to assess MET in adult populations, 
relatively few of these investigations have focused on paediatric patients. With 
the exception of one trial where the maximum stone size was 12 mm, the 
current investigation analysed six RCT studies with 415 patients who had distal 
ureter stones with a maximum size up to 10 mm. Two trials [12, 14] that 
assessed doxazosin at a dose of 0.03 mg/kg per day produced conflicting 
findings. A small rise in SER and a decrease in SET and pain episodes were 
noted in one study however the results were statistically insignificant (p > 
0.05)(24). 
Also combination of Corticosteroids and Phosphodiesterase 5 inhibitors is used 
in some patients but because the current results came from studies with small 
patient numbers, it is not suggested to use combination MET(25). 
A wide range of pharmaceutical treatments for ureteral stones, such as 
antispasmodic drugs, steroids, alpha blocker agents, calcium channel blockers, 
Phosphodiesterase 5 inhibitors, and their combinations, have been studied in 
relation to MET(8). 
  

24 
 
 
 
European association of Urology (EAU)Guidelines 
. By now, EAU only advises the use of alpha blockers as MET. Patients 
utilizing alpha blockers had significantly greater success rates (77.3 vs. 54.4%, 
respectively) in treating distal ureteral stones less than 10 mm, as compared to 
the ones receiving a placebo or no treatment, (26).  
 
Alpha adrenergic (AR) receptor’s location and distribution. 
There are three subtypes of alpha-adrenergic receptors: α-1A, α-1B, and α-1D. 
The urogenital region, which includes the prostate, bladder base, bladder neck, 
and ureter, is primarily home to α-1A and α-1D adrenergic receptors. 
Specifically, α1D receptors are concentrated in the distal portion of the ureter  
and influence the contraction of the ureter's smooth muscles, and the detrusor m
uscle. 
In terms of decreasing abundance, the distribution of αAR in the human ureter 
is as follows: α-1D > α-1A > α-1B. 
 
 
 

25 
 
 
 
Most Common Alpha Blockers Used for MET 
The Alpha blocker most commonly prescribed for MET is Tamsulosin which is 
an α1D- and α1A-receptor blocker. 
 Another alpha blocker Silodosin that is highly uroselective and is α1A-receptor 
antagonist has also been used for this purpose in many countries and due to its 
highly selective nature, it is found to have lesser side effects.  
Both of these drugs lead to relaxation of lower ureteric smooth muscle(5). 
Mechanism of action of α1A receptor blockers. 
Inhibiting the alpha-1 adrenergic receptor causes the ureteral smooth muscle to 
relax and the ureteral lumen to widen, which ultimately aids in the propagation 
of stones. By increasing the urine volume above the position of stone and 
lowering the pressure below this level, these drugs promote anterograde stone 
propagation. Additionally, α1-adrenoceptor blockers also lessen the requirement 
for analgesics by reducing ureteric contractions and colic episodes (27). 
 
 
 
 

26 
 
 
 
Studies on Alpha Blockers for Ureteral Stone Removal 
A meta-analysis on the clinical efficacy of α-blockers for treating distal ureteral 
stones stated that patients who received α-blockers had a 44% higher rate of 
spontaneous stone passage than those who did not (28). 
Thus, an RCT of use of silodosin for MET of ureteral stones which are <10 mm 
size was carried out by Itoh et al. Patients who administered 8 mg of silodosin 
daily showed a higher rate of stone expulsion and a shorter mean stone 
expulsion time when compared to those who were encouraged to drink 2 L of 
water daily. Meta-analyses conducted since the silodosin RCT have 
demonstrated that silodosin is more effective than tamsulosin for the MET of 
ureteral stones (29). 
A systematic review was undertaken to check the effectiveness of the alpha 
blockers including Tamsulosin and Silodosin for urinary tract stones. Silodosin 
was found to be the most effective drug in treating urinary tract stones followed 
by tamsulosin (6). 
A systematic review and meta-analysis from 2018, from EMBASE, PubMed, 
Scopus databases and Cochrane library also compared the same effect and 
concluded that silodosin had better efficacy in expulsion of the stone and also 
better pain relief (7). 

27 
 
 
 
 
One other prospective, an RCT, at outpatient department of Urology, in 
Bangladesh from 2017-2019 on 220 patients to evaluate the effectiveness of 
both the drugs. The results showed not much significant difference in the 
efficacy of both the drugs for the treatment of urinary tract calculi(8). A similar 
study was conducted in Egypt in children to see the efficacy of both drugs. It 
was a single blind randomized control trial on 167 patients(9). 
Side effects: 
A meta-analysis involving five RCTs stated and discovered that while there was 
no significant difference between the treatments in terms of retrograde 
ejaculation rate or stone expulsion time, silodosin significantly increased the 
distal ureteral stones expulsion ratein comparison to Tamsulosin. In a meta-
analysis, 13 RCTs are included, including 2 RCTs that are only accessible in 
abstract form) and three observational research. They discovered that silodosin 
produced a greater rate of stone ejection and a shorter expulsion duration when 
compared to tamsulosin; nevertheless, silodosin also increased the incidence of 
retrograde ejaculation (12). 
 

28 
 
 
 
In addition, the results of four different trials were reviewed as part of the 
pooled analysis; each study described particular adverse effects that were seen 
in the treatment arms. Nasal congestion, headaches, lightheadedness, nausea, 
and orthostatic hypotension—a decrease in blood pressure—were among these 
adverse effects. These side effects, which represented the variety of possible 
consequences connected to the therapies under review, were tracked and 
recorded as part of the safety evaluations conducted for the trials. 
All things considered, the thorough examination of the exclusions, withdrawals, 
and reported adverse effects in the pooled analysis sheds light on the difficulties 
and conclusions that have been found in a number of research. It emphasizes 
how crucial it is to closely monitor participant outcomes and unfavorable 
occurrences in clinical research in order to guarantee the efficacy and safety of 
the medicines being studied(30). 
The treatment for distal ureteral stones with size less than 10 mm with 
tamsulosin and silodosin has resulted in a high output rates of 57-64% and 80 -
84%, respectively, according to randomized controlled studies. Nonetheless, 
compared to other trials, the tamsulosin success rate in those investigations is 
somewhat lower (31). However, tamsulosin demonstrated an 86% success rate 
in a randomized controlled study with almost 3000 patients(32). Tamsulosin 
has a 67–90.7% success rate in treating distal ureteral stones, according to Tao 

29 
 
 
 
et al.'s meta-analysis.20 The current study's tamsulosin success rates align with 
some studies (33). 
Similar to the current investigation, the comparable rates in the Imperatore et 
al. study were 82% and 88%, and in the Arda et al. study they were 72.4% and 
78.6%. These investigations also revealed no discernible difference between 
tamsulosin and silodosin. However, only young/middle-aged men were 
included in this study, whereas both of other investigations included both men 
and women. This sums up the main distinction between prior studies and the 
present investigation (34). 
Tamsulosin is used commonly in our population for MET however Silodosin, a 
newer drug, is not used frequently for this purpose and is still under research.  
Also, comparison of Silodosin and Tamsulosin has not been explored in our 
population earlier. 
 
 
 
 
 

30 
 
 
 
 
Rationale 
The purpose of this study is to examine and compare the effectiveness of 
silodosin and tamsulosin in medical expulsive therapy (MET) in terms of the 
rate at which stones are expelled from the body, as well as the adverse effect 
profiles in our patient group. 
 
OBJECTIVES: 
To evaluate and compare the efficacy and safety of medical expulsive therapy 
containing tamsulosin and silodosin, specifically. 
 To compare the side effect profile of tamsulosin and silodosin when given for 
medical expulsive therapy.  
 
 
 
 
 
 

31 
 
 
 
HYPOTHESIS: 
 
Null Hypothesis: 
 It is hypothesized that efficacy and safety of medical expulsive therapy, 
containing tamsulosin and silodosin, is almost the same and silodosin can be 
used with the same efficacy for the treatment of lower urinary tract calculi. 
 
Alternative Hypothesis:  
Silodosin is better than Tamsulosin in efficacy and safety. 
 
