www.kjurology.org http://dx.doi.org/10.4111/kju.2012.53.5.349 Urolithiasis Comparison and Efficacy of Low-Dose and Standard-Dose Tamsulosin and Alfuzosin in Medical Expulsive Therapy for Lower Ureteral Calculi: Prospective, Randomized, Comparative Study Woo Heon Cha, Jae Duck Choi, Ki Ho Kim, Young Jin Seo, Kyungseop Lee Department of Urology, Dongguk University College of Medicine, Gyeongju, Korea Purpose: Typically in Korea, for a standard dose (0.4 mg) of tamsulosin, two low doses (0.2 mg) are administered. The aim of this study was to evaluate and compare the effi- cacy of tamsulosin (0.2 mg and 0.4 mg) and alfuzosin (10 mg) in the treatment of lower ureteral stones. Materials and Methods: A total of 141 patients presenting with a single 4- to 10-mm sized lower ureteral stone were randomly assigned to 4 groups. Patients in group 1 (n=41) and group 2 (n=30) received an oral dose of 0.2 mg tamsulosin once and twice daily, respectively, and patients in group 3 (n=36) received a daily oral dose of 10 mg alfuzosin. Patients in group 4 (n=34) received trospium chloride only. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated. Results: There were no significant differences in patient background, including age, sex, BMI, stone size, stone side, and symptom duration. The spontaneous stone passage rate through the ureter was higher and the stone expulsion time was faster in groups 1, 2, and 3 than in group 4. There were no statistically different changes in groups 1, 2, and 3. The adverse effects observed in all groups were comparable and were mild. Conclusions: Tamsulosin at 0.2 mg and 0.4 mg and alfuzosin (10 mg) proved to be safe and effective. A first cycle of medical expulsive therapy with tamsulosin 0.2 mg could be considered as an option in the management of single lower ureteral stone. Key Words: Alfuzosin; Tamsulosin; Ureter; Ureteral calculi This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Article History: received 26 January, 2012 accepted 15 March, 2012 Corresponding Author: Ki Ho Kim Department of Urology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, 87 Dongdae-ro, Gyeongju 780-350, Korea TEL: +82-54-770-8265 FAX: +82-54-771-0769 E-mail: honda400@dongguk.ac.kr INTRODUCTION Patients with urinary tract stones account for 20% of urol- ogy inpatients [1]. Urinary tract stones remain common, affecting up to 5% of people worldwide [2]. The prevalence of urinary tract stone disease in Korea is steadily rising. The location (upper, mid, and lower) and size of the stone as well as stone composition and complications are de- termining factors in the treatment of urinary stones. Treatments are divided into three broad groups: 1) ob- servation and medical therapy, 2) shock wave lithotripsy (SWL) and ureteroscopy, and 3) open surgery, laparoscopic stone removal, or percutaneous antegrade ureteroscopy. Urolithiasis treatment has been shifting to less invasive therapies such as SWL or ureteroscopy. Despite improved treatment, however, the rate of recurrence of urinary tract stones remains high. Tomson [3] reported a 67% and 75% recurrence of urolithiasis within 9 years and 25 years, respectively. Fifty percent of those with urinary tract stones will experience one or more recurrences. Therefore, the initial treatment is very important; no remaining stones should be present and ureteral injury, sepsis, and infection should not occur as a result of the intervention. For stones 5 to 10 mm in size, analysis of groups yielded an estimate that 47% would pass spontaneously [4]. Various studies of efficient stone expulsion have been done for increasing the stone expulsion rate. The 2007 Guideline for Management of Ureteral Calculi of The American Korean Journal of Urology Ⓒ The Korean Urological Association, 2012 349 Korean J Urol 2012;53:349-354