 
 
 
 
 
 
 

32 
 
 
 
 
OPERATIONAL DEFINITIONS:  
 
STONE CLEARANCE: 
 Stone clearance will be defined as no evidence of stone on follow up X-ray 
KUB imaging at 4 weeks . 
 
ANCILLARY PROCEDURES:  
Additional urological procedures needed to remove the same stone for which 
medical expulsive therapy was given if it fails to remove the stone completely. 
 
SIDE EFFECTS:  
Any undesirable effect noticed after prescription of the drug including but not 
limited to abnormal ejaculation, headache, orthostatic hypotension, backache 
and gastritis etc. 
 
 

33 
 
 
 
 MATERIALS AND METHODS: 
 
STUDY DESIGN:  
Prospective randomized control trial.  
 
STUDY SETTING: 
 Outpatient department of Sir Ganga Ram hospital, Lahore. 
 
DURATION OF STUDY:  
18 months. 
 
DURATION OF TREATMENT:  
Four weeks. 
 
 
 
 

34 
 
 
 
SAMPLE SIZE:  
Using the open-epic software, the sample size was estimated. The minimum 
sample size that we require is 208 patients with ureteric stone who fulfil the 
inclusion criterion with 104 in one group receiving tamsulosin and 104 in 
silodosin group (1:1 ratio) with an inflation of 10 percent for estimated loss to 
follow up, with an anticipated expulsion rate ranging from 58-64 percent in 
tamsulosin group and 78-83 percent in silodosin group with a risk difference of 
19 to achieve a power of 80 percent and a level of significance of 5 percent.  
 
SAMPLING TECHNIQUE: 
 Patients visiting the outpatient department of Sir Ganga Ram hospital will be 
selected by simple random sampling, fulfilling the inclusion criteria. 
SAMPLE SELECTION:  
Adult male and female patients fulfilling the inclusion criteria will be assigned 
into two groups by random allotment, 1st group will be given Tamsulosin and 
2nd group will be  given Silodosin for four weeks.  
 
 
 

35 
 
 
 
 
 
INCLUSION CRITERIA: 
 Following factors make up the inclusion criteria for this study. 
• 
Patients between ages 18 years - 55 years.  
• 
Solitary unilateral ureteral stone 
• 
Stone sizes less than 10 mm measured on non-contrast computed 
tomography of kidney, ureter and bladder. 
• 
 Stones being treated primarily with medical expulsive therapy 
• 
Radio opaque Stone 
 
 
 
 
 
 
 

36 
 
 
 
 
EXCLUSION CRITERIA:  
The presence of following factors will exclude the patients from our study: 
• 
Pregnancy 
• 
Untreated UTI 
• 
Bleeding disorders  
• 
Obstruction distal to stone 
• 
Serum Creatinine > 1.3 mg/dl in males and > 1.2 mg/dl in females. 
• 
Congenital renal anomaly/ skeletal malformation 
• 
Previous treatment for the same stone (PCNL/ URS / push back) 
• 
Solitary Kidney 
• 
Prior JJ stent insertion 
• 
Bilateral ureteral stone 
 
 
 

37 
 
 
 
DATA COLLECTION AND PROCEDURE:  
The protocol will be submitted to Ethical review committee for review and only 
once the permission is granted, the study will be started. Patients will undergo 
standard procedure like detailed history taking, examination and routine 
investigations. Once decided that the patient will undergo MET, the patient will 
be explained in detail about medications, their potential side effects, follow up 
and the potential indications for early follow up. Our study will not change any 
standard process in place except the randomization between Tamsulosin and 
Silodosin. The data will be kept confidential as a top priority. Only principal 
investigator and co-principal investigator will have access to the data.  
All patients as per inclusion and exclusion criteria as described above will be 
included in the study. The CT scan (non contrast computed tomography) will 
be done on (machine parameters at Ganga ram). Only patients with radio-
opaque stones will be included. Patients falling into the inclusion criteria will 
be explained about the study and once they agree to participate in study, 
randomization will be done. Demographic data including patients’ age and 
comorbid, stone-related data including size, location, laterality and number of 
stones and duration of symptoms will be recorded. The patient will be given 
either Capsule Tamsulosin 0.4 mg once daily at night or Tablet Silodosin 8 mg 
once daily at night based on the group assigned. The patient will also be 

38 
 
 
 
explained about the reasons for follow up earlier than four weeks including 
fever, persistent pain or gross hematuria. The patients will be called for follow 
up at 4 weeks with an X-ray KUB without bowel preparation. We will note if 
the stone has passed or not. 
ETHICAL CONSIDERATION: 
The funds for supporting this research will be provided by department of 
pharmacology and therapeutic FJMU, Lahore. Informed consent will be taken 
from patients prior to research. 
DATA ANALYSIS PROCEDURE:  
Data will be entered and analyzed on SPSS version 22. Percentages and 
frequencies will be calculated for the demographic variables of the patients. 
The comparison of the two groups will be made by using T- test. P-value of 
less than 0.05 will be considered significant and the power used will be 0.80. 
 
 
 
                                                    
 

39 
 
 
 
 
RESULTS 
 
Frequency and percentage of demographic data  
Variables  
Frequency  
Percentage  
 Gender  
Male  
105 
58.7 
Female  
74 
41.3 
Income 
status  
Less 
than 
50000 
108 
60.3 
50000 -150000 69 
38.5 
Greater than 
150000 
2 
1.1 
 
BMI 
Normal  
166 
92.7 
Obese  
13 
7.3 
 
Comorbidity  
None  
136 
76.0 
HTN 
33 
18.4 
Diabetes 
10 
5.6 
 
 

40 
 
 
 
This information sheds light on the sample population's health and 
demographic distribution, showing a preponderance of people with normal 
BMIs and lower income levels, as well as a significant percentage of people 
without comorbid diseases. 
In our study there are total 179 patients out of which 74 are females (41.3%) 
and 105 males (58.7%).  
The income, 108 people, or 60.3% of the total, make less than 50,000Rs in 
month. Just 2 members, or 1.1 percent, make more than 150,000 monthly, while 
69 participants (38.5%) have monthly salaries between 50,000 and 150,000. 
13 persons (7.3%) are classed as obese, while 166 people (92.7%) have a 
normal BMI. These numbers represent a sizable fraction of the sample. In terms 
of comorbidities, 136 individuals (76.0%) state they have no comorbid 
conditions. Of the people with comorbidities, 10 (5.6%) had diabetes, and 33 
(18.4%) had hypertension (HTN).  
 
 
 
 
 

41 
 
 
 
 
 
 
 
     
 
Figure 1: Pie chart of patients using Silodosin and Tamsulosin (Medicine 
Advised) 
 
 

42 
 
 
 
 
 
Use of medicine (Figure 1) 
Tamsulosin and Silodosin, the two drugs prescribed to a group of patients, are 
distributed as shown in the pie chart. Of the patients, 43% were advised to take 
Tamsulosin, which is shown as the blue section on the chart. And (57%) of the 
patients were advised to take silodosin, as shown by the red segment. 
  
 
 
 
 
 
 
 
 

43 
 
 
 
Table2: Patient demographic characteristics and study variables are 
presented as frequency and percentage with association  
Varibales  
Tamsulosin  Silodosin  
p-value  
Body Mass index 
Normal  
72(43.4%) 
94(56.6%) 0.730 
obese  
5 (38.5%) 
08(61.5%) 
Laterality  
Right  
65(55.6%) 
52(44.4%) 0.001 
Left  
12(19.4%) 
50(80.6%) 
Symp To CT 
Less than  1 week 67(64.4%) 
37(35.6%)  
0.001 
More than 1 week 10(15.2%) 
56(84.8%) 
More than 2 week  0 (0.0%) 
09(100%) 
Posl n Ureler 
Proximal  
28(51.9%) 
26(48.1%)  
0.001 
Mid  
08(17.4%) 
38(82.6%) 
Distal  
41(51.9%) 
38(48.1%) 
Water intake  
Less than 1 litre 
59(54.6%) 
49(45.4%)  
0.001 
More than 1 litre 
18(25.4%) 
53(74.6%) 
Analgesic requirement Yes  
26(61.9%) 
16(38.1%) 0.005 
No  
51(37.2%) 
86(62.8%) 
Time for removal  
Less than 14 days 6(10.3%) 
52(89.7%)  
0.001 
14-21 
14(27.5%) 
37(72.5%) 
22-28 
57(81.4%) 
13(18.6%) 

44 
 
 
 
 
The table compares several factors along with the corresponding p-values to 
assess statistical significance between two drugs tamsulosin and silodosin. 
 First, based on Body Mass Index (BMI), 43.4% of those with a normal BMI 
were prescribed Tamsulosin, while 56.6% were recommended Silodosin. On 
the other hand, among those who were obese, 38.5% were given Tamsulosin 
and 61.5% were given Silodosin; p-value came out to be 0.730, which meant 
that there was no statistically significant variation in the medication preferences 
according to BMI. 
15.2% of patients who had pain for more than a week prior to CT scan, 
received Tamsulosin while 84.8% received silodosin. 
51.9% of the patients with proximal ureteric stone were given Tamsulosin and 
48.1% received Silodosin.  
82.6 percent of patients with mid-ureteric stone problems received Silodosin, 
while 17.4% received Tamsulosin. 
51.9% of patients with distal ureteric stones received Tamsulosin and 48.1% on 
Silodosin. 
Only 38.1% of patients on Silodosin required analgesics, whereas 61.9% of 
patients on Tamsulosin used analgesics. 

45 
 
 
 
89.7% of patients on silodosin had their stone removed in less than 14 days, 
while only 10.3% of the patients on Tamsulosin had their stone removed in 
aforementioned duration. 
72.5% of patients on Silodosin had their stone removed in 14-21 days, while 
only 27.5% of the patients on Tamsulosin had their stone removed in same 
duration. 
Moreover, 81.4% on Tamsulosin had their stone removed in 22-28 days and 
18.6% patients on Silodosin had it removed in same duration. 
 
 
 
 
 
 
 
 
 

46 
 
 
 
Table 2   Association between  Tamsulosin and Silodosin with side effects  
 
 
Tamsulosin  
Silodosin  
p- value  
Side 
effect 
None  
61 (40.1%) 
91(59.9%) 
 
 
0.3.15  
Othostatic 
hypotension  
09 (60.0%) 
06(40.0%) 
Abnormal 
ejaculation 
2(66.7%) 
1(33.3%) 
Headache  
5(55.6%) 
4 (44.4%) 
 
 
The side effects that patients using silodosin and tamsulosin experienced are 
analyzed in the table, and the p-value denotes the statistical significance of 
these data. Patients on Silodosin, with no side effects were 59.9% while 40.1% 
on Tamsulosin did not report any side effects. This implies that, in comparison 
to Tamsulosin, Silodosin may have a marginally higher correlation with patients 
reporting no adverse effects. 
Examining particular side effects reveals various themes. Nine patients on 
tamsulosin (60.0%) and six patients on silodosin (40.0%) developed orthostatic 
hypotension, a condition marked by a considerable drop in blood pressure upon 

47 
 
 
 
standing. It suggested that Tamsulosin users are more likely to have orthostatic 
hypotension than Silodosin users. 
Only a very tiny percentage of patients reported abnormal ejaculation; 2 
individuals on tamsulosin (66.7%) and 1 patient on silodosin (33.3%). Again, 
this points to an increased chance of this specific adverse effect in Tamsulosin 
users.  
Another side effect that was identified involved headaches, which were seen by 
4 individuals on silodosin (44.4%) and 5 patients on tamsulosin (55.6%). 
Headaches were marginally more common among Tamsulosin users compared 
to Silodosin users, similar to orthostatic hypotension. 
None of the detected differences in side effect distribution between Tamsulosin 
and Silodosin is statistically significant, according to the p-value of 0.315. This 
implies that even if there are discernible variations in the frequency of 
particular adverse effects between the two drugs, these variations might just be 
the result of random variation rather than an actual distinction in the side effect 
profiles of tamsulosin and silodosin. 
In conclusion, the analysis of side effects reveals that patients taking silodosin 
have a tendency to report no side effects more often than individuals taking 
tamsulosin.  
 

48 
 
 
 
On the other hand, it seems that tamsulosin users are more likely to experience 
certain adverse effects, like headache, orthostatic hypotension, and abnormal 
ejaculation. Even with these findings, the absence of statistical significance 
suggests that more investigation using larger sample sizes would be necessary 
to conclusively identify any significant variations in the side effect profiles of 
Tamsulosin and Silodosin. 
 
 
 
 
 
 
 
 
 
 
 

49 
 
 
 
Figure 2 
Bar Chart showing  comparison of stone expulsion rate in Tamsulosin and 
Silodosin groups  
 
 
 
 
 
 
 

50 
 
 
 
This bar chart presents a comparative examination of the rates of stone 
expulsion for patients who were suggested to take Tamsulosin or Silodosin 
during three distinct time periods—less than 14 days, 14–21 days, and 21–28 
days. 
The results are color-coded, with red bars denoting silodosin and blue bars 
denoting tamsulosin.  
Silodosin shows a markedly greater efficacy in stone expulsion, with about 55 
patients expulsing stone in less than 14 days in comparison to just about 5 
patients on Tamsulosin.  
This suggests that Silodosin is far more successful at facilitating stone removal 
in less time than Tamsulosin.  
While in 14–21days duration, Silodosin continues to work better than 
Tamsulosin in removing stones. About 20 patients on Tamsulosin were able to 
successfully remove stone, compared to about 30 people on Silodosin. This 
implies that while tamsulosin is also beneficial, silodosin retains greater 
efficacy. 
In the span of 21–28 days, 57 patients on Tamsulosin while 13 on Silodosin 
were able to eliminate stones. In general, Silodosin is quite successful for rapid 
stone ejection during the first two weeks. Using the intended period for stone 

51 
 
 
 
ejection to guide medicine selection, this time-dependent efficacy analysis 
offers clinicians important information. 
 
 
 
Figure 3 Survival function 
 
 
 

52 
 
 
 
This statistical method is commonly used to estimate the time until an event 
occurs and to compare the survival curves of different groups. In this case, 
Kaplan–Meier analysis was performed to assess the duration that patients 
required to expel kidney stones while receiving either silodosin or tamsulosin 
treatment. The rate of the expulsion of stone and the time for it, for both groups, 
was evaluated using this method, as can be seen in Figure 2.  
The log-rank test was applied to compare the rate and time for stone expulsion 
between the two groups. It is a hypothesis test for comparing the survival 
distributions of two samples. It was used in this study to see if patients treated 
with silodosin and those treated with tamsulosin had significantly different 
times for stones to be expelled. With a p-value of 0.05, the log-rank test 
findings showed that there was statistically significant difference between the 
two groups. This indicates that both groups' times to stone expulsion were 
statistically comparable.  
The data showed that patients treated with silodosin demonstrated a higher rate 
of stone expulsion and faster stone expulsion compared to those treated with  
Tamsulosin. Though the difference did not achieve statistical significance in 
this trial, it shows that silodosin may be more beneficial in aiding kidney stone 
removal. The evaluation of rate and time of stone expulsion for both groups 
was conducted using Kaplan–Meier analysis, as depicted in Figure 2. This 

53 
 
 
 
statistical method is commonly used to estimate the time until an event occurs 
and to compare the survival curves of different groups. In this context, the 
Kaplan–Meier analysis was utilized to assess the duration it took for patients to 
expel kidney stones while being treated with either silodosin or tamsulosin. 
    
 
 
 
                                         
 
 
 
 
 
 
 
 
 
 
 

54 
 
 
 
DISCUSSION 
After prostate pathology and urinary tract infections, renal stones are the third 
most frequent urinary tract disorder. Ureteral stones account for 14% of stones 
in the urinary system, most of which are in the distal ureter. Five to ten percent 
of people have urolithiasis. Their rising incidence is a serious cause for 
concern(35). 
Stones can be treated medically or surgically according to European and 
American urology associations. The medical management (MET) has its own 
advantages and is preferred over surgical approach as it is has less risks 
involved than the surgical procedures.  For (MET) medical expulsive therapy 
we need to keep in view various parameters including the stone's size, position, 
and ureteric characteristics. The medical care of ureteral calculi has 
significantly improved since the market saw the release of efficient medicinal 
therapeutic agents. The results of multiple investigations suggest that alpha 
blockers aid in the transit of ureteral stones. These have shown that this strategy 
may speed up and ease the ureteral stones' natural passage. α-AR blockers have 
been suggested by recent worldwide standard guidelines as a treatment for 
ureteral stones in adults and adolescents. 
In 1970, it was initially reported on how adrenergic receptors function in the 
human ureter. Alph adrenergic receptor agonists preserve ureteral peristalsis, 

55 
 
 
 
which may aid in a spontaneous stone passage, while also preventing the 
uncoordinated muscular activity associated with renal colic. Instead of totally 
stopping the action of the ureteric smooth muscle, alpha blockers primarily 
cause relaxation of the human ureter's distal portion.  
 
There are three different types of alpha receptors. α1A-receptor α-1B, and α1D.  
Older alpha blockers had interactions with all subtypes of alpha receptors and 
therefore had more incidence of adverse effects like postural hypotension and 
retrograde ejaculation etc. 
 
Tamsulosin is highly selective for α1A and α1D receptors and has lesser 
incidence of side effects like postural hypotension, retrograde ejaculation, 
headache and gastritis as compared to aforementioned drugs with receptor non 
selectivity () Silodosin is a selective alpha 1 blocker and is also used  recently 
as medical expulsive therapy. 
After being approved in Japan in 2006, the recently introduced selective α-1A 
AR antagonist silodosin is currently licensed in over 50 countries, including the 
US and Europe, for the treatment of lower urinary tract symptoms (LUTS). 
 

56 
 
 
 
Given the growing body of evidence supporting the efficacy of medical 
expulsive therapy (MET) with selective α-blockers, MET treatment for ureteral 
stones is a financially prudent approach (36). 
 
In our study, we wanted to compare the efficacy of  two drugs in MET (medical 
expulsive therapy) with regards to stone expulsion rate as well as to compare 
the side effect profile in our population. 
Patients with distal ureteral calculi who received alpha blocker drugs had 
almost 40-50% higher chances of expulsion of stone than those who did not 
receive this treatment, according to two meta-analyses that offered strong 
evidence for the clinical benefit of this treatment [29, 34]. Hollingsworth and 
colleagues recently conducted a meta analysis of trials utilizing alpha blockers 
in individuals with ureteral stones, and they obtained similar results. 
According to a study, an alpha-1A receptor antagonist may not be as helpful for 
stone ejection as a specialized α-1D receptor antagonist.  
According to a different study, using α-1A adrenoceptor blockers instead of α-
1D adrenoceptor blockers can result in more successful stone expulsions. 
Tamsulosin and silodosin exhibit comparable α-1D receptor subtype affinity 
when taken at a dose of 8 mg once day. However, silodosin has about 38 times 
greater affinity for α-1A receptors than tamsulosin does(37). 

57 
 
 
 
Approximately 95% of stones with a diameter of less than 4 mm passed after 
40 days of conservative treatment alone, according to a research. On the other 
hand, silodosin exhibited a greater stone expulsion rate of 14% in comparison 
to tamsulosin for larger stones, measuring 5-10 mm in diameter. For distal 
ureteral stones treated with silodosin, the mean ET (in days) ranged from 6.5 to 
16.7 days. Those with symptomatic unilateral ureteral calculi less than 10 mm 
in diameter were assigned to receive silodosin (8 mg/day) and instructed to 
consume two liters of water per day for a maximum of eight weeks in a 
prospective randomized research. The average ET was 10.27 ± 8.35 days 
overall. The mean ET for distal ureteral stones was 9.29 ± 5.91 days. The mean 
ET was 9.56 ± 8.45 days for stones with a diameter of 1–5 mm and 11.33 ± 
8.31 days for stones with a diameter of less than 10 mm(38). 
Our study showed the that 51.9% of the patients with proximal ureteric stone 
were given Tamsulosin and 48.1% received Silodosin. 82.6 percent of patients 
with mid-ureteric stone problems received Silodosin, while 17.4% received 
Tamsulosin. While 51.9% of patients with distal ureteric stones received 
Tamsulosin and 48.1%  Silodosin. 
Numerous meta-analyses have investigated how different medication 
combinations affect ureteric stone treatment. However, there aren't many 
studies that specifically compare how well different alpha-blockers work to 

58 
 
 
 
cure distal ureteric calculi. For distal ureteric stones, the use of supplementary 
drugs such Tamsulosin has been shown to be beneficial in easing discomfort, 
lowering risks, and quickening the removal of the stone. According to recent 
studies, silodosin might be a suitable and effective replacement(39). 
 
 In treating distal ureteral calculi silodosin performed better than a placebo or 
tamsulosin, per a recent meta-analysis. However Silodosin’s  safety profile was 
comparable to that of tamsulosin (40).  
 
In another study involving 167 paediatric patients with distal ureteric stones 
(DUS) less than 1 cm were enrolled in this prospective single-blind placebo-
controlled randomized research. The patients were randomly assigned to three 
groups: 1st group was given 4 mg of Silodosin once a day, 2nd group was given 
0.4 mg of Tamsulosin, and 3rd group received neither medication. For a 
maximum of four weeks, the study groups' adverse medication reactions, the 
frequency and duration of expulsion of stone, an pain episodes frequency were 
compared.  
 
 

59 
 
 
 
In groups I, II, and III, the rates of stone expulsion were 89.3% (50 out of 56 
patients), 74.5% (41 out of 55 patients), and 51.8% (29 out of 56 patients), 
respectively. Group I had a significantly greater stone expulsion rate than 
groups II and III (p = 0.04 and p < 0.001, respectively). The stone ejection rate 
was higher in group II than in group III, with a statistically significant 
difference (p = 0.01). In groups I, II, and III, the corresponding expulsion times 
in days were 12.4 ± 2.3, 16.2 ± 4.2, and 21.2 ± 5.6. Group I experienced a 
considerably shorter time to expulsion compared to groups II and III (p < 
0.001). Additionally, Table 2 shows that group II's expulsion time was much 
lower than group III's (p < 0.001). There was no significant difference between 
groups I and II (p = 0.8), although group I and II had considerably fewer mean 
daily pain episodes requiring analgesia than group III (p < 0.001).  
The size, location, and makeup of the stone, the degree of the blockage, and the 
symptoms all influence the best course of action. The therapy of ureteral stones 
has undergone a paradigm change in the last ten years due to the advent of less 
intrusive techniques and the availability of more advanced pharmaceutical 
agents.(32) 
Comparably, silodosin demonstrated a statistically significant greater efficacy 
in terms of stone ejection rate and time compared to tamsulosin (82.4 vs. 
61.5%) in another study involving adult patients.(41). 

60 
 
 
 
Along with pain episodes and safety outcomes like orthostatic hypotension and 
retrograde ejaculation, the key outcomes that were taken into consideration 
were the stone expulsion rate (SER) and stone expulsion time (SET).  
  For patients with ureteral stones (distal ureteral stones with a diameter of ≥5 
mm and ≤10 mm), silodosin is very efficient in promoting stone expulsion with 
shorter expulsion times and fewer pain episodes. Additionally, it works well 
after lithotripsy to speed up stone movement and emphasize clearance rate(37). 
Dell'Atti L. evaluated the effectiveness of Tamsulosin and Silodosin in the 
ejection of 4–10 mm ureteral stones in distal parts of urethra. The research 
included 136 patients in total, all of whom were at least 18 years old. For three 
weeks, group 1 (67 patients) got 0.4 mg of tamsulosin daily, while group 2 (66 
patients) received 8 mg of silodosin daily. Compared to Tamsulosin (61.2%, 41 
out of 67 patients), patients treated with Silodosin experienced a statistically 
significant increase in the expulsion rate (80.3%, 53 out of 66); Silodosin also 
demonstrated a statistically significant advantage in terms of stone expulsion 
rate (p: 0.003) and expulsion time (weeks) (p: 0.002). There were no reported 
serious problems(42). 
 
 
 

61 
 
 
 
 
The rate and time of stone expulsion for both groups was evaluated using this 
method, as can be seen in Figure 2.  
One main result of our study was 89.7% of patients on silodosin had their stone 
removed in less than 14 days, while only 10.3% of the patients on Tamsulosin 
had their stone removed in aforementioned duration. Also, 72.5% of patients on 
Silodosin had their stone removed in 14-21 days, while only 27.5% of the 
patients on Tamsulosin had their stone removed in same duration. Moreover, 
81.4% on Tamsulosin had their stone removed in 22-28 days and 18.6% 
patients on Silodosin had it removed in same duration. 
A similar meta analysis matched our results. Every study that was part of the 
analysis prescribed silodosin for at least two weeks. The results of several 
researches were compared by observing the effects of silodosin over a 
standardized period of time thanks to this constant timeframe. The results of 
this investigation showed that individuals with distal ureteral stones saw 
significantly higher rates of stone ejection when they received Silodosin for at 
least two weeks. This implies that silodosin worked well to help stones transit 
through the body in a short amount of time, which may lessen the need for 
more intrusive procedures and enhance patient outcomes when treating distal 
ureteral stones(43). 

62 
 
 
 
A meta-analysis was carried out on the similar comparison and it showed that 
mean stone ejection time was shorter in patients receiving silodosin 8 mg daily 
compared to those directed to drink 2 L of water daily and a greater rate of 
stone ejection. Meta-analyses conducted since the silodosin RCT have 
demonstrated that efficacy of silodosin is more than that of tamsulosin for the 
Medical expulsive therapy of ureteral stones. The meta analyses discovered that 
silodosin, as opposed to tamsulosin, dramatically raised the expulsion rate of 
distal ureteral stones in a meta-analysis involving five RCTs(44). 
   
A positive but weak link was seen when the length of stone ejection was 
analyzed in relation to the frequency of renal colic episodes, the dosage of 
analgesics, and the size of the stone (Table 4; P<0.001). The number of renal 
colic episodes and the dose of analgesics were found to be positively and 
strongly correlated (P<0.001), the number of renal colic episodes and stone size 
was found to be positively and weakly correlated (P=0.015), and the analgesic 
dosage and stone size was found to be positively and weakly correlated 
(P<0.05)(28). 
 
 

63 
 
 
 
Overall, compared to 30% of patients in the placebo group, 37.5% of patients in 
the tamsulosin group experienced drug-related side events (p = 0.7). The most 
often reported side effect was dizziness, which was more common with 
tamsulosin (25%) than with placebo (22.5%) (p = 0.9). Other adverse effects 
(sinus pressure, nosebleed, nausea, tinnitus, hands and feet swelling) that may 
or may not be related to the medication were recorded in isolated cases. In 
neither group were there any significant side effects noted. However, men in the 
tamsulosin group experienced ejaculatory dysfunction more frequently [5 
(17.9%) vs. 1 (3.5%), (p = 0.1)]. 
Because both medications are safe and well tolerated, no significant side effects 
were seen in the trial. In groups A and C, anejaculation was experienced by 17 
out of 23 patients (73.9%) and 21 out of 25 patients (84%) respectively; 
nevertheless, none of the patients stopped receiving treatment. After the 
treatment was discontinued, the situation rapidly improved. In the study 
patients, there was no significant change in their blood pressure or pulse rate. A 
study of the literature supports the findings, showing no correlation between 
changes in blood pressure or heart rate and a 50 mg dose of mirabegron(45). 
Our Patients on tamsulosin accounted for 40.1% of those who did not report 
any side effects; those on silodosin made for a larger percentage (59.9%). This 

64 
 
 
 
implies that, in comparison to Tamsulosin, Silodosin may have a marginally 
higher correlation with patients reporting no adverse effects. 
There was no discernible difference in the reported orthostatic hypotension 
values of 3.6, 5.5, and 1.8% for the silodosin, tamsulosin, and placebo groups, 
respectively. Other side effects were noted in the silodosin, tamsulosin, and 
placebo groups, respectively, and included headache (3.6, 5.5, and 1.8%), 
dizziness (7.1, 10.9, and 3.6%), nasal congestion (1.8, 3.6, and 0), and nausea 
(1.8, 3.6, and 1.8%), all without a statistically significant difference. Based on 
the Common Terminology Criteria for Adverse Events, version 4.0, all cases 
were rated as grade 1(46). 
The groups who took silodosin alone and the group that took silodosin plus 
tadalafil experienced similar side symptoms, such as headache, dizziness, 
backache, orthostatic hypotension, and retrograde ejaculation (Table-III). Given 
that P > 0.05, that was not statistically significant(41). 
Examining particular side effects reveals various themes. Nine patients on 
tamsulosin (60.0%) and six patients on silodosin (40.0%) developed orthostatic 
hypotension, a condition marked by a considerable drop in blood pressure upon 
standing. Despite the fact that the sample size for this particular side effect is 
rather modest, it suggests that Tamsulosin users are more likely to have 
orthostatic hypotension than Silodosin users. 

65 
 
 
 
According to a study, the most common adverse event associated with the 
silodosin group was decreased or absent ejaculation. Of the patients in groups A 
and B, eight patients (8 were distressed, four were not, and six were distressed 
but could wait for their improvement) and nineteen patients (10 were 
distressed, four were not, and five were distressed but could wait for their 
improvement) experienced this adverse event most frequently(47). 
Only a very tiny percentage of patients reported experiencing abnormal 
ejaculation; 2 individuals on tamsulosin (66.7%) and 1 patient on silodosin 
(33.3%) reported this side event. Again, this points to an increased chance of 
this specific adverse effect in Tamsulosin users, but the numbers are too low to 
make any firm conclusions. Another side effect that was identified involved 
headaches, which were seen by 4 individuals on silodosin (44.4%) and 5 
patients on tamsulosin (55.6%). Headaches were marginally more common 
among Tamsulosin users compared to Silodosin users, similar to orthostatic 
hypotension. 
Many urologists agree when it comes to the incidence of retrograde ejaculation 
that it is an indication of therapy efficacy rather than a negative effect. It seems 
that silodosin relaxes the smooth muscles in the genital and lower urinary tracts 
sufficiently to cause a retrograde ejaculation. Retrograde ejaculation was more 
common in the individuals who experienced the most alleviation from lower 

66 
 
 
 
urinary tract symptoms, which was consistent with this conclusion. This finding 
implies that the retrograde ejaculation is, in fact, a passive marker of the 
smooth muscle relaxation brought on by silodosin(32). 
Typically, nonselective α1 adrenoceptor antagonists such doxazosin and 
terazosin are linked to orthostatic hypotension. Nonetheless, in clinical trials, 
silodosin was linked to a modest incidence of orthostatic hypotension. 
According to the combined analysis of the US and European studies, 1.1% of 
patients receiving a placebo and 1.3% of patients receiving silodosin 
experienced orthostatic hypotension(48). 
When compared to Tamsulosin, Silodosin is linked to a larger incidence of 
retrograde ejaculation but a reduced incidence of peripheral vasodilation-related 
adverse effects, such as orthostatic hypotension and dizziness, according to a 
retrospective review conducted by Imperatore et al(49). 
In our study comparing the effects of Tamsulosin and Silodosin on patients, it 
was discovered that only 38.1% of those receiving Silodosin needed analgesics 
to ameliorate ureteric pain. On the other hand, 61.9% of patients receiving 
Tamsulosin required analgesic intervention, which is a far larger percentage. 
This significant difference raises the possibility that silodosin is more 
successful in treating ureteric stones and it also lowers their need for extra 
painkillers. 

67 
 
 
 
Similar results were seen in another study showing that, individuals receiving 
just tamsulosin treatment needed a greater average analgesic dosage of 391.43 
± 165.60 mg with a p-value of 0.005, which denotes substantial significance, 
the necessary(50). 
Similarly, a study showed statistically significant difference in the amount of 
analgesics needed by patients treated with Silodosin compared to those treated 
with tamsulosin only. The robustness of the conclusion was highlighted by the 
fact that the group receiving Silodosin treatment required considerably fewer 
analgesics than the groups receiving Tamsulosin, with a p-value of < 0.001(51). 
 
 
 
 
 
 
 
 
 
 

68 
 
 
 
                                
Conclusion 
An effective treatment for ureteral stones is medical expulsive therapy. 
According to our findings, silodosin has a safer profile and is more successful 
than tamsulosin at ejecting ureteric stones. 
 Silodosin had an increased rate of stone expulsion and took less time in   stone 
expulsion compared to those treated with Tamsulosin.  
In addition, patients treated with silodosin reported fewer side effects, such as a 
retrograde ejaculation, orthostatic hypotension and headaches as compared to 
those taking Tamsulosin. 
 In addition, those who received Silodosin needed less analgesic medication 
than those who received Tamsulosin.  
. 
 
 
 
 
 

69 
 
 
 
 
 
INFORMED CONSENT FORM  
 
Research 
Title: 
COMPARISON 
BETWEEN 
TAMSULOSIN 
AND 
SILODOSIN IN MEDICAL EXPULSIVE THERAPY FOR URETERAL 
STONES. 
Researcher Name: Dr Faiza Khan 
Email. drfaizakhan@hotmail.com 
Introduction: We are conducting research to compare the effects of two drugs 
for expulsion of ureteral stones. This is based upon two drugs, Tamsulosin and 
Silodosin which are well known to expel ureteral stones less than 10 mm in 
size. 
Purpose of Research: To have alternate drug Silodosin available after 
comparing efficacy and side effect profile. 
 
 
 

70 
 
 
 
Method:  
As per routine, you will be educated about medical expulsive therapy, its dose 
and mode of administration. 
You will be given one of the two drugs and will be told about side effects also. 
You can contact us anytime during the study period if you face any problem 
regarding drug. In case the drug therapy does not suit you, you will be given 
option to change drug or go for surgery.  
Possible risks or discomforts 
There are no risks or discomforts for you in participating in this study. You can 
withdraw from the study whenever you want and this will have no adverse 
effect on your treatment. 
Possible benefits 
There will be direct benefit to patient in case one drug doesn’t suit a patient 
previously and now he is using the newer drug with lesser side effects. Results 
of this study will help to make alternate drug treatments available to market   
 

71 
 
 
 
 
Financial considerations 
There is no financial compensation for your participation in this research. There 
are no additional costs for participation in the study. 
Confidentiality 
We will not mention your name anywhere in the study and the data will be 
collected with reference to the Medical Record numbers. All data collected will 
be strictly confidential and available only to the principal investigator. Your 
identity in this study will be treated as confidential. A copy of consent form will 
be given to you. The results of the study, may be published for scientific 
purposes but your confidentiality will not be compromised. However, any 
records or data obtained as a result of your participation in this study may be 
inspected by the Fatima Jinnah Medical University ethical review committee 
members. 
 
 
 
 

72 
 
 
 
Right of refusal to participate and withdrawal 
You are free to choose whether or not to participate in this study. You may 
refuse to participate or withdraw at any time from the study. There will be no 
penalty or loss of benefits to which you are otherwise entitled if you choose not 
to participate. 
 
 
 
 
 
 
 
 
 
 
 

73 
 
 
 
Authorisation 
I have read and understand this consent form, and I volunteer to participate in 
this research study.  
 
 
 
 
 
 
Participants name (Printed or Typed): 
 
 
Date: 
Principal investigations signature : 
 
 
Date: 
Participants signature : 
 
 
Date: 
Signature of person obtaining consent: 
 
 
Date: 

74 
 
 
 
 
 
باخبر رضامندی کا فارم 
 
 تحقیق کا عنوان: پیشاب کی پتھری کے لیے طبی اخراجی عالج میں تمسولوسین اور سیلوڈوسین
کے درمیان موازنہ۔ 
محقق کا نام: ڈاکٹر فائزہ خان 
 
 ای میل۔drfaizakhan@hotmail.com
 
 
 
 تعارف: ہم دو دوائیوں کے اثرات کا موازنہ کرنے کے لیے ایک تحقیق کر رہے ہیں جو پیشاب کی
 ،پتھری کو خارج کرنے کے دشمن ہیں۔ یہ دو دوائیوںTamsulosin
 
 اورSilodosin
 
 پر مبنی ہے
 جو10
 ملی میٹر سے کم سائز کی پیشاب کی پتھری کو نکالنے کے لیے مشہور ہیں۔ 
تحقیق کا مقصد: ا فادیت اور سائیڈ ایفیکٹ پروفائل کا موازنہ کرنے کے بعد متبادل دوائی
Silodosin
 دستیاب ہونا۔ 
:طریقہ 

75 
 
 
 
 معمول کے مطابق، آپ کو طبی خارج کرنے والی تھراپی، اس کی خوراک اور انتظامیہ کے طریقہ
کار کے بارے میں تعلیم دی جائے گی۔ 
 آپ کو دو دوائیوں میں سے ایک دی جائے گی اور ضمنی اثرات کے بارے میں بھی بتایا جائے گا۔
 مطالعہ کی مدت کے دوران اگر آپ کو منشیات کے حوالے سے کوئی مسئلہ درپیش ہو تو آپ ہم
 سے کسی بھی وقت رابطہ کر سکتے ہیں۔ اگر ڈرگ تھراپی آپ کے لیے مناسب نہیں ہے، تو آپ کو
 دوا تبدیل کرنے یا سرجری کے لیے جانے کا اختیار دیا
جائے گا۔ 
 
ممکنہ خطرات یا تکلیفیں۔ 
 اس مطالعہ میں حصہ لینے میں آپ کے لیے کوئی خطرہ یا تکلیف نہیں ہے۔ آپ جب چاہیں مطالعہ
سے دستبردار ہو سکتے ہیں اور اس سے آپ کے عالج پر کوئی منفی اثر نہیں پڑے گا۔ 
 
ممکنہ فوائد 
مریض کو براہ راست فائدہ ہو گا اگر ایک دوا پہلے مری ض کو سوٹ نہیں کرتی تھی اور اب وہ نئی
 دوائی کو کم سائیڈ ایفیکٹ کے ساتھ استعمال کر رہا ہے۔ اس مطالعہ کے نتائج سے منشیات کے
متبادل عالج کو مارکیٹ میں دستیاب کرنے میں مدد ملے گی۔ 
 
 وہ کم ضمنی اثرات کے ساتھ نئی دوا استعمال کر رہا ہے۔ اس مطالعہ کے نتائج سے منشیات کے
متبادل عالج کو مارکیٹ میں دستیاب کرنے میں مدد ملے گی۔ 

76 
 
 
 
 
مالی تحفظات 
 اس تحقیق میں آپ کی شرکت کے لیے کوئی مالی معاوضہ نہیں ہے۔ مطالعہ میں شرکت کے لیے
کوئی اضافی اخراجات نہیں ہیں۔ 
 
رازداری 
ہم مطالعہ میں کہیں بھی آپ کے نام کا ذکر نہیں کریں گے اور ڈیٹا 
 کو میڈیکل ریکارڈ نمبروں کے
 حوالے سے جمع کیا جائے گا۔ جمع کردہ تمام ڈیٹا سختی سے رازدارانہ اور صرف پرنسپل تفتیش
 کار کے لیے دستیاب ہوگا۔ اس مطالعہ میں آپ کی شناخت کو خفیہ رکھا جائے گا۔ رضامندی فارم
کی ایک کاپی آپ کو دی جائے گی۔ مطالعہ کے نتائج، سائنسی مقاصد 
 کے لیے شائع کیے جا سکتے
 ہیں لیکن آپ کی رازداری سے سمجھوتہ نہیں کیا جائے گا۔ تاہم، کوئی ریکارڈ یا ڈیٹا حاصل کیا گیا
ہے۔ 
 اس مطالعہ میں آپ کی شرکت کے نتیجے میں فاطمہ جناح میڈیکل یونیورسٹی کی اخالقی جائزہ
کمیٹی کے اراکین کی طرف سے معائنہ کیا جا سکتا ہے۔ 
 
 
 
شرکت سے انکار اور دستبرداری کا حق 

77 
 
 
 
 آپ اس مطالعہ میں حصہ لینے یا نہ کرنے کا انتخاب کرنے کے لیے آزاد ہیں۔ آپ کسی بھی وقت
 مطالعہ میں حصہ لینے یا واپس لینے سے انکار کر سکتے ہیں۔ اگر آپ شرکت نہ کرنے کا انتخاب
 کرتے ہیں تو اس پر کوئی جرمانہ یا فوائد کا نقصان نہیں ہوگا جس کے آپ بصورت دیگر حقدار
ہیں۔ 
 
 
اجازت 
 میں نے رضامندی کے اس فارم کو پڑھ اور سمجھ لیا ہے، اور میں اس تحقیقی مطالعہ میں حصہ
لینے کے لیے رضاکارانہ طور پر تیار ہوں۔ 
 
 
 
 
 
 
 

78 
 
 
 
پرنسپل تحقیقاتی دستخط 
 
:تاریخ 
 
: شرکاء کا نام 
 
 
 
 رضامندی حاصل کرنے والے شخص کے
:دستخط 
 
 
:تاریخ 
 
:شرکاء کے دستخط 
 
 
:تاریخ 
 
 
 
 
 
 
 
 
 
 
 
 

79 
 
 
 
                                          REFERENCES 
 
1. Ahmed AFAM, Al-Sayed AYS. Tamsulosin versus Alfuzosin in the 
Treatment of Patients with Distal Ureteral Stones: Prospective, 
Randomized, Comparative Study. Korean J Urol. 2010 Mar;51(3):193–7.  
2. Bashir A, Zuberi SK, Musharraf B, Khan H, Ather MH, Musharraf MB, et 
al. Perception of dietary influences on renal stone formation among the 
general population. Cureus [Internet]. 2022 [cited 2024 Jun 1];14(6). 
Available 
from: 
https://www.cureus.com/articles/101406-perception-of-
dietary-influences-on-renal-stone-formation-among-the-general-
population.pdf 
3. Strohmaier WL, Wrobel BM, Schubert G. Overweight, insulin resistance 
and blood pressure (parameters of the metabolic syndrome) in uric acid 
urolithiasis. Urol Res. 2012 Apr;40(2):171–5.  
4. Hughes T, Ho HC, Pietropaolo A, Somani BK. Guideline of guidelines for 
kidney and bladder stones. Turkish journal of urology. 2020;46(Suppl 
1):S104.  
5. Pietropaolo A, Proietti S, Geraghty R, Skolarikos A, Papatsoris A, 
Liatsikos E, et al. Trends of ‘urolithiasis: interventions, simulation, and 

80 
 
 
 
laser technology’ over the last 16 years (2000–2015) as published in the 
literature (PubMed): a systematic review from European section of Uro-
technology (ESUT). World J Urol. 2017 Nov;35(11):1651–8.  
6. Ibrahim AIA, Shetty SD, Awad RM, Patel KP. Prognostic Factors in the 
Conservative Treatment of Ureteric Stones. British Journal of Urology. 
1991 Apr;67(4):358–61.  
7. Jw S. Ureteral stones clinical guidelines panel summary report on the 
management of ureteral calculi. J Urol. 1997;158:1915–21.  
8. Morita T, Wada I, Saeki H, Tsuchida S, Weiss RM. Ureteral urine 
transport: changes in bolus volume, peristaltic frequency, intraluminal 
pressure and volume of flow resulting from autonomic drugs. The Journal 
of urology. 1987;137(1):132–5.  
9. Malin JM, Deane RF, Boyarsky S. CHARACTERISATION OF 
ADRENERGIC RECEPTORS IN HUMAN URETER1. British Journal of 
Urology. 1970 Apr;42(2):171–4.  
 
 
 

81 
 
 
 
10. Sharma G, Pareek T, Kaundal P, Tyagi S, Singh S, Yashaswi T, et al. 
Comparison of efficacy of three commonly used alpha-blockers as medical 
expulsive therapy for distal ureter stones: A systematic review and network 
meta-analysis. International braz j urol. 2022;48:742–59.  
11. Rahman MJ, Faridi MS, Mibang N, Singh RS. Comparing tamsulosin, 
silodosin versus silodosin plus tadalafil as medical expulsive therapy for 
lower ureteric stones: A randomised trial. Arab Journal of Urology. 
2018;16(2):245–9.  
12. Hsu YP, Hsu CW, Bai CH, Cheng SW, Chen KC, Chen C. Silodosin versus 
tamsulosin for medical expulsive treatment of ureteral stones: A systematic 
review and meta-analysis. PLoS One. 2018;13(8):e0203035.  
13. Original Research Article A study on ureteric calculi... - Google Scholar 
[Internet]. 
[cited 
2024 
Jun 
1]. 
Available 
from: 
https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=Original+Re
search+Article+A+study+on+ureteric+calculi+in+a+rural+tertiary+care+ce
nter+Kailash+Jagannath%2C+Ashwin+KanakarajaGupta*%2C+Narayanas
wamy+Srinivasan+Jagannath+Ket+al.+Int+Surg+J.+2019+Apr%3B6%284
%29%3A1312-1317+pISSN+2349-3305+eISSN+2349-2902&btnG= 

82 
 
 
 
14. Del Real O, Arzeno L, Barría S, Eltit I, Acuña JI, Telayna F, et al. 
Prevalence of urinary stones in an urban population in Chile. 2023 [cited 
2024 
Jul 
8]; 
Available 
from: 
https://www.academia.edu/download/115587631/latest.pdf 
15. Halinski A, Bhatti KH, Boeri L, Davidoff K, Popov E, Elqady A, et al. 
Stone composition of renal stone formers from different global regions. 
Archivio Italiano di Urologia Andrologia. 2021;93(3):307–12.  
16. Saeed S, Ullah A, Ahmad J, Hamid S. The prevalence of incidentally 
detected urolithiasis in subjects undergoing computerized tomography. 
Cureus [Internet]. 2020 [cited 2024 Jun 26];12(9). Available from: 
https://www.cureus.com/articles/31970-the-prevalence-of-incidentally-
detected-urolithiasis-in-subjects-undergoing-computerized-tomography.pdf 
17. REHMAN I, KHAN H, FAROOQ A, MAHMOOD A, DIN QAM, HABIB 
B. Study on Uroliths Composition in Tertiary Care Hospital of Pakistan. 
Magnesium. 2021;7:18–9.  
18. Jagannath K, Gupta AK, Srinivasan N. A study on ureteric calculi in a rural 
tertiary care centre. International Surgery Journal. 2019;6(4):1312–7.  

83 
 
 
 
19. Kino M, Hayashi T, Hino D, Nakada T, Kitoh H, Akakura K. Patients’ poor 
performance status is an independent risk factor for urosepsis induced by 
kidney and ureteral stones. Urolithiasis. 2021;49(5):477–84.  
20. Thongprayoon C, Krambeck AE, Rule AD. Determining the true burden of 
kidney stone disease. Nature Reviews Nephrology. 2020;16(12):736–46.  
21. Ang AJ, Sharma AA, Sharma A. Nephrolithiasis: approach to diagnosis and 
management. The Indian Journal Of Pediatrics. 2020;87:716–25.  
22. Bhanot R, Jones P, Somani B. Minimally Invasive Surgery for the 
Treatment of Ureteric Stones – State-of-the-Art Review. RRU. 2021 
May;Volume 13:227–36.  
23. Lim 
I, 
Sellers 
DJ, 
Chess‐Williams 
R. 
Current 
and 
emerging 
pharmacological targets for medical expulsive therapy. Basic Clin Pharma 
Tox. 2022 Jan;130(S1):16–22.  
 
 
 
 
 

84 
 
 
 
24. Comparative study between Silodosin alone and Silodosin... - Google 
Scholar 
[Internet]. 
[cited 
2024 
Jun 
21]. 
Available 
from: 
https://scholar.google.com.pk/scholar?hl=en&as_sdt=0%2C5&q=Comparat
ive+study+between+Silodosin+alone+and+Silodosin+plus+Tadalafil+for+t
he+medical+management+of+lower+Ureteric+Stone+in+South-
Western+part+of+the+Bangladesh&btnG= 
25. Bai Y, Yang Y, Wang X, Tang Y, Han P, Wang J. Tadalafil Facilitates the 
Distal Ureteral Stone Expulsion: A Meta-Analysis. Journal of Endourology. 
2017 Jun;31(6):557–63.  
26. Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, et 
al. 
Surgical 
Management 
of 
Stones: 
American 
Urological 
Association/Endourological Society Guideline, PART I. Journal of 
Urology. 2016 Oct;196(4):1153–60.  
27. Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M. 
Guidelines on urolithiasis. European urology. 2001;40(4):362–71.  
28. Parsons JK, Hergan LA, Sakamoto K, Lakin C. Efficacy of α-blockers for 
the treatment of ureteral stones. The Journal of urology. 2007;177(3):983–
7. 

85 
 
 
 
29. Liu XJ, Wen JG, Wan YD, Hu BW, Wang QW, Wang Y. Role of silodosin 
as medical expulsive therapy in ureteral calculi: a meta-analysis of 
randomized controlled trials. Urolithiasis. 2018 Apr;46(2):211–8.  
30. Bacchus MW, Locke RA, Kwenda EP, DeMarco RT, Grant C, Bayne CE. 
Medical expulsive therapy (MET) for ureteral calculi in children: 
systematic review and meta-analysis. Frontiers in Urology. 2022;2:866162.  
31. Kumar S, Jayant K, Agrawal MM, Singh SK, Agrawal S, Parmar KM. Role 
of tamsulosin, tadalafil, and silodosin as the medical expulsive therapy in 
lower ureteric stone: a randomized trial (a pilot study). Urology. 
2015;85(1):59–63.  
32. GUpta S, Lodh B, Singh AK, Somarendra K, Meitei KS, Singh SR. 
Comparing the efficacy of tamsulosin and silodosin in the medical 
expulsion therapy for ureteral calculi. Journal of Clinical and Diagnostic 
Research: JCDR. 2013;7(8):1672.  
33. Dell’Atti L. Silodosin versus Tamsulosin as Medical Expulsive Therapy for 
Distal Ureteral Stones: A Prospective Randomized Study. Urologia. 2015 
Jan;82(1):54–7.  

86 
 
 
 
34. Imperatore V, Fusco F, Creta M, Di Meo S, Buonopane R, Longo N, et al. 
Medical expulsive therapy for distal ureteric stones: tamsulosin versus 
silodosin. Archivio Italiano di Urologia e Andrologia. 2014;86(2):103–7.  
35. Venkatesh N. Section: Preventive and Social Medicine. Int J Acad Med 
Pharm. 2023;5(3):960–6.  
36. Jiang P, Xie L, Arada R, Patel RM, Landman J, Clayman RV. Qualitative 
Review of Clinical Guidelines for Medical and Surgical Management of 
Urolithiasis: Consensus and Controversy 2020. Journal of Urology. 2021 
Apr;205(4):999–1008.  
37. Sadasivam B, Chenchula S, Ray A. Systematic Review of Efficacy and 
Safety of Silodosin in Medical Expulsive Therapy for the Management of 
Ureteral Stones–Based on Indian Evidences. Biomedical and Pharmacology 
Journal. 2021;14(2):733–8.  
38. Itoh Y, Okada A, Yasui T, Hamamoto S, Hirose M, Kojima Y, et al. 
Efficacy of selective α1A adrenoceptor antagonist silodosin in the medical 
expulsive therapy for ureteral stones. Int J of Urology. 2011 Sep;18(9):672–
4.  

87 
 
 
 
39. Dhinakarbabu N, Kumar DM. EFFICACY OF SILODOSIN VERSUS 
TAMSULOSIN IN MEDICAL EXPULSIVE TREATMENT FOR 
URETERAL STONES-A SYSTEMATIC REVIEW. Int J Acad Med 
Pharm. 2024;6(2):43–8.  
40. Huang W, Xue P, Zong, H, Zhang Y. Efficacy and safety of silodosin in the 
medical expulsion therapy for distal ureteral calculi: a systematic review 
and meta‐analysis. Brit J Clinical Pharma. 2016 Jan;81(1):13–22.  
41. Ahmed M, Saha PK, Ghosh KC, Islam SA, Mondal N. Comparative study 
between Silodosin alone and Silodosin plus Tadalafil for the medical 
management of lower Ureteric Stone in South-Western part of the 
Bangladesh. Bangladesh j urol. 2020;23:67–71.  
42. ti L. Silodosin versus tamsulosin as medical expul... - Google Scholar 
[Internet]. 
[cited 
2024 
Jun 
21]. 
Available 
from: 
https://scholar.google.com.pk/scholar?hl=en&as_sdt=0%2C5&q=ti+L.+Sil
odosin+versus+tamsulosin+as+medical+expul+sive+therapy+for+distal+ur
eteral+stones%3A+a+prospective+ran+domized+study.+Urologia+2015%3
B82%281%29%3A54-57.&btnG= 
 

88 
 
 
 
43. Ramadhani MZ, Kloping YP, Rahman IA, Yogiswara N, Soebadi MA, 
Renaldo J. Silodosin as a medical expulsive therapy for distal ureteral 
stones: A systematic review and meta-analysis. Indian Journal of Urology. 
2023;39(1):21–6.  
44. Jung HD, Cho KS, Jun DY, Jeong JY, Moon YJ, Chung DY, et al. 
Silodosin versus tamsulosin for medical expulsive therapy of ureteral 
stones: an updated systematic review and meta-analysis of randomized 
controlled trials. Medicina. 2022;58(12):1794.  
45. Abdel-Kader MS, Sayed AM, Sayed SM, AbdelRazek M. Evaluation of the 
efficacy and safety of either or both mirabegron and silodosin, as a medical 
expulsive therapy for distal ureteric stones. Int Urol Nephrol. 2023 Dec 
2;56(5):1605–10.  
46. Soliman MG, El-Gamal O, El-Gamal S, Abdel Raheem A, Abou-Ramadan 
A, El-Abd A. Silodosin versus tamsulosin as medical expulsive therapy for 
children with lower-third ureteric stones: Prospective randomized placebo-
controlled study. Urologia Internationalis. 2021;105(7–8):568–73.  
 
 

89 
 
 
 
47. Hussein AM, Hussein AM, Ahmed AE, Hassanin A. Efficacy and Safety of 
Silodosin, Prednisolone or Both for Spontaneous Passage of Lower 
UretericStones and Renal Colic Control. Egyptian Journal of Medical 
Research. 2022;3(1):84–94.  
48. Keating GM. Silodosin: A Review of Its Use in the Treatment of the Signs 
and 
Symptoms 
of 
Benign 
Prostatic 
Hyperplasia. 
Drugs. 
2015 
Feb;75(2):207–17.  
49. Imperatore V, Fusco F, Creta M, Di Meo S, Buonopane R, Longo N, et al. 
Medical expulsive therapy for distal ureteric stones: tamsulosin versus 
silodosin. Archivio Italiano di Urologia e Andrologia. 2014;86(2):103–7.  
50. Parashar S, Saxena PK, Pathak A, Gupta H. Comparative Study of the 
Stone Expulsion Rate after Treatment with Tamsulosin, Tadalafil and 
Combination of Tamsulosin and Tadalafil. [cited 2024 Jun 24]; Available 
from: 
https://www.researchgate.net/profile/Akshat-Pathak-
3/publication/377158881_Comparative_Study_of_the_Stone_Expulsion_R
ate_after_Treatment_with_Tamsulosin_Tadalafil_and_Combination_of_Ta
msulosin_and_Tadalafil/links/6597ab426f6e450f19caf509/Comparative-
Study-of-the-Stone-Expulsion-Rate-after-Treatment-with-Tamsulosin-
Tadalafil-and-Combination-of-Tamsulosin-and-Tadalafil.pdf 

90 
 
 
 
51. Abdullah A, Gupta YB, Selvaraj S, Ganapathy R, Ilangovan AK, 
Sivalingam S, et al. A Comparison Between Silodosin and Tamsulosin for 
Medical Expulsive Therapy of Distal Ureteric Calculus. Cureus [Internet]. 
2023 
[cited 
2024 
Jun 
24];15(10). 
Available 
from: 
https://www.cureus.com/articles/186558-a-comparison-between-silodosin-
and-tamsulosin-for-medical-expulsive-therapy-of-distal-ureteric-
calculus.pdf